Full Health Care Benefits
We provide whole-person health care at no cost to our members. With CalOptima Health Medi-Cal, you get:
Full Health Care Services
Health care that covers each part of your well-being, from preventive care to specialist visits.
Compassionate Mental Health Care
Behavioral health services that help you live a balanced and fulfilling life.
Essential Medical Equipment
Prescribed medical equipment, supplies and more— everything you need to stay healthy.
Quality Vision Care
Routine eye exams, corrective lenses and expert care to help you see the world clearly.
Convenient Transportation
Drivers to make visiting your doctor or going to the pharmacy easier.
Personalized, Long-Term Care
Long-term care services and supports that offer peace of mind, so you can live independently.
Case Management
Members with more complex health needs may qualify for extra services that help with care coordination.
More Health Care Services
Access additional services from our partners.*
Services for the Developmentally Disabled
Call the Regional Center of Orange County:
- East/Central Office: 1-714-796-5100
- West Area Office: 1-714-796-2900
Services for Alcohol and Drug Problems
Call the Orange County Health care Agency Alcohol and Drug Abuse Administration at
1-714-834-3840
Short-Doyle and Medi-Cal Mental Health Services
Call the Orange County Behavioral Health Plan at 1-800-723-8641 (TTY 711)
*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.
Learn More About WCM and CCS
- Family Resource Centers (FRCs)/Family Empowerment Centers (FECs)
- DHCS – CCS Program Overview
- Learn More About the WCM Family Advisory Committee (WCM FAC)
- Orange County Health Care Agency – CCS Info and Resources
- Department of Health Care Services (DHCS) – WCM
- Family Voices of California – WCM Fact Sheet
- DHCS – CCS Advisory Group
- WCM Provider Training
- WCM Frequently Asked Questions
- WCM Referral Form
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 Support for Pregnant and Postpartum Members
We offer doula services at no cost to our Medi-Cal members who are currently pregnant or have delivered a baby within the past 12 months.
Doulas are birth workers who give non-medical support to pregnant and postpartum persons before, during and after childbirth, including support during miscarriages, stillbirths, and abortions. They can:
- Help you understand your health care choices
- Make a birth plan that fits your needs
- Teach you about breastfeeding
- Connect you with community resources
- Support your physical and emotional health
Members can reach out to any doula in their health network to start service. No prior authorization is needed.
Questions? Call CalOptima Health Customer Service 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.
Covered Services
Perinatal Support
Access to 1 initial visit and up to 8 additional visits at any time during the perinatal period (before or after birth).
Postpartum Support
Up to 2 extended 3-hour postpartum visits after the end of a pregnancy with the standing recommendation issued by the Department of Health Care Services (DHCS).
Labor and Delivery
Support during labor and delivery, including through stillbirth, abortion or miscarriage.
Additional Support
Up to 9 additional postpartum visits with recommendations from a doctor or other licensed provider.
This recommendation can be noted in your medical record by your provider. You can also ask your provider to complete the Doula Recommendation Form and give it to your doula. (The standing recommendation from DHCS cannot be used for additional postpartum visits.)
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.
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:
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: