Multiple layers of administration create complexity. The CCS administrative process is highly complex with multiple entities participating and is under significant stress due to budget reductions. The state establishes policy and operates part of the program including the smaller counties, claims payment, and rate setting. Each large county operates its own program based on state policy, establishing eligibility for children and authorizing services. Since much of CCS’s services are provided by regional providers, this means that each regional provider must work with multiple counties, each of which operates in a different manner. Further, counties are having difficulty operating the CCS program especially after major budget reductions. Overlaying this are Medi-Cal and Healthy Families health plans who must work with both the CCS program to get qualified children enrolled in the program and then coordinate who is responsible for what services. With the Healthy Families plan structure, there are multiple plans in these counties.
Inadequate funding at state and local level creates pressure. State law limits county responsibility and treats the program as a benefit limited to the funds available. However, historic practice has been to operate the program as an entitlement. Limited funding for state-only CCS, however, does raise the unanswered question of whether the program is an entitlement, and what fiscal responsibility the state and counties have to provide care for all eligible children.
The CCS program in California is at a critical juncture where most stakeholders, even those strongly supportive, believe that the program requires modernization. The program’s fragmentation, multiple layers of administration, combined with budget reductions have put stress on the program and put at risk the state’s ability to deliver care to this fragile population.
DHCS has several change opportunities that could improve the quality of care and the cost of the program. There are also opportunities to explore a more effective use of program funding. The program is administratively costly and budget reductions in administration could negatively impact timely access to care. Further the fee-for-service program may not lend itself to establishing the correct priorities for how care is delivered.
Nature of the carve-out. Currently the carve-out includes all CCS conditions and carves out the CCS services rather than the child. Having one set of providers for primary care and another set for treatment of severe health conditions makes it difficult to coordinate or manage care. Consideration should be given to:
Whether the entire child should be carved out or just conditions.
To which conditions should the carve-out apply, and are all CCS conditions the same? For example, should the carve-out for cancer or hemophilia be treated the same as for the treatment of a broken bone?
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