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At CalOptima, we’ve shown what’s possible when health care providers, consumers, community advocates, business leaders and government all work together to improve health care in Orange County.
In the early 1990s, the Medicaid system, known as Medi-Cal in California, was struggling to meet the needs of Orange County’s residents and providers. Many patients found it difficult to find primary care providers, and too often they were forced to seek primary care in emergency rooms. Sometimes they waited for hours, only to see doctors with whom they had no prior relationship. And sometimes they gave up or were turned away and didn’t get the care they needed.
It became such as severe problem that a concerned group of community members, health care providers, business leaders and elected officials got together to find a solution. That solution was CalOptima.
CalOptima was created by the Orange County Board of Supervisors in 1993 as a County Organized Health System (COHS). We are a public agency and the largest of six COHS in California.
CalOptima manages programs that are funded by the state and federal government, but operates independently, under the leadership of a Board of Directors made up of members, providers, business leaders and local government representatives.
Today, CalOptima is the single largest health insurer in Orange County, providing coverage through four major programs, Medi-Cal, OneCare Connect Cal MediConnect Plan (Medicare-Medicaid Plan), OneCare (HMO SNP) and PACE (Program of All-Inclusive Care for the Elderly).
We are proud of who we are and what we’ve become. We were created by the community to fill a critical need, and now we are a model community health plan. Leaders from across the country frequently look to CalOptima as they work to improve their local health systems.
CalOptima provides access to quality health care services for members while remaining a prudent steward of public funds. We use our resources wisely – about 96 cents of every dollar spent goes directly to medical care. Our administrative costs are among the lowest in California, compared with other public and commercial health plans.
At CalOptima, we take our mission seriously and strive daily to exceed expectations. Our members are why we are here and central to what we do.
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