DATE: October 20, 2026
TO: Board of Supervisors
SUBMITTED BY: Joe Prado, Director, Department of Public Health
SUBJECT: Retroactive FY 2026-27 California Children’s Services Allocation Budgets
RECOMMENDED ACTION(S):
TITLE
1. Approve and authorize the Department of Public Health to submit the retroactive FY 2026-27 California Children’s Services Administrative and Monitoring and Oversight allocation budget and authorize the Director of the Department of Public Health to execute the Certification Statement as required by the Department of Health Care Services, effective July 1, 2026, through June 30, 2027 ($7,690,388); and
2. Approve and authorize the Department of Public Health to submit the retroactive FY 2026-27 California Children’s Services Medical Therapy Program allocation budget, effective July 1, 2026, through June 30, 2027 ($1,659,252).
REPORT
There is no additional Net County Cost associated with the recommended actions. Approval of the recommended actions will allow the County to continue receiving its non-competitive allocations from Department of Health Care Services (DHCS) to administer the California Children’s Services (CCS) program and the CCS Medical Therapy Program (MTP). The CCS Administrative allocation of $7,690,388 will fund approximately 96% of anticipated FY 2026-27 program costs and provide full recovery of indirect costs. The CCS MTP allocation of $1,659,252 will fund approximately 50% of anticipated FY 2026-27 program costs and provide full recovery of indirect costs. This item is countywide.
ALTERNATIVE ACTION(S):
There are no viable alternative actions for the recommended actions, as the County is mandated under Health and Safety Code (HSC) Section 123850 to administer the CCS program and HSC Article 5, Section 123950 to administer the CCS MTP. Should your Board not approve the recommended actions, the Department would not have sufficient funding to offset the costs required to operate these mandated programs.
RETROACTIVE AGREEMENT:
The Fresno County Department of Public Health (Department) received notification of the FY 2026-27 CCS Administrative allocation from DHCS on July 14, 2026, and the CCS MTP allocation on August 27, 2026. Funding is retroactive to July 1, 2026, and the CCS budgets are due to DHCS October 26, 2026. This item is brought to your Board in accordance with the agenda item processing timelines.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended actions. The FY 2026-27 non-competitive CCS Administrative allocation of $7,690,388, which is comprised of Federal and State funding, represents a $471,330 (7%) increase over the previous year’s allocation. The allocation will fund approximately 96% of the anticipated FY 2026-27 CCS Administrative program costs. The required County match of $287,002 will be funded by 1991 Realignment.
The FY 2026-27 non-competitive CCS MTP allocation of $1,659,252, which is comprised of State funding, represents a $318,113 (23.72%) increase over the previous year’s allocation. The allocation will fund approximately 50% of the anticipated FY 2026-27 MTP costs of $3,318,504. The remaining $1,659,252, representing the required County match, will be funded by 1991 Realignment.
The CCS Administrative and CCS MTP allocations provide full recovery of indirect costs. The Department’s indirect cost rate is 22.85%. Sufficient appropriations and estimated revenues are included in the Department’s Org 5620 FY 2026-27 Adopted Budget.
DISCUSSION:
The CCS program is administered as a partnership between County Health Departments and DHCS, in accordance with HSC Section 123800 et seq. DHCS provides funding to counties to administer the CCS program, which serves medically fragile children with eligible medical conditions that are chronic, disabling, or life-threatening.
The program provides medical case management, as well as diagnostic and treatment services, for children under the age of 21 with special and complex healthcare needs. CCS eligible medical conditions include, but are not limited to, heart disease, cancer, cystic fibrosis, chronic lung disease, serious congenital disabilities, hearing loss, cerebral palsy, and traumatic injuries.
The CCS allocation supports the County’s administration, management, and delivery of CCS services to approximately 7,200 clients annually, including:
• Medical, financial, and residential eligibility review for children and youth applying for CCS services.
• Authorization of appropriate diagnostic, treatment, therapy, specialized medical care, supplies, and related services.
• Medical case management, care coordination, assessment, and intervention to ensure authorized services are provided.
• Consultation and guidance to providers and hospitals regarding CCS services and requirements.
• Assistance to families in navigating CCS and connecting with community resources and support services.
• Transition planning and support for clients aging out of the CCS program.
CCS MTP is a special program within CCS that provides medically necessary physical therapy (PT), occupational therapy (OT), and care coordination services for children and youth up to age of 21 with eligible conditions such as cerebral palsy, muscular dystrophy, arthrogryposis, juvenile rheumatoid arthritis, spina bifida, brachial plexus injury, and acquired injury and illnesses such as burns and traumatic brain injuries. The County has three (3) Medical Therapy Units (MTUs) sites located at three public schools throughout the County.
The CCS MTP’s goal is to maximize each child’s functional abilities and independence in gross and fine motor skills needed for activities of daily living, such as dressing, bathing, toileting, and eating, as well as mobility skills such as crawling, standing, and walking. For children who are dependent on caregivers, therapy may focus on maintaining range of motion and supporting safe, effective care and hygiene. Through these services, the MTUs help children achieve their greatest level of independence and enhance the quality of life for both the child and family.
DHCS determines allocations based on each county’s average expenditures during FY 2022-23 through FY 2024-25 and the counties’ average caseload for calendar year 2025. The CCS MTP allocation also takes into consideration the County’s requested budget.
Beyond the administration of the CCS program, and in accordance with HSC Section 123940, CCS counties share financial responsibility with the State and Federal governments for medically necessary services such as diagnostics, treatment, medication, and therapy to CCS clients. Counties pay their share of costs through the quarterly invoice process.
To finalize the allocation process, DHCS requires the County to submit a budget for the allocation amount and sign a certification stating that the County will comply with applicable laws, regulations, and policies related to the CCS program. The allocations are retroactive to July 1, 2026, and serve in lieu of an agreement. Upon approval of the recommended actions by your Board, no additional executed documents are required to receive funding.
REFERENCE MATERIAL:
BAI #54, August 19, 2025
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk - FY 2026-27 CCS Administrative and CCS M&O Budget
On file with Clerk - CCS FY 2026-27 Allocation Memo
On file with Clerk - FY 2026-27 CCS MTP Budget
On file with Clerk - CCS MTP FY 2026-27 Allocation Memo
CAO ANALYST:
Ronald W. Alexander Jr.