Full Health Care Benefits to Help You Flourish
We provide whole-person health care at no cost to members—because your health is everything to us! With CalOptima Health Medi-Cal, you can:
Experience Full Health Care Services
Health care that covers each part of your well-being, from preventive care to specialist visits:
- Primary care doctor visits
- Medical specialist visits
- Hospital and emergency care
- Prenatal and newborn baby care
- Immunizations
- Medications
- Laboratory services
Access Compassionate Mental Health Care
Behavioral health services that help you live a balanced and fulfilling life:
- Outpatient psychotherapy (individual, family and group therapy)
- Psychological testing when clinically indicated to evaluate a mental health condition
- Outpatient services that include lab work, drugs and supplies
- Outpatient services for the purposes of monitoring drug therapy
- Psychiatric consultation
- Dyadic services
- Behavioral Health Treatment (BHT) for members age 21 or younger
- Substance use services, such as Screening, Assessment, Brief Intervention and Referral to Treatment (SABIRT) and Medication-Assisted Treatment (MAT)
Get Essential Medical Equipment and Supplies
Prescribed medical equipment, supplies and more—everything needed to stay healthy and thrive:
- Wheelchairs, walkers, crutches, etc.
- Hearing aids
- Home health services
- Medical supplies
Enjoy High-Quality Vision Care
Routine eye exams, corrective lenses and expert care to help you see the world clearly:
- Routine eye exams
- Eyeglasses or contact lenses
Rely on Convenient Transportation
Drivers to make visiting your doctor easier than ever:
- Emergency transportation
- Non-emergency medical transportation
- Non-medical transportation
Receive Personalized, Long-Term Care
Long-term care services and supports that offer peace of mind, so you can live independently:
- In-home supportive services
- Multipurpose Senior Services Program
- Community-based adult services
- Nursing facility care
- Hospice care
More Health Care Services From Our Partners
Access additional services from our partners. (Some services need prior authorization to be covered. Prior authorization is an approval for special medical services given by your health network.)
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 to Assist With Alcohol and Drug Problems
Call the Orange County Health care Agency Alcohol and Drug Abuse Administration at
1-714-834-3840
Short-Doyle/Medi-Cal and Medi-Cal Mental Health Services
Call the Orange County Behavioral Health Plan at 1-800-723-8641 (TTY 711)
Care for Children With Serious Health Conditions Through Whole-Child Model
Do you take care of a child who has a serious medical condition? Our Whole-Child Model (WCM) program offers enhanced care coordination, improved access to care and better health outcomes for children with California Children’s Services (CCS)-eligible conditions. With WCM, your child’s Medi-Cal and CCS benefits are combined under CalOptima Health. CCS is a statewide program that provides specialized medical care, equipment and other essential services for children and young adults under age 21 who have certain serious health conditions.
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
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.
Support for a Better Birth and Postpartum Experience With Doula Services
Did you know we provide doula support services at no cost to our members? You can get doula services if you are currently pregnant or have delivered a baby within the past 12 months and are enrolled in CalOptima Health Medi-Cal.
What Are Doula Services?
Doula services are non-medical support provided by trained professionals during pregnancy, childbirth and the postpartum period. Doulas offer emotional and physical support as well as help with communication and decision-making. They can also help you through difficult experiences, such as miscarriage, stillbirth and abortion.
How Do You Get Doula Services?
To get doula support, contact your health care provider. You can reach out to your health network to find a doula provider who is enrolled with us. Simply call the customer service phone number provided on the back of your health network card.
Where Can I Get More Info on Doula Services?
For questions or more info about doula services, our Customer Service team is here to help. Call us toll-free at 1-888-587-8088 (TTY 711), Monday through Friday, from 8 a.m. to 5:30 p.m. We have staff who speak your language. If you are a doula interested in providing services to our members, we welcome you to visit our provider page for info on how to enroll and offer your support.
Help 24 Hours a Day, 7 Days Week From Our Nurse Advice Line
Need health advice? 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). It’s like talking to a nurse at your doctor’s office, urgent care or the emergency room. We can help:
- Figure out your symptoms and what you can do
- Give you facts about non-urgent and urgent care
- 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
Call 911, if you think you have a medical or psychiatric emergency or go to the nearest hospital.
Medicines Covered By Medi-Cal Rx
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
Requesting Pre-Approval 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. This is called asking for prior authorization, prior approval or pre-approval. It means that your health network or CalOptima Health must make sure that the care is medically necessary or needed.
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.
The following services always need pre-approval, even if you receive them from a provider in your health network or in the CalOptima Health network:
- 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.
If you would like to request prior authorization, please contact your primary care provider (PCP) or specialist.
Below is a list of procedure codes that require prior authorization by your provider:
2025 Procedure Codes
2024 Procedure Codes
2023 Procedure Codes
Access Helpful Resources
Find a Doctor Near You
Search our network to find a trusted provider that meets your health care needs.
Learn About California Advancing and Innovating Medi-Cal (CalAIM)
Find out how CalAIM is transforming health care with new services and supports.
Discover Our Mental Health Services
Read about our integrated behavioral health services to support your mental wellness.
Find Out About Our Other Programs
Learn about our other programs and services offered to our Medi-Cal members.