CalOptima Health Bylaws
This document contains the current Bylaws of Orange County Health Authority (CalOptima Health), as amended and revised on April 6, 2023.
State Audit
On May 2, 2023, the California State Auditor (CSA) released a report following a comprehensive nine-month audit of CalOptima Health that covered an eight-year period from January 2014 through June 2022. In accordance with the terms of the audit, CalOptima Health was required to submit 60-day, six-month and one-year status updates to CSA regarding the implementation of the report’s seven recommendations. Following its assessment of the one-year status update, CSA confirmed that CalOptima Health had fully implemented all recommendations without any further actions or responses required. To promote transparency and accountability, CalOptima Health is publicly posting audit materials.
California State Auditor Report (May 2, 2023)
60-Day Status Update (July 1, 2023)
Solicitation and Receipt of Gifts Policy
This policy defines the criteria and procedure for gifts received from outside sources, in accordance with the Political Reform Act and the Federal Anti-Kickback Statute.
Public Records Request
This form can be used to make written requests for public records containing information related to the conduct of the public’s business that is prepared, owned, used or retained by CalOptima Health. For more information on public records requests, see California Government Code Section 6250 et seq. and CalOptima Health Policy AA.1215.
Transparency in Coverage Rule
These links lead to the machine readable files that are made available in response to the federal Transparency in Coverage Rule and include negotiated service rates and out-of-network allowed amounts between health plans and health care providers. The machine-readable files are formatted to allow researchers, regulators and application developers to more easily access and analyze data.
Women, Infants & Children MOU Meetings
January 31, 2024, from 1–2 p.m.
June 3, 2024, from 2–4 p.m.
August 29, 2024, from 9–11 a.m.
January 23, 2025, from 2–4 p.m.
March 27, 2025, from 1–3 p.m.
May 22, 2025, from 2–4 p.m.
September 25, 2025, from 2–4 p.m.
November 20, 2025, from 1–3 p.m.
Government Claim Form
This form can be used for claims for money or damages against CalOptima Health after pursuing all applicable administrative remedies and prior to filing a lawsuit. For more information on claim presentation, see California Government Code Section 900 et seq. and CalOptima Health Policy AA.1217.
Voluntary Rate Range Intergovernmental Transfer Program (VRR/IGT)
The Voluntary Rate Range Intergovernmental Transfer (VRRP/IGT) Program is a Medi-Cal program funded by state funds and matching federal funds.
CalOptima Health and Orange County Health Care Agency (OCHCA) Collaboration Meeting - Behavioral Health Services
January 15, 2025, from 9–10 a.m.
March 19, 2025, from 9–10 a.m.
May 21, 2025, from 9–10 a.m.
July 16, 2025, from 9–10 a.m.
September 17, 2025, from 9–10 a.m.
November 19, 2025, from 9–10 a.m.
CalOptima Health and Orange County Health Care Agency (OCHCA) Collaboration Meeting – Local Health Department
February 13, 2025, from 2–3 p.m.
March 13, 2025, from 2–3 p.m.
April 10, 2025, from 2–3 p.m.
March 13, 2025, from 2–3 p.m.
June 12, 2025, from 2–3 p.m.
July 10, 2025, from 2–3 p.m.
August 14, 2025, from 2–3 p.m.
September 11, 2025, from 2–3 p.m.
October 9, 2025, from 2–3 p.m.
November 5, 2025, from 2–3 p.m.
December 3, 2025, from 2–3 p.m.
CalOptima Health and Orange County Health Care Agency (OCHCA) Collaboration Meeting – Targeted Case Management
January 21, 2025, from 10–10:30 a.m.
April 15, 2025, from 11–11:40 a.m.
July 15, 2025, from 11 a.m.–12 p.m.
October 21, 2025, from 11 a.m.–12 p.m.
Medical Audits and Corrective Action Plans (CAPs)
Each year, the California Department of Health Care Services (DHCS) conducts medical surveys of CalOptima Health’s Medi-Cal program. These audits are detailed reviews of how CalOptima Health complies with DHCS contract requirements, regulations, and policies and procedures. They help DHCS monitor the program and find areas of non-compliance, so corrective actions can be taken.
Below are recent DHCS audit reports along with the related corrective action plans (CAP).
2023 Focused Audit Report
2023 Focused Audit CAP
2024 DHCS Medical Audit Report
Medical Audits and Corrective Action Plans - Spanish
Medical Audits and Corrective Action Plans - Vietnamese
Medical Audits and Corrective Action Plans - Korean
Medical Audits and Corrective Action Plans - Farsi
Medical Audits and Corrective Action Plans - Arabic
Medical Audits and Corrective Action Plans - Chinese