Jane Dotson
CalOptima Health is a county-organized health system and the largest health insurer in Orange County, California. It offers health insurance plans for low-income families, children, adults, seniors, and people with disabilities. CalOptima Health was created in 1993 by the Orange County Board of Supervisors as an independent entity to ensure quality healthcare services for vulnerable residents. The organization covers nearly one-third of Orange County residents and provides access to a comprehensive network of providers, including doctors, specialists, hospitals, health networks, and medical groups. With an annual budget of $4 billion as of July 2022, CalOptima serves almost 940,000 members and is led by CEO Michael Hunn.
| Characteristics | Values |
|---|---|
| Type of Insurance | Health Insurance |
| Target Group | Low-income families with children, seniors, people with disabilities, foster care children, pregnant women, and low-income people with specific conditions |
| Area Served | Orange County, California |
| Number of Members | 940,000 |
| Network of Doctors and Specialists | 7,200+ |
| Number of Hospitals | 30 |
| Type of Health System | County-Organized Health System (COHS) |
| Year Established | 1993 |
| Governing Body | Orange County Health Authority |
| Number of Governing Body Members | 10 (9 voting members and 1 non-voting member) |
| Meeting Frequency | Monthly, typically on the first Thursday of every month (except January and July) |
Explore related products
What You'll Learn
- CalOptima Health is Orange County's largest health insurer
- It offers health insurance plans for low-income families, children, adults, seniors, and people with disabilities
- CalOptima Health was created in 1993/1995 by the Orange County Board of Supervisors
- It offers three programs: Medi-Cal, OneCare, and PACE
- CalOptima Health operates independently, under the leadership of a Board of Directors
CalOptima Health is Orange County's largest health insurer
CalOptima Health is the largest health insurer in Orange County, California. It was created by the Orange County Board of Supervisors in 1993 as a County-Organized Health System (COHS) and is a public agency and the largest of six COHS in California.
CalOptima Health manages programs that are funded by the state and federal government, but operates independently, under the leadership of a Board of Directors made up of members, providers, business leaders and local government representatives.
The health insurer provides coverage for nearly one in three residents, or about a quarter of the population, of Orange County. This includes health insurance plans for low-income children, adults, seniors, and people with disabilities. In July 2022, it was reported to serve 940,000 members with a network of more than 7,200 primary care doctors and specialists at 30 hospitals.
CalOptima Health offers three programs: Medi-Cal, OneCare, and PACE. Medi-Cal is California's Medicaid program for low-income children, adults, seniors, and people with disabilities, offering comprehensive coverage for physical and mental health care as well as social services support. OneCare Complete and OneCare Flex Plus are Medicare Advantage plans that combine the benefits of Medi-Cal and Medicare for seniors and people with disabilities.
In addition to providing health insurance, CalOptima Health is committed to health equity and access to care for all. They offer services in multiple languages and have initiatives such as the Comprehensive Community Cancer Screening and Support program, which aims to boost screening rates for breast, cervical, colon, and lung cancer.
Understanding Private Hire Insurance: What You Need to Know
You may want to see also
Explore related products
It offers health insurance plans for low-income families, children, adults, seniors, and people with disabilities
CalOptima is a health insurance provider that offers plans for low-income families, children, adults, seniors, and people with disabilities in Orange County, California. It was launched in 1995 as a county-organized health system to better serve vulnerable residents and provide access to quality healthcare.
Health Insurance Plans for Low-Income Families
CalOptima offers no-cost health coverage for low-income families with children, seniors, people with disabilities, foster care children, pregnant women, and low-income people with specific conditions. This includes comprehensive coverage for physical and mental healthcare, as well as social services support through the Medi-Cal program.
Health Insurance Plans for Children
CalOptima provides health insurance plans for low-income children in Orange County. About a third of their members are children, and they believe in health equity and access to care for all. They work with a network of providers, including doctors, specialists, hospitals, and medical groups, to meet the needs of their young members.
Health Insurance Plans for Adults
CalOptima offers health insurance plans for low-income adults in Orange County. Their plans provide comprehensive coverage, including physical and mental healthcare, as well as social services support through the Medi-Cal program.
Health Insurance Plans for Seniors
CalOptima has health insurance plans tailored for low-income seniors in Orange County. Their OneCare plans, including OneCare Complete and OneCare Flex Plus, combine the benefits of Medi-Cal and Medicare. Additionally, their Program of All-Inclusive Care for the Elderly (PACE) provides a full range of health and social services to help seniors remain living at home.
Health Insurance Plans for People with Disabilities
CalOptima offers health insurance plans for low-income individuals with disabilities. Their plans include comprehensive coverage for physical and mental healthcare, as well as social services support through the Medi-Cal program. The OneCare plans also cater to individuals with disabilities, providing supplemental services and combining the benefits of Medi-Cal and Medicare.
