Current Initiatives

Learn About the Whole-Child Model

Latest Updates

The Whole-Child Model is live! As of July 1, 2019, CalOptima members who are CCS-eligible will receive their CCS services and non-CCS services under CalOptima’s Whole-Child Model program. This means these members will be receiving the majority of their health care needs through CalOptima from now on.

Under the WCM program, CalOptima members will have the ability to be more involved with their care and have access to additional resources to help navigate the health system. A Personal Care Coordinator (PCC) is assigned to every CalOptima WCM member and may be reached for questions regarding their health care.

If you have any questions regarding the WCM program, contact the CalOptima Customer Service department at 888-587-8088.

Previous Updates

CalOptima is committed to keeping our stakeholders informed and providing opportunities for feedback. Our most recent efforts for Whole-Child Model include:

Member Notices and Outreach

The transition from California Children’s Services (CCS) to the Whole-Child Model (WCM) will occur on July 1, 2019. Members and their families currently enrolled in CCS will receive notices on April 1 (90-day notice) and May 1 (60-day notice) informing them about the transition. The notices will include information about the transition, next steps and answers to frequently asked questions. The 60-day notice will also contain a WCM member guide with further details about CalOptima’s WCM program. Additionally, CalOptima will conduct outreach calls to members regarding the transition in mid-May.

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About the Whole-Child Model

California Children’s Services (CCS) is a statewide program for children with certain medical conditions. CCS provides medical care, case management, physical/occupational therapy and financial assistance. Prior to July 1, 2019, CCS services were carved out (separated) from most Medi-Cal managed care plans, including CalOptima.

The Orange County Health Care Agency (OC HCA) managed the local CCS program. It provided case management, eligibility determination, service authorization and direct therapy under the Medical Therapy Program.

CCS became a Medi-Cal managed care plan benefit in select California counties starting July of 2018. The goal is to improve health care coordination for the whole child, rather than handle CCS conditions separately. This approach is known as the Whole-Child Model.

As of July 1, 2019, CalOptima members’ needs related to CCS services became a part of CalOptima’s Medi-Cal plan. Under this model, OC HCA will continue to determine eligibility and manage the Medical Therapy Program.

CalOptima and OC HCA continue to work diligently on a seamless transition for the CalOptima children and families involved.

Whole-Child Model Family Advisory Committee

CalOptima created a Whole-Child Model Family Advisory Committee (WCM FAC). Committee members include CCS family representatives/members, community-based organizations, and/or consumer advocates.

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Learn More About The Whole-Child Model Family Advisory Committee
Guiding the transition of California Children’s Services

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