If you see any activity that you think is fraud or waste, we strongly encourage you to call our Compliance and Ethics Hotline at 1-855-507-1805 (TTY 711). You can also report the activity using CalOptima Health’s Compliance and Fraud, Waste and Abuse (FWA) Reporting form.
You do not have to give your name to report fraudulent activity.
Medi-Cal eligibility and benefits are changing for some adults starting in 2026. Learn more about the new rules and how they affect your coverage.
Learn More About Medi-Cal Changes
A new federal rule requires California to change how some members who do not meet certain federal immigration requirements get Medi-Cal services. Starting January 1, 2027, these members will move from CalOptima Health to Medi-Cal Fee-for-Service.
CalOptima Health works with thousands of Orange County providers, including doctors, specialists, hospitals, health networks, medical groups and more. Find the right providers for your needs.
Take action to protect your Medi-Cal coverage by reporting new contact information or family changes to the County of Orange Social Services Agency. Look for the yellow envelope in the mail with your annual renewal forms.
No-cost health coverage for low-income families with children, seniors, people with disabilities, foster care children, pregnant women, and low-income people with specific conditions.
Coordinated care for low-income seniors and people with disabilities who qualify for both Medicare and Medi-Cal. Benefits are combined in one single plan, making it easier to get health care.
Comprehensive health care to keep frail elders active and living at home. PACE combines preventive, primary and acute care along with day health services in one plan for seniors with Medi-Cal only or Medicare and Medi-Cal.
34
Orange County Cities Served
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.
915K+
Members Served
CalOptima Health members have access to care from one of three health plans:
30
Years of Serving OC
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.
Through the Comprehensive Community Cancer Screening and Support program, CalOptima Health is focused on boosting screening rates for breast, cervical, colon and lung cancer. Learn more about when to get screened, what to do about test results and how to manage cancer care.
California Advancing and Innovating Medi-Cal (CalAIM) is a statewide initiative to improve the quality of life and health outcomes of Medi-Cal members. CalAIM offers benefits that address the social drivers of health care, such as housing and food security.
CalOptima Health welcomes participation in our public meetings. Get the latest schedule and materials for Board of Directors, Board committee and advisory committee meetings.
CalOptima Health’s Community Relations team collaborates with local organizations to support our members. Learn more about our sponsorships, educational programs, health resources and events.