California Children's Services Grievances, Appeals, and State Hearings
The California Children's Services (CCS) is a state program for children with certain diseases or health problems. Through this program, children up to 21 years old can get the health care and services they need. All children in Classic counties, as well as CCS Only children and Medi-Cal Fee for Service (FFS) children with CCS in Whole Child Model (WCM) counties, have the right to file a CCS Program grievance, request a First Level Appeal, or request a State Hearing when the County CCS Program takes negative or adverse actions for program eligibility or services.
A CCS Program applicant, beneficiary, authorized representative, or legal guardian who filed a grievance, requested a First Level Appeal, or requested a State Hearing is referred to as a “Claimant".
Below you will find information about how to file
a CCS Program grievance, request a First Level Appeal, or request a State
Hearing.
How Do I File a Grievance?
Please use the following links to learn about grievance guidance.
Please contact your County CCS Program Office for ways to file for a grievance.
A grievance is defined as a complaint, either written or oral, expressing dissatisfaction with the services provided or the quality of care.
You can file a grievance any time for concerns with:
- Coordination of care, services, equipment, or appointments
- Poor customer service
- Discrimination
- Health information privacy
- Quality of care
- Referrals for services
- Scheduling appointments
- Timelines of services authorizations or CCS Program eligibility decisions
Submitting a grievance will not reinstate CCS benefits. For services that were previously denied, reduced or modified, a First Level Appeal or State Hearing is required.
What is a First Level Appeal and How Do I File an Appeal?
A First Level Appeal is a request to review a decision to modify, terminate, reduce, or deny a CCS service. It is a re-examination of an initial claim determination and can be requested by contacting your County CCS program office. The appeal can be filed verbally, in person, by telephone, or in writing once you receive a written Notice of Action (NOA) and must be filed within 30-days from the date of the NOA. In your appeal request be sure to state the reason(s) you disagree with the decision.
NOTE: A First Level Appeal is not required to request a state hearing.
You can file an appeal about:
- A reduction or change of services.
- Requested services not being covered.
- A decision to end your or your child's CCS Program eligibility.
- An increase in the amount to be paid to the CCS Program.
First Level Appeals can only be submitted by Claimants for:
- Beneficiaries in Classic CCS counties
- CCS State Only beneficiaries in WCM counties
- Medi-Cal FFS beneficiaries with CCS in WCM counties
CCS First Level Appeal and State Hearing process timelines –
CCS TimelinesHow Do I Request Continuation of Services While Waiting for a Resolution of an Appeal or State Hearing?
Medi-Cal and non-Medi-Cal Claimants who had previously authorized services denied, terminated, reduced, or modified are entitled to continuation of services or benefits while awaiting a hearing and/or decision. This is also known as Aid Paid Pending (APP).
Continuation of services is not available for pending CCS Program applicants, as they have not previously received CCS services. If services are denied, reduced, or modified, members can receive those services previously approved while awaiting a final decision on the matter. If you withdraw your First Level Appeal, APP will stop at that time.
Please reference this CCS Program Due Process Information document for more information.
What is a State Hearing?
State Hearings are legal meetings or hearings for families or beneficiaries to challenge the decision made between beneficiaries and the program or agency that denied the services in an impartial, independent, fair, and timely manner, ensuring that due process is met in accordance with federal and state laws.
What are Your Hearing Rights
You have the right to request for a state hearing to challenge the decision or any action. The 90* days starts the day after you are sent a notice.
*Note: CCS Program has temporarily extended the time to request a hearing to 120 days due to 1135 Waiver which will end on June 30, 2025.
Department of Health Care Services (DHCS) has authority under Section 1902(e)(14)(A) of the Social Security Act and 1135 Waiver flexibilities to continue providing benefits pending the outcome of a State Hearing decision to Claimants who request a State Hearing within 120 days of the NOA, regardless of whether the Claimant has requested the continuation of benefits during the appeals process.
You may be able to file your request after the deadline if you have good cause as to why you were not able to file for a hearing within the specified days.
To request a State Hearing, please refer to the CCS Program Due Process Information document for more information.
Whole Child Model
CCS members residing in a WCM county please refer to the CCS WCM Grievances Appeal and Hearing Process.
CCS Program Resources for Claimants
If you need more information about the CCS Program, please visit California Children's Services DHCS webpage.
If you need information about Medi-Cal Fair Hearing, please refer to the web page for additional detail. (Medi-Cal Fair Hearing)
Contact Us
Please direct any CCS State Hearing questions to DHCS Hearings and Appeals unit at ISCDHAU@dhcs.ca.gov.
Please direct any CCS Program questions to CCSProgram@dhcs.ca.gov.
Please direct any CCS Compliance, Monitoring and Oversight program questions to CCSMonitoring@dhcs.ca.gov.
Filing a Discrimination Complaint
If you think discrimination has affected your benefits or services, you may file a discrimination complaint with the DHCS Office of Civil Rights below:
Office of Civil Rights
Department of Health Care Services
P. O. Box 997413, MS 0009
Sacramento, CA 95899-7413
Phone: ( 916) 440-7370
Email: CivilRights@dhcs.ca.gov.
You may use the ADA Title VI Discrimination Complaint form to submit your complaint to DHCS Office of Civil Rights. The form also contains additional information about your rights. A complaint should be filed as soon as possible or within 180 days of the last act of discrimination. If your complaint involves matters that occurred longer ago than this and you are requesting a waiver of the time limit, you will be asked to show good cause why you did not file your complaint within the 180-day period.
You may also submit a discrimination complaint to United States Department of Health and Human Services, Office of Civil Rights. Additional information on filing discrimination complaints is available on the Non-Discrimination Policy and Language Access webpage.
