Your Health Is Everything to Us
Who We Are
CalOptima Health offers health insurance plans for low-income children, adults, seniors and people with disabilities in Orange County. Local leaders launched CalOptima Health in 1995 as a county organized health system to better serve vulnerable residents and provide access to quality health care. CalOptima Health operates independently, under the leadership of a Board of Directors made up of members, providers, business leaders and local government representatives.
What We Do
CalOptima Health members have access to care from one of three health plans:
- Medi-Cal: Medi-Cal is California’s Medicaid program for low-income children, adults, seniors and people with disabilities. Recognized for quality care year after year, our Medi-Cal plan offers comprehensive coverage for physical and mental health care as well as social services support.
- OneCare: OneCare Complete and OneCare Flex Plus are Medicare Advantage plans that combine the benefits of Medi-Cal and Medicare for seniors and people with disabilities. Our OneCare plans add supplemental services to make getting care easier.
- Program of All-Inclusive Care for the Elderly: PACE is for seniors in need of a full range of health and social services so they can remain living at home. Our PACE participants give us high ratings for customer satisfaction.
Why It Matters
CalOptima Health is the single largest health insurer in Orange County, and we cover nearly one in three residents. About a third of our members are children, so we are responsible for caring for the next generation in our community. We believe in health equity and access to care for all, and we serve members in the languages they prefer so they are engaged in their health and realize better outcomes. When our members are healthy, Orange County is healthier.
Guiding Principles
Our Mission
To serve member health with excellence and dignity, respecting the value and needs of each person.
Our Vision
Provide all members with access to care and supports to achieve optimal health and well-being through an equitable and high-quality health care system.
Our Values
CalOptima Health C-A-R-E-S: To best serve our members and Orange County, we will lead with Collaboration, Accountability, Respect, Excellence and Stewardship.
Our Motto
“Better. Together.” is our motto, and it means that by working together, we can make things better for our members and community.
Leadership
About Our Leadership
CalOptima Health draws strength from the diversity of our leadership, which spans from the Board of Directors and executive team to our advisory committees representing members and providers.
CalOptima Health Programs
Medi-Cal
Medi-Cal is California’s Medicaid program for low-income children, adults, seniors and people with disabilities, offering comprehensive health care coverage.
OneCare (HMO D-SNP)
OneCare is our Medicare Advantage Dual Eligible Special Needs Plan for seniors and people with disabilities who qualify for both Medicare and Medi-Cal.
Program of All-Inclusive Care for the Elderly (PACE)
PACE supports frail older adults, providing a full range of health and social services so seniors can remain living in the community.
The History of CalOptima Health
A Look Back
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 Medi-Cal members found it difficult to find health care services, and too often they were forced to seek primary care in emergency rooms. It became such a 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 Health.
The Solution
CalOptima Health 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 Health 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.
CalOptima Health Today
Today, CalOptima Health is the single largest health insurer in Orange County, providing coverage for nearly one in three residents through three programs, Medi-Cal, OneCare and PACE. 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 recognized for delivering access to quality care. CalOptima Health is also a prudent steward of public funds. About 95 cents of every dollar we receive goes directly to medical care. Our administrative costs are among the lowest in California, compared with other public and commercial health plans. At CalOptima Health, we take our mission to serve members seriously and strive daily to exceed their expectations.
Strategic Plan
At CalOptima Health, we are committed to improving health care access and outcomes for our members. Our 2025–2027 Strategic Plan lays the foundation for fulfilling our mission and achieving our vision.
We are focused on four key strategic priorities:
Equity and Population Health
CalOptima Health will infuse the pursuit of health equity throughout our work and will continue to innovate and develop tools and interventions that advance the physical, behavioral and social health of our members.
Quality and Value
CalOptima Health is committed to providing the highest quality of physical, behavioral and social health care to our members and to ensuring sound stewardship of public dollars by achieving greater value.
Community Partnerships and Investment
CalOptima Health will continue to demonstrate our partnership with Orange County members, providers, county agencies and community organizations through Medi-Cal Transformation programs and robust community investments and partnerships to advance health equity.
Operations, Finance and People
CalOptima Health’s continued investment in our performance and people is vital to ensuring the highest level of care and service to our members across their lifespan.
Fast Facts
Looking for a quick summary of CalOptima Health basics? You’ve come to the right place for current data about our membership, budget, provider network, employees and more. Fast Facts is published on the first business day of each month.
