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CalOptima Health Medi-Cal Benefits and Services

No matter your age or health needs, we’re here to support you.

Full Health Care Benefits

We provide whole-person health care at no cost to our members. With CalOptima Health Medi-Cal, you get:

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Full Health Care Services

Health care that covers each part of your well-being, from preventive care to specialist visits.

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Compassionate Mental Health Care

Behavioral health services that help you live a balanced and fulfilling life.

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Essential Medical Equipment

Prescribed medical equipment, supplies and more— everything you need to stay healthy.

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Quality Vision Care

Routine eye exams, corrective lenses and expert care to help you see the world clearly.

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Convenient Transportation

Drivers to make visiting your doctor or going to the pharmacy easier.

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Personalized, Long-Term Care

Long-term care services and supports that offer peace of mind, so you can live independently.

More Health Care Services

Access additional services from our partners.*

 

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Dental Services

Call Medi-Cal Dental at 1-800-322-6384

Dental Services
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Services for the Developmentally Disabled

Call the Regional Center of Orange County:

Services for the Developmentally Disabled
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Services for Alcohol and Drug Problems

Call the Orange County Health care Agency Alcohol and Drug Abuse Administration at
1-714-834-3840

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Short-Doyle and Medi-Cal Mental Health Services

Call the Orange County Behavioral Health Plan at 1-800-723-8641 (TTY 711)

Short-Doyle/Medi-Cal and Medi-Cal Mental Health Services

*Some services need prior authorization to be covered. Prior authorization is an approval for special medical services given by your health network.

Whole-Child Model (WCM)

Our WCM program offers enhanced care coordination, improved access to care and better health outcomes for children with conditions eligible for California Children’s Services (CCS). With WCM, your child’s Medi-Cal and CCS benefits are combined under CalOptima Health. 

Medi-Cal for Kids and Teens

If your child or teen is under age 21 and enrolled in Medi-Cal, they may qualify for free health care services to support their growth, development and well-being. Medi-Cal for Kids & Teens covers check-ups, shots, dental care, mental health services, vision and hearing care and more—even if your child isn’t sick. These services are designed to catch health issues early and treat them before they become more serious.

Learn about your child’s rights, what services are covered, and how to get care from the resources below. 

Doula Services

We provide doula services at no cost to our members who are currently pregnant or have delivered a baby within the past 12 months.

 

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What Are Doula Services?

  • Non-medical support provided by trained professionals during pregnancy, childbirth and the postpartum period
  • Emotional and physical support as well as help with communication and decision-making
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How Do You Get Doula Services?

Contact your health care provider to find a doula provider who is enrolled with us.

Pregnant woman looking at phone

Where Can I Get More Info on Doula Services?

Call us toll-free at 1-888-587-8088 (TTY 711), Monday–Friday, from 8 a.m.–5:30 p.m. We have staff who speak your language.

24/7 Nurse Advice Line

Call 1-844-447-8441

If you can’t get a hold of your doctor or health network, you can speak to one of our nurses 24 hours a day, 7 days a week at 1-844-447-8441 (TTY 1-844-514-3774). We can help: 

  • Figure out your symptoms and what you can do
  • Refer you to get help or see your doctor, go to urgent care or visit the hospital
  • Explain your condition or your diagnosis
  • Learn about your medicines
  • Provide interpreter services by phone

For medical or psychiatric emergencies, call 911 or go to the nearest hospital.

Telephone advice nurse

Medi-Cal Rx

Call 1-800-977-2273

Prescription drugs given by a pharmacy are covered by Medi-Cal Rx, a pharmacy program from the California Department of Health Care Services (DHCS). Visit the Medi-Cal Rx website to learn more and find a pharmacy near you. You can also call Medi-Cal Rx Customer Service at 1-800-977-2273 (TTY 711), 24 hours a day, 7 days a week.

Every 3 months, CalOptima Health’s Pharmacy and Therapeutics (P&T) Committee reviews the most recent drug recalls and withdrawals. We inform you, your prescribers and pharmacies when there is a Class I or Class II medication recall or when a drug is removed from the market. See the most recent drug recalls and withdrawals:

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Prior Authorization for Special Medical Services

For some types of care, your doctor or specialist will need to ask your health network or CalOptima Health for permission before you get care, such as prior authorization, prior approval or pre-approval. Care is medically necessary if it is reasonable and necessary to protect your life, keeps you from becoming seriously ill or disabled, or relieves severe pain.

Services that need pre-approval include:

  • Hospitalization
  • Services out of the CalOptima Health service area
  • Outpatient surgery
  • Long-term care at nursing facility
  • Specialized treatments

You never need pre-approval for emergency care, even if it is out of network. This includes having a baby.

To request a prior authorization, contact your primary care provider (PCP) or specialist. See a list of procedure codes that require prior authorization by your provider below:

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