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 and health care.

In the early 1990’s, the Medicaid system, or what is referred to 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 escalated into a problem so severe 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.

We manage programs that are funded by the state and federal government, but operate independently, under the leadership of a Board of Directors made up of members, providers, business leaders and local government representatives.

Today, CalOptima is the second largest health insurer in Orange County, providing coverage to one in seven residents and almost a third of our community’s children. CalOptima is the fifth largest Medi-Cal managed care plan in California, and we are larger than the entire Medicaid programs of 18 other states.

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.

We provide access to quality health care services to our members while remaining an effective and prudent steward of public funds. We use our resources wisely - 95 cents of every dollar we spend goes directly to medical care. Our administrative costs are lower than nearly every health plan in California, whether commercial or non-profit.

At CalOptima, we take our mission seriously, and strive daily to exceed expectations. We always remember that our members are why we are here and central to what we do.