We provide whole-person health care at no cost to our members. With CalOptima Health Medi-Cal, you get:
Access additional services from our partners.*
*Some services need prior authorization to be covered. Prior authorization is an approval for special medical services given by your health network.
Health care that covers each part of your well-being, from preventive care to specialist visits.
Behavioral health services that help you live a balanced and fulfilling life.
Prescribed medical equipment, supplies and more— everything you need to stay healthy.
Routine eye exams, corrective lenses and expert care to help you see the world clearly.
Drivers to make visiting your doctor or going to the pharmacy easier.
Long-term care services and supports that offer peace of mind, so you can live independently.
Members with more complex health needs may qualify for extra services that help with care coordination.
Call the Regional Center of Orange County:
Call the Orange County Health care Agency Alcohol and Drug Abuse Administration at
1-714-834-3840
Call the Orange County Behavioral Health Plan at 1-800-723-8641 (TTY 711)
Our WCM program offers enhanced care coordination, improved access to care and better health outcomes for children with conditions eligible for California Children’s Services (CCS). With WCM, your child’s Medi-Cal and CCS benefits are combined under CalOptima Health.
If your child or teen is under age 21 and enrolled in Medi-Cal, they may qualify for free health care services to support their growth, development and well-being. Medi-Cal for Kids & Teens covers check-ups, shots, dental care, mental health services, vision and hearing care and more—even if your child isn’t sick. These services are designed to catch health issues early and treat them before they become more serious.
Learn about your child’s rights, what services are covered, and how to get care from the resources below.
We offer doula services at no cost to our Medi-Cal members who are currently pregnant or have delivered a baby within the past 12 months.
Doulas are birth workers who give non-medical support to pregnant and postpartum persons before, during and after childbirth, including support during miscarriages, stillbirths, and abortions. They can:
Members can reach out to any doula in their health network to start service. No prior authorization is needed.
Questions? Call CalOptima Health Customer Service toll-free at 1-888-587-8088 (TTY 711), Monday–Friday, from 8 a.m.–5:30 p.m. We have staff who speak your language.
Access to 1 initial visit and up to 8 additional visits at any time during the perinatal period (before or after birth).
Up to 2 extended 3-hour postpartum visits after the end of a pregnancy with the standing recommendation issued by the Department of Health Care Services (DHCS).
Support during labor and delivery, including through stillbirth, abortion or miscarriage.
Up to 9 additional postpartum visits with recommendations from a doctor or other licensed provider.
This recommendation can be noted in your medical record by your provider. You can also ask your provider to complete the Doula Recommendation Form and give it to your doula. (The standing recommendation from DHCS cannot be used for additional postpartum visits.)
Call 1-844-447-8441
If you can’t get a hold of your doctor or health network, you can speak to one of our nurses 24 hours a day, 7 days a week at 1-844-447-8441 (TTY 1-844-514-3774). We can help:
For medical or psychiatric emergencies, call 911 or go to the nearest hospital.
Call 1-800-977-2273
Prescription drugs given by a pharmacy are covered by Medi-Cal Rx, a pharmacy program from the California Department of Health Care Services (DHCS). Visit the Medi-Cal Rx website to learn more and find a pharmacy near you. You can also call Medi-Cal Rx Customer Service at 1-800-977-2273 (TTY 711), 24 hours a day, 7 days a week.
Every 3 months, CalOptima Health’s Pharmacy and Therapeutics (P&T) Committee reviews the most recent drug recalls and withdrawals. We inform you, your prescribers and pharmacies when there is a Class I or Class II medication recall or when a drug is removed from the market. See the most recent drug recalls and withdrawals:
For some types of care, your doctor or specialist will need to ask your health network or CalOptima Health for permission before you get care, such as prior authorization, prior approval or pre-approval. Care is medically necessary if it is reasonable and necessary to protect your life, keeps you from becoming seriously ill or disabled, or relieves severe pain.
Services that need pre-approval include:
You never need pre-approval for emergency care, even if it is out of network. This includes having a baby.
To request a prior authorization, contact your primary care provider (PCP) or specialist. See a list of procedure codes that require prior authorization by your provider below: