California Children’s Services Whole Child Model
Senate Bill (SB) 586 authorized the Department of Health Care Services (DHCS) to establish the Whole Child Model (WCM) program in designated County Organized Health System (COHS) or Regional Health Authority counties to incorporate California Children’s Services (CCS) program covered services for Medi-Cal eligible CCS children and youth into a Medi-Cal managed care plan (MCP) contract.
DHCS developed a “Whole Child Model” which was implemented in 21 specified counties, effective July 2018-July 2019. The results are improved care coordination for primary, specialty, and behavioral health services for CCS and non-CCS conditions. The benefits are consistent with CCS program standards and provided by CCS paneled providers, specialty care centers, and pediatric acute care hospitals. The WCM approach meets the six goals for CCS Redesign:
The approach is consistent with the primary goals of providing comprehensive treatment and focusing on the whole child, including the child’s full range of needs rather than only on the CCS health condition.
Assembly Bill (AB) 2724 added a new section to define an alternate health care service plan (AHCSP), and to authorize DHCS to enter into a comprehensive risk contract with an AHCSP, as a primary MCP in specified geographic areas effective January 1, 2024. DHCS has selected Kaiser Permanente as the Department’s AHCSP.
Kaiser Permanente will be responsible for providing care for Medi-Cal eligible CCS children and youth that are enrolled with Kaiser Permanente, and will implement the WCM program in the following counties where the WCM program currently exists: Marin, Napa, Orange, San Mateo, Santa Cruz, Solano, Sonoma, and Yolo. CCS is a capitated service for members receiving health care services through Kaiser Permanente in these counties, effective for dates of service on or after January 1, 2024,
Effective January 1, 2025, AB 118 authorizes DHCS to expand the WCM program for Medi-Cal eligible CCS children and youth enrolled in a MCP served by a COHS, Regional Health Authority, or AHCSP in the following counties: Butte, Colusa, Glenn, Mariposa, Nevada, Placer, Plumas, San Benito, Sierra, Sutter, Tehama, and Yuba.
Current Whole Child Model Health Plans and COHS Counties
San Luis Obispo, Santa Barbara
| Merced, Monterey, Santa Cruz | San Mateo | Orange | Del Norte, Humboldt, Lake, Lassen, Marin, Mendocino, Modoc, Napa, Siskiyou, Shasta, Solano, Sonoma, Trinity, Yolo
|
Kaiser Permanente WCM Implementation in Existing WCM Counties Effective January 1, 2024
- Marin
- Napa
- Orange
- San Mateo
- Santa Cruz
- Solano
- Sonoma
- Yolo
WCM Expansion Health Plans and Counties Effective January 1, 2025
Central California Alliance for Health
| Partnership HealthPlan of California
| Kaiser Permanente
|
Mariposa, San Benito
| Butte, Colusa, Glenn, Nevada, Placer, Plumas, Sierra, Sutter, Tehama, Yuba
| Mariposa, Placer, Sutter, Yuba
|
Whole Child Model: Final Evaluation Report
The DHCS is pleased to release the Whole Child Model: Final Evaluation Report as required by
SB 586 (Chapter 625, Statutes of 2016). This is an independent evaluation prepared by the University of California, San Francisco – Institute for Health Policy Studies. SB 586 required DHCS to contract with an independent entity to conduct an evaluation to assess MCP performance and the outcomes and the experience of CCS-eligible children and youth participating in the WCM program, including access to primary and specialty care, and youth transitions from WCM program to adult Medi-Cal coverage.
Resources and Information
Information for Members
DHCS will mail a 90 day member notice to CCS eligible members who are impacted by the 2025 WCM Expansion 90 days before January 1, 2025. The Medi-Cal health plans will mail member notices to CCS eligible members who are impacted by the 2025 WCM Expansion 60 and 30 days before January 1, 2025. The member notices are listed below.
90/60/30-day Notices
Notice of Additional Information (NOAI)
The Whole Child Model (WCM) Expansion 2025 Notice of Additional Information (NOAI) has more information about the WCM Program and the impacts to the CCS services members receive through the CCS Program.
Where Members Can Go for Information and Help
Members can contact any of the following groups with questions about the WCM expansion. All calls are free.
Questions about the WCM Program and CCS Services
- Call the Medi-Cal health plan number located on the back of your Medi-Cal health plan card or to find your Medi-Cal health plan’s phone number go to the Health Plan Directory webpage.
- Call the county CCS office. To find the county’s phone number, go to the County Offices webpage.
Learn More about Health Plan and Provider Choices:
Health Care Options:
- Health Care Options helps people with plan choices and doctor or clinic choices
- Call (800) 430-4263 (TTY: (800) 430-7077), Monday to Friday, 8 a.m. to 6 p.m.
- Go to the Health Care Options website
Questions about Why your CCS Services are Changing
DHCS Ombudsman Office:
- The Ombudsman Office helps people with Medi-Cal use their benefits and understand their rights and responsibilities
Questions about Medi-Cal
DHCS Medi-Cal Helpline:
- Call (800) 541-5555 (toll free), Monday to Friday, 8 a.m. to 5 p.m. PT.
Whole Child Model Documents
Archive/Resources
Contact Us
Any comments, questions, or suggestions regarding the WCM, or requests to be added to the CCS stakeholder e-mail distribution list can be submitted to CCSProgram@dhcs.ca.gov. 