MedicaidPrior AuthMedium impact
20-667 Learn When to Coordinate Care with California Children's Services
Health Net·CA · Pediatrics·Prior Authorization
We identified it
Jun 20, 2026
Summary
This policy clarifies care coordination requirements for California Children's Services (CCS) eligible members in specific Medi-Cal counties. When a child establishes CCS eligibility, the CCS program takes over case management and prior authorization for all services related to the CCS-eligible condition, and care must be provided by CCS-paneled providers at CCS-approved facilities.
Action Required
Immediately: Billing team must verify CCS eligibility for pediatric patients in Kern, Los Angeles, Sacramento, San Diego, San Joaquin, Stanislaus, and Tulare counties before scheduling services. For CCS-eligible conditions, coordinate with county CCS programs using provided phone/fax numbers for prior authorization. Emergency admissions to non-CCS facilities require referral to county CCS program on next business day and transfer to CCS-approved facility once stabilized. Claims for CCS-eligible conditions will be denied if not provided by CCS-paneled providers.