Request CCS Services

How Do I Know If My Child Qualifies For CCS In San Bernardino?

Your child may be eligible for CCS services or benefits if he or she meets all four of the following requirements:

  1. Age: Your child must be under 21 years of age.
  2. Residence: Your child must be a permanent resident of San Bernardino County. (Your child’s residence is usually where you live.)
  3. Income: Your family income must be less than $40,000 per year, according to the adjusted gross income on your California income taxes. A child may be eligible when the family income is more than $40,000 if medical care for the child’s CCS condition is expected to cost the family more than 20 percent of the family’s annual gross income. If your child was adopted with a known CCS eligible condition, proof of income is not required. There is no financial eligibility requirement for diagnostic or therapy services in California, only a CCS application is required.
  4. Medical Conditions: Only certain conditions are eligible for CCS. In general, CCS covers medical conditions that are physically disabling or require medical, surgical, or rehabilitative services. Examples of medical conditions that may be covered are: congenital heart disease; biliary atresia; cancers, tumors, spina bifida; severe head, brain or spinal cord injuries, and severe burns; cerebral palsy, diabetes; muscular dystrophy; cystic fibrosis and glaucoma.

How Do I Refer a Client to CCS?

Referrals may originate from any source. Examples of who may initiate a referral include, but are not limited to: health care providers, parents, legal guardians, nurses, regional center counselors, and/or other interested parties. Referrals must include demographic information and types of services requested (with prescriptions and/or medical reports). The best way to make a referral to CCS is by completing the New Referral CCS/GHPP Client Service Authorization Request (SAR) and submit it to the CCS Program at:

California Children’s Services
150 E. Holt Blvd, 3rd Floor
Ontario, CA 91761
Phone: (909) 458-1637
Fax: (909) 986-2970

It is helpful for the SAR to be completed by a medical provider who also provides medical reports supporting their request. This will help to expedite processing of the referral.

What Happens Next?

Once the referral is received at the CCS office, it is reviewed by both a Public Health Nurse (PHN) and an Office Specialist to determine eligibility. If CCS does not have medical reports, the PHN will request those reports from the medical provider to determine medical eligibility. Once the medical eligibility is established, the Office Specialist will send an application packet to the client and/or responsible party and begin reviewing the information we have to determine if the client is residentially and financially eligible for CCS Services.
The application packet will include a CCS Application, a Financial Questionnaire, an Insurance Questionnaire and an Insurance Notification Form that need to be completed and returned within forty days. Additionally, CCS will include a Notice of Privacy Practices so that the client and/or family are aware of their rights and responsibilities under the Health Insurance Portability and Accountability Act (HIPAA). This Act is the federal law that establishes standards to protect the privacy and security of health information.
Once the CCS Program receives all of the information they need to make a determination, they will verify eligibility and either authorize the necessary service or deny the service. The client and/or responsible party will be notified by mail whether their request has been approved or denied. If an application or a service is denied, the client and/or responsible party will receive a Notice of Action (NOA) explaining the reason for the denial.

Health Insurance Portability and Accountability Act (HIPAA) Information

For information on the Health Insurance Portability and Accountability Act (HIPAA), please visit our Privacy Information page.


The following forms are available for your use. Forms are mailed to clients when they are required, but if you have misplaced a form or need a new copy, you can print them from here. 

Forms Required to Apply for CCS Services: