Gold Coast Health Plan

What Gold Coast Health Plan does

Gold Coast Health Plan is a County Organized Health System (COHS) operating under the Ventura County Medi-Cal Managed Care Commission and serving as the exclusive community Medi-Cal managed care plan for Ventura County, California. Founded in 2011, the plan covers approximately 230,000-245,000 Medi-Cal members across a contracted network of primary care physicians, specialists, hospitals, pharmacies, and community-based organizations, with workforce having grown from 25 to over 400 employees. Revenue is generated exclusively through capitated payments from the California Department of Health Care Services (DHCS) for Medi-Cal members and from CMS for Medicare Advantage Dual Special Needs Plan (D-SNP) enrollees; the plan does not publicly disclose specific financial figures.

The core product is the Medi-Cal Managed Care plan delivering medical, pharmacy, mental health, dental, vision, transportation, and specialty benefits, supplemented by Enhanced Care Management and Community Supports under California's CalAIM initiative. In 2025, the plan launched Total Care Advantage (HMO D-SNP), integrating Medicare and Medi-Cal benefits for dual-eligible members with Part D drug coverage administered by Prime Therapeutics. Operational infrastructure includes a member portal, provider portal, CoverMyMeds electronic prior authorization integration, and credentialing verification partnerships with CAQH and Gemini Diversified Services.

The plan holds dual NCQA accreditations (Health Equity Accreditation in 2025 and Health Plan Accreditation in 2026) and operates the RISE Grant Program, deploying over $13 million cumulatively to local healthcare organizations, including a $2 million grant to expand mammography services at Ventura County Medical Center. Operational leadership was refreshed in October 2025 with the appointment of Suma Simcoe as Chief Operating Officer, bringing prior experience from L.A. Care Health Plan and Molina Healthcare.

Name

Gold Coast Health Plan

Legal name

Ventura County Medi-Cal Managed Care Commission dba Gold Coast Health Plan

Website

https://goldcoasthealthplan.org

Company type

Private

Founded year

2011

Operating status

Operating

Headcount range

101–250 employees

Short description

Gold Coast Health Plan is a County Organized Health System serving approximately 230,000-245,000 Medi-Cal members in Ventura County, California under capitated contract with the California DHCS. Founded in 2011, it operates as the county's exclusive community Medi-Cal plan and recently launched a Medicare D-SNP for dual-eligible members.

Ownership category

akta.pro rank

Product category

Medicaid Managed Care

NAICS

Health Care and Social Assistance (62), Services for the Elderly and Persons with Disabilities (624120)

SIC

Hospital & Medical Service Plans (6324), Services-Health Services (8000)

akta.pro primary industry

TANF/CHIP Managed Care Plans (HLAEAEAA)

akta.pro secondary industries

Medicaid Expansion (ACA Adult) Managed Care Plans (HLAEAEAB), Integrated Physical-Behavioral-Social Care (Whole-Person) Medicaid Plans (HLAEAEAI), Medicaid Managed Care HMOs (HLAEAMAI), Medicare Advantage (MA) Plans (FSAIAGAA), MA Chronic Condition Management & Supplemental Benefits (SSBCI) (HLAEACAI)

Keywords

• Medicaid managed care
• Medi-Cal health plan
• Government health insurance
• Dual-eligible coverage
• Healthcare services administration

Headquarters

HQ city

Camarillo

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2C

Offering type

Services

Cost components

Operations, Personnel, Infrastructure, Technology or R&D, Marketing or Sales

Revenue model

1. Government Healthcare Contracts: Gold Coast Health Plan operates as a County Organized Health System (COHS) contracted with the California Department of Health Care Services (DHCS) to serve Medi-Cal eligible beneficiaries in Ventura County. Revenue is derived from capitated payments from DHCS based on enrolled member enrollment. Additionally, the plan contracts with CMS for Medicare Advantage Dual Special Needs Plan (D-SNP) services through its Total Care Advantage product for dual-eligible members.

Pricing tiers

Go-to-market motion1 record

Distribution channels3 records

Marketing channels5 records

Core offering

Gold Coast Health Plan delivers Medi-Cal managed care to approximately 245,000 low-income members in Ventura County as a County Organized Health System, providing physical health, behavioral health, vision, and pharmacy benefits through a contracted provider network. It also offers Total Care Advantage, a Medicare Medi-Cal Plan (HMO D-SNP) for individuals dually eligible for both programs, integrating Medicare and Medi-Cal coverage into a single plan.

Product overview

Gold Coast Health Plan is a County Organized Health System (COHS) operating as a single unified managed care platform serving Medi-Cal members in Ventura County, California. The core product is the Medi-Cal Managed Care plan covering approximately 230,000-245,000 members, supplemented by Total Care Advantage (HMO D-SNP), a Medicare Advantage Dual Special Needs Plan that integrates Medi-Cal and Medicare benefits for dual-eligible members. The portfolio includes care management and coordination services (Enhanced Care Management, Community Supports, Care Management, Complex Case Management), behavioral health services (Mental Health through Carelon, Non-Specialty Mental Health), specialty services (Children's Services/CCS, Doula Services, Palliative Care, Dental, Vision), pharmacy benefits (Medi-Cal Rx for state coverage, Prime Therapeutics for Medicare Part D), transportation, and member support programs (RISE Grant Program, Member Rewards, Staying Healthy Assessment). All services are delivered through contracted provider networks with 24/7 nurse advice line support.

Differentiator

Problem solved

Functional benefit

Brands

• Total Care Advantage: An HMO D-SNP (Dual Special Needs Plan) that integrates Medi-Cal and Medicare benefits for members who have both programs, launched in 2025.

Products and services

• Gold Coast Health Plan Medi-Cal Managed Care County Organized Health System plan providing physical health, behavioral health, vision, and pharmacy benefits to approximately 245,000 Medi-Cal beneficiaries in Ventura County through a contracted provider network. Members receive primary care, specialist referrals, hospitalization, and care coordination including Enhanced Care Management and Community Supports under CalAIM.
• Total Care Advantage (HMO D-SNP) Total Care Advantage is an HMO Dual-Eligible Special Needs Plan (D-SNP) that integrates Medicare and Medi-Cal benefits into a single plan for dual-eligible beneficiaries in Ventura County. It provides medical, pharmacy, behavioral health, and supplemental benefits such as dental, vision, and transportation, with care coordination designed for higher-acuity seniors and persons with disabilities.

Quantifiable outcome

• Grew from 100,000 Medi-Cal members in 2011 to nearly 255,000 peak membership
• +2 more outcomes

Named customers3 records

Segments2 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration3 records

Partnerships

Eight partnerships are on record, tiered core and minor.

• Institute for Healthcare Improvement (IHI)coreStrategic or Co-development Partner · 20 February 2026RISE Grant Program partnership with IHI for the second year of grants to fund community-driven solutions to safeguard Medi-Cal coverage. IHI provides program guidance for outreach, re-enrollment assistance, and navigation services to help Ventura County residents maintain coverage as federal eligibility requirements expand through 2027.
• Prime TherapeuticscoreTechnology or IntegrationPharmacy benefit manager administering Part D drug benefit for Total Care Advantage (HMO D-SNP) plan. Also processes Medi-Cal pharmacy claims under the Medi-Cal Rx program carved out by the state Department of Health Care Services.
• Carelon Behavioral HealthcoreTechnology or IntegrationMental health services partner providing non-specialty mental health services to Medi-Cal members through the plan's behavioral health benefit.
• Ventura County Behavioral HealthcoreTechnology or IntegrationCounty agency providing 24/7 crisis intervention services for members experiencing mental health crises. Crisis help available at 1-866-998-2243.
• Health Care Foundation for Ventura CountyminorGTM or Marketing Partner$2 million grant recipient to expand mammography services at Ventura County Medical Center, increasing screening capacity and introducing advanced imaging technologies to improve early breast cancer detection in underserved communities.
• Ventura County Human Services AgencycoreGTM or Marketing PartnerCounty agency conducting Medi-Cal eligibility determinations and renewals (redeterminations) for Ventura County residents. Partnership enables coordinated eligibility assistance and coverage retention for members.
• El Concilio Family ServicesminorGTM or Marketing PartnerCommunity partner providing eligibility assistance to Medi-Cal members, particularly Spanish-speaking communities in Ventura County.
• Mixteco / Indigena Community Organizing Project (MICOP)minorGTM or Marketing PartnerCommunity partner providing culturally appropriate outreach and eligibility assistance to Mixtec and indigenous communities in Ventura County.

Scale indicators6 records

Recent moves6 records

Expansion highlights5 records

Broad incumbents

• Health Net (Centene): Health Net, a Centene subsidiary, is one of California's largest Medi-Cal managed care plans operating across multiple counties - comparable as a multi-county Medi-Cal competitor with broad HMO and D-SNP offerings.
• Molina Healthcare: Molina is a national government-sponsored managed care company with significant Medi-Cal membership in California - comparable as a Medi-Cal competitor in the state and as a prior employer of GCHP's COO, with overlapping product portfolio (Medicaid and MA D-SNP).
• Kaiser Permanente Medi-Cal: Kaiser Permanente operates as an integrated Medi-Cal plan in California with a vertically integrated provider model - comparable as a large-scale California Medi-Cal competitor with HMO D-SNP offerings to dual-eligibles.
• Anthem Blue Cross Medi-Cal: Anthem Blue Cross operates one of the largest Medi-Cal contracts in California serving multiple counties - comparable as a major statewide Medi-Cal competitor with integrated Medicaid and D-SNP products.

Direct peers

• Partnership HealthPlan of California: Partnership HealthPlan is a COHS serving Northern California counties under a county-organized model, comparable on governance structure, Medi-Cal contract exclusivity, and regional managed care operations.
• Santa Clara Family Health Plan: Santa Clara Family Health Plan is a county-based local initiative Medi-Cal plan serving Santa Clara County - directly comparable community-based public managed care plan with similar Medicaid-only concentration.
• CalOptima: CalOptima is a COHS Medi-Cal managed care plan serving Orange County, California - the closest structural analogue to GCHP with the same single-county COHS governance model, exclusive DHCS contract, and dual-eligible focus, making it directly comparable.
• CenCal Health: CenCal Health is a COHS serving Santa Barbara and San Luis Obispo counties with Medi-Cal managed care - directly comparable single-region public managed care plan with hospital and physician network model akin to GCHP.
• Inland Empire Health Plan (IEHP): IEHP is a COHS serving San Bernardino and Riverside counties with Medi-Cal and Medicare D-SNP plans - directly comparable COHS model with D-SNP product line matching GCHP's Total Care Advantage.
• L.A. Care Health Plan: L.A. Care is the largest public Medi-Cal plan in the US, operating a local initiative model in Los Angeles County with Medi-Cal, L.A. Care Covered (Covered California), and D-SNP lines - directly comparable public managed care plan and GCHP COO's prior employer.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/gold-coast-health-plan

Compliance5 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles4 records

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments16 records

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Gold Coast Health Plan