Transparency
At CalOptima Health, transparency is central to how we operate. We are committed to providing clear, accessible information about our decisions, policies and performance. This section includes key resources, such as our bylaws, audit status updates, public records policies and other important documents. By sharing this information openly, we aim to promote accountability, build trust and keep our members, providers and the Orange County community informed.
Finances and Budget
CalOptima Health receives state and federal funding to provide health insurance to members. Our Board of Directors oversees our finances and budget in a transparent manner during public Board meetings. The following key documents provide a clear picture of CalOptima Health’s financial status.
Doing Business With Us
CalOptima Health is committed to an open, competitive and fair procurement process that ensures the best value while responsibly managing public funds. CalOptima Health uses BidNet Direct to manage all bidding and proposal activities, including solicitation, publishing, notifications and electronic submissions.
Frequently Asked Questions
Is CalOptima Health an insurance company?
Yes, CalOptima Health is the single largest health insurance company in Orange County. We manage Medi-Cal, California’s Medicaid program, which pays for comprehensive medical services for low-income individuals, including families with children, seniors, people with disabilities, pregnant women and those with specific diseases. We also offer a Medicare Advantage plan called OneCare for those who qualify for both Medi-Cal and Medicare. For seniors, we offer a Program of All-Inclusive Care for the Elderly (PACE).How do I apply for CalOptima Health coverage?
You can apply online at BenefitsCal.com, by mail or by calling 1-800-281-9799. You can also apply in person at your nearest local office of the County of Orange Social Services Agency (SSA) to get personal assistance completing your application.
What is the difference between Medi-Cal and Medicare?
Medi-Cal is California’s Medicaid plan. It’s a state-federal program designed to serve people whose income and resources are limited, regardless of their age or health status. According to 2025 income guidelines, you will generally qualify for Medi-Cal’s free coverage if you’re an individual earning $21,597 or less a year or a family of four making $44,367 or less annually. If you earn more, you may still qualify if you are pregnant, have a disability or are under 18.
Medicare has no income requirements, and you qualify when you turn 65 or if you have a qualifying disability before that age. If you meet the eligibility requirements for both Medicare and Medi-Cal — for example, turning 65 and having a low income — you can be dually enrolled in both programs.
Does CalOptima Health offer a Medicare Advantage plan?
Yes, our Medicare Advantage plan is called OneCare. It coordinates dual-eligible members’ Medicare and Medi-Cal benefits. While Medicare is the primary payer for OneCare benefits, there are Medi-Cal wraparound services that cover gaps where Medicare does not provide coverage. This is a unique feature of our OneCare program that most other Medicare Advantage plans in Orange County cannot provide.
OneCare provides all-in-one coverage by combining the benefits of both Medicare and Medi-Cal into a single plan for little to no cost. This means members have one card, one plan and one place to call for help with their health care needs.
What programs does CalOptima Health have for seniors?
CalOptima Health offers a program for seniors that combines health care and adult day care for people with multiple chronic conditions. Our Program of All-Inclusive Care for the Elderly (PACE) is a long-term comprehensive health care program that helps older adults to remain as independent as possible. PACE also offers recreation and social activities, nutritious meals, transportation and more. For information, call 1-844-999-PACE (7223).
We also offer a Medicare Advantage Dual-Eligible Special Needs Plan for low-income seniors and people with disabilities who qualify for both Medicare and Medi-Cal. CalOptima Health OneCare (HMO D-SNP) supports seniors and people with disabilities who are enrolled in both Medicare and Medi-Cal. OneCare benefits are covered in one plan, making it easier to get health care. For more information, call 1-877-412-2734 (TTY 711).
Who can I call for questions about CalOptima Health coverage?
Medi-Cal members, call 1-888-587-8088 (TTY 711)
OneCare members, call 1-877-412-2734 (TTY 711)
PACE participants, call 1-844-999-PACE (7223)
To apply for Medi-Cal, visit BenefitsCal.com or call 1-800-281-9799.
News and Media
Telling Our Story
CalOptima Health is proud to tell our story. We work hard to make sure local stakeholders and the media understand how we serve our members and the vital role we play in Orange County. Visit our News and Media page to watch member videos, view news coverage, read press releases and more.
Report to the Community
This report highlights the impacts and accomplishments of the past year, working with our community partners to achieve results and transform the delivery of care to our members.