Calviva Health

What Calviva Health does

CalViva Health is a locally managed, non-profit public health care plan that operates under California's Medi-Cal Managed Care Program. It serves as the designated Local Initiative Plan for Fresno, Kings, and Madera Counties in California's Central Valley, providing comprehensive health coverage to low-income Medi-Cal beneficiaries — including children, pregnant individuals, adults with disabilities, and seniors — across an addressable population of approximately 450,000 eligible residents. The plan is sponsored by the Regional Health Authority, a public governance entity that provides local control and oversight.

The plan's core product is a Medi-Cal managed care benefit delivered through a contracted network of 1,600+ providers and 160 pharmacies. Member-facing digital services include a Member Portal (powered by NTT DATA) for eligibility checks, ID card access, and claims information; telehealth services delivered through a Teladoc Health partnership (24/7 video and phone appointments covering general medical, pediatrics, urgent care, women's health, and behavioral health); an online Provider Directory; and FHIR-based interoperability APIs (Provider Directory and Patient Access APIs) accessible via the Centene Partner Portal in compliance with the CMS-9115-F rule. In 2025, CalViva Health earned both NCQA Health Plan Accreditation and NCQA Health Equity Accreditation.

CalViva Health's business model is capitation-based: the California Department of Health Care Services (DHCS) pays per-member monthly premiums to CalViva Health for each enrolled beneficiary, who receives covered services at $0 direct cost. The plan does not charge member premiums or copays. Members are acquired via direct enrollment through county social services offices (Fresno, Kings, and Madera), the state-administered Health Care Options (HCO) packet process, and auto-assignment when no plan choice is made within 30 days. A sub-brand, Wellcare CalViva Health Dual Align, extends coverage to dual-eligible (Medicare + Medi-Cal) members. The company is supported operationally by a small administrative staff (11-50 employees) and appears to leverage Health Net/Centene infrastructure for back-office functions.

Name

Calviva Health

Legal name

CalViva Health

Website

https://calvivahealth.org

Company type

Private

Founded year

2011

Operating status

Operating

Headcount range

11–50 employees

Short description

CalViva Health is a non-profit Local Initiative Plan providing Medi-Cal Managed Care coverage to low-income beneficiaries in California's Fresno, Kings, and Madera Counties. It is sponsored by the Regional Health Authority and contracts with DHCS for per-member capitation revenue.

Ownership category

akta.pro rank

Product category

Medicaid Managed Care

SIC

Hospital & Medical Service Plans (6324)

akta.pro primary industry

Integrated Physical-Behavioral-Social Care (Whole-Person) Medicaid Plans (HLAEAEAI)

akta.pro secondary industry

Virtual Specialty Care Programs (Payer-Sponsored) (HLALACAD)

Keywords

• Medi-Cal managed care
• Public health insurance
• Medicaid health plan
• Healthcare coordination
• Managed care plan

Headquarters

HQ city

Fresno

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

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

Revenue model

1. Medi-Cal Managed Care Premiums: CalViva Health operates as a locally managed public health plan under California's Medi-Cal Managed Care Program. The plan receives capitation payments from the California Department of Health Care Services (DHCS) for each enrolled beneficiary to provide comprehensive healthcare coverage including medical, hospital, pharmacy, and ancillary services.

Pricing tiers

Go-to-market motion1 record

Distribution channels2 records

Marketing channels3 records

Core offering

CalViva Health is a locally managed public health care plan operating under California's Medi-Cal Managed Care Program, serving beneficiaries in Fresno, Kings, and Madera Counties. The plan provides comprehensive healthcare coverage including medical, hospital, pharmacy, dental, vision, behavioral health, transportation, and care management services through a contracted provider network of more than 1,600 physicians, hospitals, and ancillary providers. It offers a tailored Wellcare CalViva Health Dual Align sub-plan for members dually eligible for Medi-Cal and Medicare, supported by a member portal, 24/7 telehealth, and FHIR-based interoperability APIs.

Product overview

CalViva Health is a locally managed Medi-Cal Managed Care plan serving Fresno, Kings, and Madera Counties in California, sponsored by the Regional Health Authority. Its product portfolio consists of a core managed care plan offering supplemented by member-facing digital service modules: a Member Portal (powered by NTT DATA) for benefits management, claims, and ID card access; telehealth services delivered through a Teladoc Health partnership; an online Provider Directory for finding in-network clinicians; and Member Resources including handbooks, transportation services guides, and continuity-of-care documentation. The plan also supports interoperability APIs (Provider Directory API and Patient Access API) via the Centene Partner Portal for third-party app connections to member health data.

Differentiator

Problem solved

Functional benefit

Brands

• Wellcare CalViva Health Dual Align: Dual eligible members (Medicare + Medi-Cal) plan option for members enrolled in both Medicare and Medi-Cal programs.

Products and services

• CalViva Health Medi-Cal Managed Care Plan A public, locally managed Medi-Cal health plan providing medical, hospital, pharmacy, dental, vision, behavioral health, transportation, and care management benefits to Medi-Cal beneficiaries in Fresno, Kings, and Madera Counties through a contracted provider network.
• Wellcare CalViva Health Dual Align An aligned Medicare-Medicaid plan for individuals dually eligible for Medi-Cal and Medicare, offering combined coverage under a single product with a dedicated member website at member.wellcare.com/calvivahealth.
• Member Portal

Segments2 records

Ideal customer profiles2 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration2 records

Feature2 records

Partnerships

Four partnerships are on record, tiered core.

• Teladoc HealthcoreTechnology or IntegrationCalViva Health has partnered with Teladoc Health to provide telehealth services to members. Through this partnership, members have 24/7 access to video appointments for general medical care, pediatrics, urgent care, women's health, and behavioral health therapy and counseling services available weekdays from 7 a.m. through 9 p.m. Pacific time.
• Regional Health AuthoritycoreOthersCalViva Health is sponsored by the Regional Health Authority, which provides local governance, local control, and local responsive healthcare. The Regional Health Authority creates infrastructure to take advantage of opportunities from local, state, or national healthcare coverage efforts.
• California Department of Health Care Services (DHCS)coreOthersDHCS is the state agency that administers California's Medi-Cal program and contracts with CalViva Health as a managed care plan. CalViva Health receives per-member capitation payments from DHCS to provide covered services to enrolled beneficiaries.
• Health Care Options (HCO)coreOthersHealth Care Options, a DHCS program, administers the enrollment process for Medi-Cal managed care plans including CalViva Health. New members receive HCO packets and are auto-assigned to plans if no selection is made within 30 days.

Scale indicators4 records

Recent moves5 records

Expansion highlights5 records

Broad incumbents

• Anthem Blue Cross Medi-Cal: A major statewide Medi-Cal managed care plan operating in multiple California counties, including as a commercial plan option in CalViva's service region. Comparable as a multi-line, multi-state Medi-Cal competitor with broader product portfolio than CalViva.
• Health Net (Centene): One of California's largest Medi-Cal managed care plans, operating as the commercial plan counterpart in California's two-plan model counties including Fresno. Directly competes with CalViva for member choice and auto-assignment, but at substantially greater scale and with multi-state backing from Centene.
• Centene Corporation: The largest U.S. Medicaid managed care operator nationally and the parent of Health Net, which competes directly with CalViva in Fresno/Kings/Madera. Centene represents both an indirect competitor and the parent ecosystem providing CalViva's interoperability APIs via the Centene Partner Portal.
• Molina Healthcare: A national Medicaid managed care organization operating across multiple states including California. Comparable as a Medicaid-focused MCO serving low-income populations, though at much larger scale and with multi-state diversification CalViva lacks.

Direct peers

• Kern Family Health Care: A community-based Medi-Cal managed care plan exclusively serving Kern County, California, operating under a similar Local Initiative/COHS-style model to CalViva. Comparable in being a single-county regional Medi-Cal MCO with a safety-net mission.
• LA Care Health Plan: LA County's Local Initiative Health Plan, structurally analogous to CalViva as a publicly sponsored Medi-Cal managed care plan with local governance and exclusive county service territory. Both operate as community-based safety-net MCOs under California's two-plan model.
• Inland Empire Health Plan (IEHP): A Local Initiative Health Plan serving Riverside and San Bernardino Counties under Medi-Cal Managed Care. Comparable to CalViva in governance model, exclusive service territory, and member population, though IEHP operates at significantly larger scale.
• Contra Costa Health Plan: A county-operated Medi-Cal managed care plan serving Contra Costa County. Comparable as a regionally restricted, public-affiliated Medi-Cal MCO with member-focused care coordination and similar population-health mission.
• Santa Clara Family Health Plan: Local Initiative Health Plan serving Santa Clara County under Medi-Cal, including a dual-eligible Cal MediConnect product. Comparable to CalViva's Local Initiative Plan structure with county-level exclusivity and community governance.

Regional players

• Kaiser Permanente Medi-Cal: An integrated payer-provider system serving Medi-Cal members across multiple California counties, including parts of the Central Valley. Comparable as a Medi-Cal managed care option in California but differentiated by its integrated provider-owned delivery model that CalViva does not have.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat4 records

Key risks7 records

Key highlights7 records

Customer concentration

• YouTubeyoutube.com/channel/UCuEsUPnxFwNQ_GHIqZXCPqw
• Facebookfacebook.com/CalVivaHealthCares
• Instagraminstagram.com/calvivahealthcares
• LinkedInlinkedin.com/company/calviva-health

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

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

M&A

Investments

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

Frequently asked questions about Calviva Health