PHC

What PHC does

Partnership HealthPlan of California (PHC) is a non-profit, community-based managed care organization headquartered in Fairfield, California, that contracts with the California Department of Health Care Services (DHCS) to administer Medi-Cal (California's Medicaid program) benefits on a capitated, per-member-per-month basis. Founded in 1994 in Solano County, PHC has expanded to serve over 900,000 Medi-Cal recipients across 24 Northern California counties through a contracted network of primary care physicians, specialists, hospitals, behavioral health providers, and ancillary service partners. Covered benefits span preventive care, inpatient and outpatient medical services, mental health and substance use disorder treatment (delivered in partnership with Carelon Behavioral Health), prescription drugs (administered via the state-run Medi-Cal Rx program), dental (via Denti-Cal), and vision (via VSP), plus non-emergency transportation and care coordination services.

PHC's core operating model rests on capitated state revenue, county-by-county exclusive service-area rights, and a dual NCQA-accredited quality program (Health Plan Accreditation and Health Equity Accreditation). Its technology stack includes a member-facing portal, provider-facing online services (eEligibility, eRAF, eTAR), a daily-updated provider directory, the Partnership MDL Navigator formulary tool, and FHIR-based Patient Access and Provider Directory APIs hosted on Edifecs' platform and registered with CAQH. In February 2025 PHC migrated to HealthRules Payer as its new claims adjudication system, and the organization is actively scaling California's CalAIM Enhanced Care Management (ECM) and Community Supports programs — including a March 2026 partnership with YoloCares — to address social determinants of health. PHC's customer base is structurally a single payer (the State of California), with 900,000+ individual Medi-Cal members distributed across its 24-county service area and no disclosed parent company, equity sponsor, or non-Medi-Cal revenue line.

Name

PHC

Legal name

Partnership HealthPlan of California

Website

https://partnershiphp.org

Company type

Private

Founded year

1994

Operating status

Operating

Headcount range

501–1,000 employees

Short description

Partnership HealthPlan of California is a non-profit Medi-Cal managed care plan serving over 900,000 low-income members across 24 Northern California counties under a capitated contract with the State of California.

Ownership category

akta.pro rank

Product category

Medicaid Managed Care

NAICS

Health Care and Social Assistance (62)

SIC

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

akta.pro primary industry

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

akta.pro secondary industry

Healthcare-Linked Social Benefits Administration (e.g., Medicaid/Means-Tested Health Coverage) (BPAIAKAH)

Keywords

• Medi-Cal managed care
• Medicaid health plan
• Healthcare administration
• Community health services
• Care coordination

Headquarters

HQ city

Fairfield

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Capitated Medi-Cal Contracts: Partnership HealthPlan of California is a non-profit community-based health care organization that contracts with the State of California to administer Medi-Cal benefits on a capitated basis. The organization receives per-member-per-month (PMPM) capitated payments from the state to cover comprehensive health care services for Medi-Cal recipients in 24 Northern California counties. Services covered include preventive care, inpatient hospital care, outpatient services, mental health care, prescription drugs (via Medi-Cal Rx), dental services (via Denti-Cal), vision care (via VSP), transportation, and more.

Pricing tiers

Go-to-market motion1 record

Distribution channels8 records

Marketing channels7 records

Core offering

Partnership HealthPlan of California is a non-profit community-based health care organization that contracts with the State of California to administer Medi-Cal benefits through a network of local care providers across 24 Northern California counties. It serves over 900,000 Medi-Cal recipients with comprehensive services including preventive care, inpatient and outpatient care, mental health and substance use disorder treatment, prescription drugs (via Medi-Cal Rx), dental (via Denti-Cal), vision (via VSP), and transportation. Digital infrastructure includes FHIR-based Patient Access and Provider Directory APIs, a Member Portal, Provider Online Services, a Provider Directory, and the HealthRules Payer claims system.

Product overview

Partnership HealthPlan of California is a non-profit community-based health care organization that administers Medi-Cal benefits through local care providers across 24 Northern California counties. The core offering consists of Medi-Cal managed care administration supported by member-facing (Member Portal) and provider-facing (Provider Online Services, Provider Directory, Provider Manual) platforms. Value-added programs include the Wellness and Recovery substance use disorder program, CalAIM initiative programs (Enhanced Care Management, Community Supports), and Quality Improvement Programs (QIP). The organization offers FHIR-based interoperability APIs (Patient Access API, Provider Directory API) for third-party integration. Specialty benefit partners include Carelon Behavioral Health for mental health, Medi-Cal Rx for pharmacy, VSP for vision, and Denti-Cal for dental services.

