​​Partners for Children

Updated Numbered Letter: Palliative Care Options for CCS Eligible Children

DHCS released the updated Numbered Letter (NL) “Medi-Cal Palliative Care Options for California Children's Services (CCS) Eligible Children" for a 14-day public comment period from October 9-23, 2019. Updates to the NL have now been finalized and reflect input received during the public comment period.

Access the revised Number Letter

A Pediatric Palliative Care Waiver Program

In accordance with Assembly Bill 1745, the Department of Health Care Services (DHCS) worked with advocacy groups and other stakeholders to develop the Pediatric Palliative Care (PPC) Waiver Program. The Waiver was approved by the Centers for Medicare and Medicaid Services in December 2008. Through the PPC Waiver Program, children with life-limiting or life-threatening medical conditions receive supportive services at home and in the community.
The goal of the PPC Waiver Program is to provide an extra layer of support that reduces stress and improves the child’s and family’s quality of life.  The PPC waiver team provides families with the special help and support needed to manage a child’s complex life threatening condition outside of the hospital setting.  
On October 5, 2018, the DHCS received approval to continue PPC Waiver operations with the intent to end the program on December 31, 2018. The DHCS previously engaged in extensive discussions with PPC Waiver counties and providers on how to effectively operate the waiver under the guidance given by Children’s Medical Services (CMS). Ultimately, the DHCS was unable to identify CMS approvable changes that worked within the capacity of existing PPC Waiver county partners and providers. The DHCS then informed stakeholders that it will not be renewing the PPC Waiver.  As a result, the PPC Waiver ended effective December 31, 2018. During a stakeholder meeting on June 11, 2018, DHCS informed PPC Waiver County partners and providers about the PPC Waiver ending and the transition of care to managed care plans or Fee-for-Service delivery systems. At that time, DHCS also educated meeting participants about the expansion of pediatric palliative care services through the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services program, and provided a platform for county and provider partners to present their questions and concerns.
EPSDT services are an existing State Plan Benefit that provides comprehensive, preventive, diagnostic, and treatment services to eligible participants under the age of 21, as specified in Section 1905(r) of the Social Security Act. The goal of this benefit is to ensure that eligible participants under the age of 21 receive age-appropriate screening, preventive services, and treatment services that are medically necessary to correct or improve any identified conditions. Since EPSDT services are a part of the Medi-Cal program, EPSDT service providers are already equipped with the experience of providing palliative care services to children and young adults.
The DHCS then implemented a transition plan that included a warm hand off of palliative care services to Managed Care or Fee-for-Service delivery systems which facilitated continuity of care among beneficiaries. The warm hand off also ensured freedom of choice while educating beneficiaries of Managed Care benefits.
More information is available on the EPSDT landing page.

Transition of PPC Services effective January 1, 2019

With the end of the PPC Waiver on January 1 2019, the DHCS has implemented a 60-day transition campaign to ensure former Waiver participants are successfully transitioned from receiving care under the Waiver to receiving care provided by a managed care plan or the Fee-for-Service delivery systems. The DHCS has been working directly with stakeholders, beneficiaries and their families, and providers to:
1.    Facilitate warm handoffs between care systems,
2.    Ensure participants’ are knowledgeable about their options and are free to choose services and providers, and
3.    Oversee and ensure continuity of care.
For additional information on the PPC Waiver Transition, please see Transition Materials below.

What is Palliative Care?

Palliative care is treatment of the pain, other symptoms, and stress of a life-limiting or life-threatening illness.  Through the PPC Waiver Program, palliative care services are provided during the course of a child’s illness and are an important source of support for the sick child, parents, and siblings.

Is Palliative Care the Same as Hospice?

To receive hospice care, a doctor must certify that the child has six month or less to live. To participate in the PPC Waiver Program, the sick child must be expected to require 30, non-consecutive days of hospitalization during the course of the year if waiver services are not provided.


Summary of Public Comment on the PPC Waiver Amendment
PPC Reference Tool
PPC Service Codes

 Transition Materials

Last modified date: 3/24/2021 12:32 AM