Insurance 101: Understanding the 1199 Plan
You may want to see also
Explore related products
CalOptima Health was created in 1993/1995 by the Orange County Board of Supervisors
CalOptima Health is a publicly funded health insurance plan for low-income citizens of Orange County, California. It was created in 1993 by the Orange County Board of Supervisors as a County-Organized Health System (COHS) to manage care for county residents covered by Medi-Cal, California's Medicaid program. It later became a standalone organization, launching in 1995 as a county-organized health system to better serve vulnerable residents and provide access to quality healthcare.
As the single largest county-organized health insurer in California, CalOptima serves nearly one in three Orange County residents, including many children, adults, seniors, and people with disabilities. The organization operates independently and is led by a Board of Directors comprising members, providers, business leaders, and local government representatives.
CalOptima administers health insurance programs with an emphasis on holistic care, recognizing that factors such as housing and food security are integral to health. They work with thousands of Orange County providers, including doctors, specialists, hospitals, health networks, and medical groups, to meet the diverse needs of their members.
The organization offers a range of health insurance plans, including Medi-Cal, OneCare, and PACE. Medi-Cal is California's Medicaid program, providing comprehensive coverage for physical and mental healthcare, as well as social services support for low-income individuals and families. OneCare is a Medicare Advantage plan that combines the benefits of Medi-Cal and Medicare for seniors and people with disabilities.
CalOptima is committed to health equity and accessibility, serving members in their preferred languages to promote engagement in their health and improve outcomes. They also focus on community initiatives, such as boosting cancer screening rates and addressing social drivers of healthcare through programs like California Advancing and Innovating Medi-Cal (CalAIM).
Veterans' Insurance: What Coverage Do They Get?
You may want to see also
Explore related products
It offers three programs: Medi-Cal, OneCare, and PACE
CalOptima is a health insurance provider that serves Orange County, California. It offers health insurance plans for low-income children, adults, seniors, and people with disabilities. CalOptima is the single largest health insurer in Orange County, covering nearly one-third of the county's residents.
Medi-Cal
Medi-Cal is California's version of Medicaid, offering full health care coverage to those with low incomes. It provides comprehensive coverage for physical and mental health care, as well as social services support. This includes preventive care, specialist visits, prescribed medical equipment, and supplies. It also offers family planning services, such as counseling, pregnancy testing, and birth control methods.
OneCare
OneCare is a Medicare Advantage plan that combines the benefits of Medi-Cal and Medicare for seniors and people with disabilities. There are two OneCare options: OneCare Complete and OneCare Flex Plus. Both options integrate an individual's Medicare and Medi-Cal benefits, providing comprehensive coverage. OneCare also offers additional benefits, such as dental services, transportation to and from the gym, and grocery benefits for those with medically complex chronic conditions.
PACE
The Program of All-Inclusive Care for the Elderly (PACE) supports seniors aged 55 and older who qualify for nursing home care but wish to remain in their homes. The PACE program helps participants live independently through personalized care plans, which include activities, counseling, transportation services, and assistance with daily tasks. It is funded by Medicare, Medi-Cal, or both, and has been serving Orange County's Medi-Cal and Medicare seniors for over ten years.
CHIP vs Private Insurance: Which Offers Better Coverage?
You may want to see also
Explore related products
CalOptima Health operates independently, under the leadership of a Board of Directors
CalOptima Health is a publicly funded health insurance plan for low-income citizens in Orange County, California. It was created by the Orange County Board of Supervisors in 1993 as a County-Organized Health System (COHS). CalOptima is the largest of six COHS in California.
The Board of Directors is made up of members, providers, business leaders, and local government representatives. The Board meets monthly, typically on the first Thursday of every month, except in January and July.
The Board of Directors selects the CEO of CalOptima Health, who is responsible for the day-to-day operations of the organization. The Board also approves salary increases for officers and other key positions. In recent years, CalOptima has come under scrutiny for its hiring and pay practices, with some questioning whether the organization is considering the constituents they serve when making these decisions.
The CalOptima Health Board of Directors works closely with the executive management team, elected officials, regulatory agencies, associations, contractors, and key stakeholders to fulfill its mission to serve Orange County's vulnerable populations.
Understanding Federal Insurance's Private Option
You may want to see also
Frequently asked questions
CalOptima is a publicly funded health insurance plan for low-income citizens in Orange County, California. It was created by the Orange County Board of Supervisors in 1993 as a County-Organized Health System (COHS).
CalOptima offers three programs: Medi-Cal, OneCare (HMO D-SNP), and a Program of All-Inclusive Care for the Elderly (PACE). Medi-Cal is California's Medicaid program, while OneCare combines the benefits of Medi-Cal and Medicare for seniors and people with disabilities.
CalOptima insurance plans are designed for low-income families, children, adults, seniors, and people with disabilities in Orange County, California.