Differentiator

Problem solved

Functional benefit

Products and services

• Medi-Cal Managed Care Plan Administration Core managed care service in which Partnership contracts with the State of California Department of Health Care Services (DHCS) to administer Medi-Cal benefits on a capitated per-member-per-month (PMPM) basis across 24 Northern California counties. Covered services include preventive care, inpatient hospital care, outpatient services, mental health care, substance use disorder treatment, prescription drugs (via Medi-Cal Rx), dental services (via Denti-Cal), vision care (via VSP), and transportation for eligible low-income Medi-Cal members.
• Member Portal Secure self-service web portal enabling Medi-Cal members to view lab results, order and print ID cards, change their primary care provider (PCP), and access clinical, non-clinical, and benefits information.
• Provider Online Services Secure provider portal for network providers delivering Medi-Cal services, supporting eligibility verification, referral authorizations, and treatment authorization requests.
• Provider Directory Publicly searchable directory of contracted network providers including primary care physicians, specialists, facilities, hospitals, labs, and durable medical equipment suppliers serving Medi-Cal members across Partnership's 24 counties.
• Patient Access API FHIR-based interoperability API permitting third-party applications to retrieve a member's health information, including claims, encounter, and clinical data, with member approval and at their direction. Secured and requires app developers to apply for and create an account. Endpoints are hosted via Edifecs FHIR cloud and registered with CAQH's national endpoint directory.
• Provider Directory API Publicly accessible FHIR-based API providing provider directory information without requiring secure credentials, enabling third-party application developers to integrate Partnership's provider network data. Endpoints are hosted via Edifecs FHIR cloud and registered with CAQH's national endpoint directory.
• CalAIM Initiative Programs (Enhanced Care Management and Community Supports) California Advancing and Innovating Medi-Cal (CalAIM) programs implemented by Partnership that include Enhanced Care Management (ECM) and Community Supports, addressing social determinants of health through whole-person care approaches for eligible Medi-Cal members across the 24-county service area.
• Wellness and Recovery Program (Drug Medi-Cal Organized Delivery System) Drug Medi-Cal Organized Delivery System (DMC-ODS) program providing substance use disorder treatment services to Medi-Cal members in Humboldt, Lassen, Mendocino, Modoc, Shasta, Siskiyou, and Solano counties through Partnership's Wellness and Recovery Program.
• Quality Improvement Programs (QIP) Quality Incentive Payment Programs offered to network providers, including PCP QIP, Hospital QIP, Palliative Care QIP, Perinatal QIP, and Extended Care Center QIP, providing performance-based incentives tied to quality and equity measures.
• Partnership MDL Navigator Online formulary navigation tool enabling network providers to search covered drugs and pharmacy benefit information, including prior authorization requirements, for Medi-Cal members served by Partnership.
• HealthRules Payer Claims Processing System Modern claims adjudication system replacing legacy infrastructure, requiring taxonomy codes for all billing providers as of February 1, 2025.

Quantifiable outcome

• Serving over 900,000 Medi-Cal recipients across 24 Northern California counties since 1994
• +1 more outcomes

Named customers1 record

Segments1 record

Ideal customer profiles1 record

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration5 records

Feature5 records

Partnerships

15 partnerships are on record, tiered core and minor.

