What is the Whole Child Model (WCM) program?
The Whole Child Model is a program developed by the State of California for California Children Services (CCS). Starting January 1, 2019, Partnership HealthPlan of California (PHC) members who have been receiving CCS care through their county will get these services through PHC Whole Child Model program. PHC will help these families with CCS care and Medi-Cal covered services.
What is the benefit of this change for my child?
All your child’s care needs (CCS and Medi-Cal covered services) will be coordinated, approved, and paid by one organization.
If my child’s benefits change to straight Medi-Cal, will he/she still be in the WCM?
No. Children assigned to straight Medi-Cal will not be in Whole Child Model.
Who qualifies for Whole Child Model?
A child would qualify if he/she is:
• Under the age of 21
• A PHC member
• Eligible for CCS
Who decides who is eligible for CCS?
Your county’s CCS program makes that decision.
How will members be informed of the changes to the CCS program under the Whole Child Model?
Through the following efforts:
• Department of Health Care Services (DHCS) letter
• PHC letters
• PHC stakeholder meetings
• Information on PHC’s website
• Call PHC Member Services at (800-863-4155)
Will CCS members be assigned to a PCP?
Whole Child Model program members are asked to choose a local medical home. They may see their CCS-paneled specialty providers as needed.
Will Whole Child Model members have access to the CCS provider network?
Yes
How can I find or confirm a provider is paneled by CCS?
Paneled provider information is available at the DHCS California Children’s Services website at: https://www.dhcs.ca.gov/services/ccs/Pages/CCSProviders.aspx.
Will my child receive transportation benefits under Whole Child Model?
Yes.
Will PHC cover the same benefits and services that CCS did?
Yes. PHC will provide the same benefits that CCS children received from their county programs.
How will this change affect the Medical Therapy Program (MTP)?
The MTP will continue to give the therapy services in your county and will recommend equipment. PHC will review all requests for equipment.
Will I need approval from PHC to see a specialist?
No.
What will happen to services the county CCS program has already authorized for 2019?
PHC will honor and pay for all services approved by county CCS until the approval expires.
Will a CCS member have a case manager or care coordinator?
Yes. You have access to PHC’s Care Coordination Department when you need help with case management
Will my child still be able to get CCS medications under PHC managed care?
Prescriptions covered under the CCS benefit will continue to be covered under Whole Child Model.
What is PHC’s approach to CCS children who are aging out of the CCS program?
PHC’s Care Coordination department has a multi-year process to assist families with a smooth shift into adult services.
Will the appeal and fair hearing process be available to CCS children under PHC managed care?
Yes.
