Are You Eligible for Medi-Cal, Regional Center, IHSS, and CCS? (You Might Be Surprised)

Medi-Cal, Regional Center, In-Home Supportive Services (IHSS), and California Children’s Services (CCS) are some of the major government programs that can help pay for medical visits, therapies, durable medical equipment, services, and more. Many families we work with assume they aren’t eligible for these programs so it’s always gratifying when we help families unlock the funds that they need and deserve. Our experts—including Public Benefits Specialist Lisa Concoff Kronbeck, who answers lots of financial questions during our member office hours—is here to demystify eligibility for Medi-Cal, Regional Center, IHSS, and CCS.

Is my child eligible for Medi-Cal?

Medi-Cal—California’s Medicaid program—will always be secondary coverage for children with private primary insurance, but it can help fill some of the funding gaps by eliminating copays and many other out-of-pocket expenses when your child sees Medi-Cal contracted providers. Medi-Cal may also fund medical supplies (such as diapers and feeding-tube formula) and durable medical equipment. Be sure to check out our Medi-Cal 101 article for more details.

There are a few ways children can qualify for Medi-Cal, notes Concoff Kronbeck. The first and most typical is by household income (modified adjusted gross income). The second is if your child receives Supplemental Security Income (SSI); SSI qualification is income and disability based. And third, Concoff Kronbeck shares that if you don’t qualify by any of the financial thresholds and your child is a Regional Center client, they can also qualify for the Medi-Cal institutional deeming waiver for people with developmental disabilities.

Is my child eligible for Regional Center?

Regional Centers are a statewide network of local agencies that serve children and adults with developmental disabilities as defined by California law. For children under age three, Regional Center provides early intervention services to children with a diagnosed developmental disability and to children who are at risk of developmental delay but don’t always have a diagnosis.

After age three, eligibility requires a diagnosed developmental disability that constitutes a substantial disability that is expected to continue indefinitely. A substantial disability is defined as a disability that results in “significant functional limitations” in three or more areas. Many of these are adaptive skills—skills that involve the ability to care for themselves and live independently, says Concoff Kronbeck. For additional information about what constitutes a developmental disability and substantial disability, check out our Regional Center 101 article.

Concoff Kronbeck underscores two additional important notes: First, Regional Center is always the payer of last resort; meaning, families must exhaust all other options (e.g., private insurance, Medi-Cal) before going to Regional Center. Second, there is a new provisional status for 3- to 4-year-old children who continue to have developmental delays but don’t have a formal diagnosis and will be reassessed at age five.

Is my child eligible for In-Home Supportive Services (IHSS)?

In-Home Supportive Services (IHSS) is a Medi-Cal program that provides home-based personal care and related services so that people with disabilities can remain safely in their communities instead of institutions. Part of a broader network of Medi-Cal-funded supports, the IHSS program will help pay for certain services for an eligible child with a disability to remain safely in their own home.

Children with disabilities may be eligible for IHSS to the extent that their disability-related care needs exceed those of a typically developing child of the same age. This article provides more information on the eligibility criteria and how many hours your child might receive if eligible. Note that your child must be enrolled in Medi-Cal before you apply for IHSS. If your family’s income exceeds the Medi-Cal threshold, you may be able to enroll in Medi-Cal using the institutional deeming waiver.

Is my child eligible for California Children’s Services (CCS)?

California Children’s Services (CCS) is a state program that is strictly medical. Concoff Kronbeck notes that there is a lot of overlap between Regional Center eligibility and CCS, but that eligibility for one does not convey eligibility for the other because there are a lot of conditions that are CCS eligible but not Regional Center eligible, and vice versa. CCS can be an avenue of assistance for children with significant medical needs regardless of whether they are Regional Center clients.

In addition to having a CCS-eligible medical disability, your child also needs to meet the following criteria in order to access services:

• Your child must be a California resident under age 21.
• Your family adjusted gross income must be less than $40,000 OR your out-of-pocket medical expenses for your child must be expected to exceed 20 percent of your family’s income.
• Family income is NOT a factor for children who:
  • Need diagnostic services to confirm they have a CCS-eligible medical condition.
  • Were adopted with a known CCS-eligible medical condition.
  • Are applying only for services through the Medical Therapy Program. Children with certain neuromusculoskeletal conditions may be eligible for physical and occupational therapy services in conjunction with local education agencies regardless of household income or Medi-Cal status.
  • Have full-scope Medi-Cal with no share of cost—meaning that you never pay for some of the costs of services provided to your child each month. (For families of children who are Regional Center eligible, it may be worthwhile to investigate Medi-Cal enrollment under the institutional deeming waiver so that income will not be a factor for CCS.)

For more information and to dig into additional funding options, check out our popular guide, How Do We Pay For It All? Undivided’s Guide to Funding Resources. And consider an Undivided membership so you can get your burning questions answered during our member office hours.