Board of Directors considers how to keep young members with complex needs from experiencing gaps in care as they age out of specialized program
ORANGE, Calif. (April 15, 2026) — Recognizing the difficulty that medically fragile children face as they age out of Medi-Cal’s Whole-Child Model (WCM) program, the CalOptima Health Board of Directors is taking steps to improve this crucial transition and develop industry-leading proactive solutions. Two years in the making, the Come to the Table initiative was created to address what is known as “the cliff,” which occurs when pediatric members with conditions such as cystic fibrosis, hemophilia, cerebral palsy, heart disease, diabetes and cancer leave the WCM at age 21.
The transition of pediatric members can be fraught with challenges, including losing longstanding coordinated care with trusted providers and specialists, a gap in knowledge about adult health care, and a fragmented adult care system that can be difficult to navigate. This can lead to health risks, emergency room visits and hospitalizations for these members and place significant demands on their families.
At the April 2 CalOptima Health Board meeting, the Board heard an analysis of the issue and recommendations for innovative solutions. These include a standardized transition playbook now being drafted that would guide members, their families and providers through the transition process and an incentive program for providers to serve members aging out of WCM.
“Too many families are forced to navigate a cliff at the very moment they need stability the most,” said Vicente Sarmiento, CalOptima Health Board Chair and Orange County Supervisor. “This is a critical gap in care — and one we have the opportunity to fix — so young adults with complex medical needs don’t lose the support they rely on, and families aren’t left to navigate this transition alone.”
Currently, CalOptima Health has 1,105 WCM members between the ages of 19 and 21 across all health networks. While care teams begin planning for this transition when members are 14, the handoff remains challenging. One reason is that pediatric providers are expected to develop transition plans but have limited expertise in adult care.
“As these kids get older, it gets more complicated for parents to find doctors who have the capacity to care for their children’s complex needs,” said Maura Byron, CalOptima Health Board Vice Chair, who helped launch Come to the Table. “It is a complex issue with no single answer, but CalOptima Health has an opportunity to do something amazing, not just in California but nationally.”
The Come to the Table initiative focuses on communication, collaboration and problem-solving to support WCM members. The initiative includes CalOptima Health’s clinical teams working alongside stakeholders such as the Regional Center of Orange County, Home and Community-Based Alternatives Waiver Program teams, and Rady Children’s Health.
About CalOptima Health
A county organized health system, CalOptima Health provides quality health care coverage for low-income children, adults, seniors and people with disabilities in Orange County, California. CalOptima Health’s mission is to serve member health with excellence and dignity, respecting the value and needs of each person. CalOptima Health serves more than 850,000 members with a network of 9,500 primary care doctors and specialists and 42 acute and rehab hospitals. Visit www.caloptima.org.