We Speak Your Language

Welcome To CalOptima Medi-Cal!

In California, the Medicaid program is called Medi-Cal. Medi-Cal is a public health insurance program for low-income people including families with children, seniors, persons with disabilities, foster care children, and pregnant women. It is also for low-income people with specific health conditions such as tuberculosis, breast cancer or HIV/AIDS.

CalOptima provides health care coverage for Orange County residents who are eligible for full Medi-Cal. Once you are enrolled through the California Department of Social Service Agency, we will work with you to find the right health care providers to meet your needs. We also have many special programs to help you get and stay healthy.

If you have questions or need help with your health care, please call our Customer Service department toll-free at 1-888-587-8088, 24 hours a day, 7 days a week. TDD/TTY users can call 1-800-735-2929. Or visit our office Monday through Friday from 8 a.m. to 5 p.m. Walk-ins are welcome.

Important Documents for CalOptima Members

Your health is important to us. We are here to help you understand and access all your benefits as a CalOptima member. The documents below explain your rights, your benefits, how to get care and more. If there are documents not listed that you would like in your language, please call our Customer Service department toll-free at 1-888-587-8088, 24 hours a day, 7 days a week. TDD/TTY users can call 1-800-735-2929. You can also visit our office Monday through Friday from 8 a.m. to 5 p.m. Walk-ins are welcome.

We have a no-cost interpreter service to answer any questions you may have about CalOptima. To get an interpreter, just call us at 1-888-587-8088.

Enrollment Information

Learn About Medi-Cal and How to Apply

Benefits Information

Member Handbook PDF File Indicator Image
The Member Handbook is a guide to all your benefits as a CalOptima member, including information about what is covered, how to get services, your rights as a member, your responsibilities and more.

Search for a Provider
Search the online Provider Directory to find a covered doctor, specialist, pharmacy or other provider near you.

Search for a Pharmacy
Search the online Pharmacy Directory to find a covered pharmacy near you.

Search for a Facility or Ancillary Provider
Use this online search tool to find a facility or ancillary provider near you.

Search for a Behavioral Health Provider
Search the online Behavioral Health Provider Directory to find a covered Behavioral Health Provider near you.

View the Notice of Privacy Practices PDF File Indicator Image
CalOptima has a privacy policy that explains the steps we take to keep your personal information private. It also describes how and when we might share your health information with others.

You Can Report Fraud Or Abuse

If you see any activity that you think is fraudulent or wasteful, we strongly encourage you to call our Compliance and Ethics Hotline at 1-877-837-4417 or report the activity using the Suspected Fraud or Abuse Referral Form. You do not have to give your name to report fraudulent activity.

CalOptima Approved Drug List

CalOptima Approved Drug List PDF File Indicator Image
The formulary lists all of the drugs covered by CalOptima.

Changes To The CalOptima Approved Drug List

2018
2017

Drug Recalls And Withdrawals

2018
2017

How to File a Grievance

As a CalOptima member, we want to hear your concerns about the health care services you get. We want you to talk with your doctor or health network if you have any questions about your health care. If this is not possible, or you need help, please call our Customer Service department toll-free at 1-888-587-8088, 24 hours a day, 7 days a week. TDD/TTY users can call 1-800-735-2929. Or visit our office Monday through Friday from 8 a.m. to 5 p.m. Walk-ins are welcome.

How to File an Appeal or Grievance

Notice Of Non-Discrimination

CalOptima complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. CalOptima does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

View CalOptima’s Notice of Non-DiscriminationPDF File Indicator Image

Common Forms

CalOptima wants to make it easier for you to get the health care you need. Listed below are forms you may use when talking to CalOptima or your doctors. If you can't find what you are looking for, please call our Customer Service department toll-free at 1-888-587-8088, 24 hours a day, 7 days a week. TDD/TTY users can call 1-800-735-2929. Or visit our office Monday through Friday from 8 a.m. to 5 p.m. Walk-ins are welcome.

Authorization for Release of Protected Health Information (PHI)PDF File Indicator Image

Instruction Sheet for CalOptima Health Insurance Portability and Accountability Act (HIPAA) Authorization for Release of Protected Health Information (PHI)PDF File Indicator Image

Individual Request for Protected Health Information (PHI) AccessPDF File Indicator Image

Medical Release FormPDF File Indicator Image

Member Complaint FormPDF File Indicator Image

Member Request to Amend Protected Health Information (PHI)PDF File Indicator Image

Request for an Accounting of DisclosuresPDF File Indicator Image

Request for Restriction on Manner/Method of Confidential CommunicationsPDF File Indicator Image

Request for Restriction on Use and Disclosure of Protected Health Information (PHI)PDF File Indicator Image

Statement of Disagreement PDF File Indicator Image

Suspected Fraud or Abuse Referral FormPDF File Indicator Image

We Speak Your Language

At CalOptima, we believe in the importance of providing services that are sensitive to the needs of the community. We want to make sure you have access to the best health care possible.

CalOptima respects you, your culture and your beliefs. We want you to feel comfortable talking with us and your health care providers.

To Make It Easier For You, CalOptima Provides:

  • Bilingual staff to help you in your language

  • Interpreter services, including American Sign Language, at no cost to you for all of your health care needs. You do not need to ask friends or family members to interpret for you. You can get interpreter services 24 hours a day, 7 days a week for:

    Medical services: doctor visits, after-hours services, urgent care services, pharmacy services and health education classes

    Non-medical services: customer service, member complaints and member orientation meetings

  • Health education and enrollment materials printed in several languages at no cost to you

  • Upon request, materials in other formats, such as Braille, audio or large print

All you need to do is call your health network or CalOptima. For scheduled appointments, make sure to ask for an interpreter at least 5 working days before your appointment.

To reach CalOptima, call 1-714-246-8500 or toll-free at 1-888-587-8088. We are here to help you 24 hours a day, 7 days a week. TDD/TTY users can call 1-800-735-2929. Or visit our office Monday through Friday from 8 a.m. to 5 p.m. Walk-ins are welcome.

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