• YoloCarescoreStrategic or Co-development Partner · 11 March 2026YoloCares, a Davis-based nonprofit hospice and palliative care provider, partnered with Partnership HealthPlan of California through California's CalAIM initiative. The partnership enables Partnership to offer community support services at Joshua's House (a facility for unhoused patients recovering from hospitalization) and Galileo Place (short-term respite care for low-income residents needing assistance with daily activities).
• Molina HealthcareminorStrategic or Co-development PartnerMolina Healthcare partnered with YoloCares under California's CalAIM initiative, with Partnership HealthPlan of California also participating in the initiative. This collaboration supports community support services for Medi-Cal recipients.
• Carelon Behavioral HealthcoreStrategic or Co-development PartnerPartnership HealthPlan of California partnered with Carelon Behavioral Health (formerly Beacon Health Options) to manage mental health benefits for most Partnership Medi-Cal members with mild to moderate mental health conditions in need of outpatient mental health services. Carelon provides provider directories, provider tools, credentialing, and claims support for behavioral health services.
• Vision Service Plan (VSP)coreChannel Partner/ Reseller/ DistributorPartnership contracts with Vision Service Plan (VSP) to provide routine vision services for Partnership Medi-Cal members. VSP provides the provider network and covers routine eye exams, lenses, and frames every 24 months.
• Denti-Cal (Medi-Cal Dental Program)coreChannel Partner/ Reseller/ DistributorDental services are covered through the state's Medi-Cal Dental Program (Denti-Cal). Partnership coordinates member access to Denti-Cal dental providers through the Denti-Cal Provider Directory and the Medi-Cal Dental Telephone Service Center.
• Medi-Cal Rx (DHCS)coreChannel Partner/ Reseller/ DistributorStarting January 1, 2022, pharmacy benefits are provided by the Department of Health Care Services through Medi-Cal Rx rather than by Partnership directly. Partnership coordinates member access to pharmacy services through Medi-Cal Rx.
• CalHOPEminorStrategic or Co-development PartnerPartnership references CalHOPE as a mental health resource for members. CalHOPE is a California program providing mental health support for youth, young adults, and families via online apps.
• First 5 CaliforniacoreStrategic or Co-development PartnerPartnership, in collaboration with First 5, works to strengthen care coordination and connect members to vital early childhood services — from developmental screenings to health services and family resources. A First 5 Liaison works with county First 5 commissions to improve health outcomes for families with young children aged 0-5 years across Partnership's 24-county service area.
• BrightLife KidsminorStrategic or Co-development PartnerPartnership promotes the BrightLife Kids app, a CalHOPE program that brings no-cost behavioral health support to families. Families can receive expert coaching for sleep issues, worry, social skills, and more, as well as live one-on-one video sessions with behavioral health experts.
• California Primary Care Association (CPCA)minorStrategic or Co-development PartnerPartnership co-sponsored an Eating Disorders Webinar Series with the California Primary Care Association. Webinars were offered by experts from the National Center of Excellence for Eating Disorders (NCEED).
• National Center of Excellence for Eating Disorders (NCEED)minorStrategic or Co-development PartnerNCEED, founded in 2018 by the Substance Abuse and Mental Health Services Administration (SAMHSA), provided expert content for Partnership's Eating Disorders Webinar Series.
• Safe SpacesminorOthersPartnership promotes Safe Spaces, free online professional learning modules designed to help early care and education personnel respond to trauma and stress in children, as a resource for providers serving members.
• ACEs AwareminorOthersPartnership promotes ACEs Aware training and policy resources for multi-sector providers to prevent, screen for, treat, and heal trauma-induced toxic stress, as referenced on the First 5: Child Health Services page.
• California Youth Connection (CYC)minorStrategic or Co-development PartnerPartnership's Child Welfare Programs page references California Youth Connection as a resource for foster youth. CYC empowers youth in foster care to take leadership roles in advocating for changes in foster care policy and practice.
• iFosterminorStrategic or Co-development PartnerPartnership's Child Welfare Programs page references iFoster as a resource providing hundreds of free and deeply discounted products and services to meet the needs of foster youth, resource families, and kinship families.

Scale indicators4 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• L.A. Care Health Plan: L.A. Care is the largest public Medi-Cal managed care plan in California, serving ~2.5 million members in Los Angeles County. It is a nonprofit, state-contracted Medi-Cal plan with the same capitated revenue model and whole-person care focus as Partnership.
• Inland Empire Health Plan (IEHP): IEHP is a nonprofit, community-based Medi-Cal and Medicare-Medicaid Plan serving Riverside and San Bernardino counties. Operates the same state-contracted capitated model with whole-person care programs, making it one of the closest comparables to Partnership.
• CalOptima: CalOptima is a county-organized health system administering Medi-Cal (and OneCare/Medicare) in Orange County. Direct competitor in the California Medi-Cal managed care market under the same state-contracted framework.
• Health Net (Centene): Health Net is one of California's largest Medi-Cal managed care plans, operating across multiple counties as a for-profit subsidiary of Centene. Same state-contracted capitated Medi-Cal model; competing for some of the same counties as Partnership.
• Molina Healthcare: Molina Healthcare is a major Medicaid managed care company with significant California Medi-Cal membership. For-profit, publicly traded plan operating on the same state capitated contract model.
• Kaiser Permanente (Medi-Cal): Kaiser Permanente operates a vertically integrated Medi-Cal managed care plan in California, with capitated state contracts overlapping Partnership's service area in Northern California counties.
• Santa Clara Family Health Plan: Santa Clara Family Health Plan is a local, community-based Medi-Cal managed care plan serving Santa Clara County. Highly comparable nonprofit, locally governed model.
• San Francisco Health Plan: San Francisco Health Plan is a nonprofit community Medi-Cal managed care plan serving San Francisco County. Operates the same capitated state-contract model with comparable scale.
• Kern Health Systems: Kern Health Systems is a county-operated, nonprofit Medi-Cal managed care plan serving Kern County. Same state-contracted model and community-based nonprofit positioning.
• Anthem Blue Cross California (Medicaid): Anthem Blue Cross operates a Medi-Cal managed care plan in multiple California counties, including some overlapping Partnership's Northern California footprint. Large for-profit peer using the same capitated state contract structure.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• YouTubeyoutube.com/@partnershiphealthplanofcal5797
• Xx.com/partnershiphp

Compliance3 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

Investments

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

Frequently asked questions about PHC