Learn About the Whole-Child Model

In light of the COVID-19 public health emergency, the Department of Health Care Services (DHCS) has issued temporary guidance and direction for the administration of the Whole-Child Model (WCM) program and California Children’s Services (CCS). The guidance ensures that WCM members (CalOptima Health members who are CCS-eligible) can access medically necessary services without any delay.

Below is a DHCS memorandum that provides COVID-19-related guidance:

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

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

Under the WCM program, CalOptima Health 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 Health WCM member and may be reached for questions regarding their health care.

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

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 Health.

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

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

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