CalOptima

What CalOptima does

CalOptima Health, legally the Orange County Health Authority, is a California local public agency and the largest of the state's six county organized health systems (COHS). Created by the Orange County Board of Supervisors in 1993 and launched operationally in 1995, it administers health coverage exclusively for Orange County's low-income and vulnerable populations through three core programs: Medi-Cal (California's Medicaid managed care plan for low-income children, adults, seniors, and people with disabilities), OneCare (a Medicare Advantage Dual Eligible Special Needs Plan that coordinates Medicare and Medi-Cal benefits for seniors age 21+ and people with disabilities), and PACE (Program of All-Inclusive Care for the Elderly, serving frail adults age 55+ who qualify for nursing home level of care but wish to remain at home via a dedicated Garden Grove PACE Center).

The organization is funded through capitation payments from the California Department of Health Care Services (DHCS) and the Centers for Medicare & Medicaid Services (CMS), operating independently under a Board of Directors composed of members, providers, business leaders, and local government representatives. Its technology infrastructure comprises member-facing portals (member.caloptima.org and the new HealthHub at healthhub.caloptima.org), a contracted-provider portal (providers.caloptima.org), telehealth/virtual care capabilities, and standard interoperability for electronic data interchange in claims and eligibility. It directs approximately 95 cents of every dollar to medical care, with administrative costs among the lowest in California.

CalOptima Health serves 915,000+ members across 34 Orange County cities — covering nearly one in three county residents — through a delegated provider network of nearly 8,400 PCPs and specialists, 600+ pharmacies, 40 hospitals, and 200+ long-term care facilities. Distribution is hybrid: passive eligibility-driven enrollment via BenefitsCal.com and the County of Orange Social Services Agency, supplemented by phone-based customer service (including 24/7 lines for OneCare), provider referrals, and direct community outreach including street medicine teams operating in Garden Grove, Costa Mesa, and Anaheim. Strategic partners include Liberty Dental Plan, Vision Service Plan (VSP), and a recently announced 2026 collaboration with Wider Circle for dual-eligible member outreach.

Name

CalOptima

Legal name

Orange County Health Authority

Website

https://caloptima.org

Company type

Private

Founded year

1993

Operating status

Operating

Headcount range

1,001–5,000 employees

Short description

CalOptima Health is a county organized health system (public agency) serving 915,000+ low-income Orange County residents through Medi-Cal, OneCare (Medicare Advantage D-SNP), and PACE programs. As the largest health insurer in Orange County covering nearly one in three residents, it administers federally and state-funded managed care benefits via an 8,400-provider network.

Ownership category

akta.pro rank

Product category

Managed Care Health Insurance

NAICS

Services for the Elderly and Persons with Disabilities (624120), Services for the Elderly and Persons with Disabilities (62412), Nursing and Residential Care Facilities (623), Continuing Care Retirement Communities and Assisted Living Facilities for the Elderly (6233)

SIC

Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321)

akta.pro primary industry

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

akta.pro secondary industries

Medicaid Waiver / PACE-Partnered Adult Day Programs (HLADAIAM), Affordable / Low-Income Assisted Living (Medicaid Waiver Focused) (HLADABAE)

Keywords

• Medicaid managed care
• Medicare Advantage D-SNP
• Program of All-Inclusive Care
• County organized health system
• Government health insurance

Headquarters

HQ city

Orange

HQ country

United States

HQ region

North America

Offices3 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

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

Revenue model

1. Medi-Cal Managed Care Revenue: CalOptima Health receives capitation payments from the California Department of Health Care Services (DHCS) for managing Medi-Cal benefits for eligible members. As a county organized health system (COHS), it receives federal and state Medicaid funding to provide comprehensive health coverage.
2. Medicare Advantage (OneCare) Revenue: OneCare is a Medicare Advantage Dual Eligible Special Needs Plan (D-SNP) that combines Medicare and Medi-Cal benefits. Revenue comes from Medicare Part C capitation payments and Medi-Cal wraparound payments for dual-eligible members.
3. PACE Program Revenue: PACE (Program of All-Inclusive Care for the Elderly) receives capitation payments from both Medicare and Medicaid for comprehensive care of frail seniors meeting nursing home level of care criteria.

Pricing tiers

Go-to-market motion2 records

Distribution channels7 records

Marketing channels9 records

Core offering

CalOptima Health is a California local public agency that delivers publicly funded managed health care coverage to eligible residents of Orange County. It administers Medi-Cal (Medicaid), OneCare (a Medicare Advantage Dual-Eligible Special Needs Plan), and the Program of All-Inclusive Care for the Elderly (PACE), serving low-income children and adults, dual-eligible seniors and people with disabilities, and frail older adults through a contracted provider network.

Product overview

CalOptima Health is a county organized health system (COHS) offering three distinct health insurance programs for low-income Orange County residents. The core offering is Medi-Cal, California's Medicaid program providing comprehensive health coverage for children, adults, seniors, and people with disabilities. OneCare (also called OneCare Complete) is a Medicare Advantage Dual Eligible Special Needs Plan (HMO D-SNP) that bundles Medicare and Medi-Cal benefits for dual-eligible members into a single coordinated plan with enhanced supplemental benefits. PACE (Program of All-Inclusive Care for the Elderly) is a specialized program serving frail seniors age 55+ who need nursing home-level care but wish to remain in their homes, delivering wraparound medical and social services through a dedicated PACE Center. Together, these three programs serve approximately 915,000+ members, making CalOptima the single largest health insurer in Orange County covering nearly one in three residents.

Differentiator

Problem solved

Functional benefit

Brands

• Medi-Cal: California's Medicaid program offered by CalOptima Health for low-income families with children, seniors, people with disabilities, foster care children, pregnant women, and low-income people with specific conditions
• OneCare
• PACE
• HealthHub

Products and services

• Medi-Cal
• OneCare (HMO D-SNP)
• Program of All-Inclusive Care for the Elderly (PACE)

Quantifiable outcome

• 95 cents of every dollar goes directly to medical care
• +4 more outcomes

Named customers3 records

Segments4 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature4 records

Partnerships

Six partnerships are on record, tiered core.

• Wider CirclecoreStrategic or Co-development Partner · 4 February 2026Wider Circle partnered with CalOptima Health to improve health outcomes for dual-eligible Medicare-Medi-Cal members in Orange County. Supported by a grant from the California Health Care Foundation, the program deploys peer-driven circles with culturally relevant outreach focused on Spanish- and Vietnamese-speaking members to address barriers like food insecurity, housing instability, and language. This marks Wider Circle's eleventh California partnership.
• Liberty Dental PlancoreStrategic or Co-development PartnerCalOptima Health OneCare works with Liberty Dental Plan to provide comprehensive dental services that supplement Medi-Cal Dental coverage for dual-eligible members.
• Community-Based OrganizationscoreStrategic or Co-development PartnerCalOptima Health's Community Relations team collaborates with local community-based organizations across Orange County to support members through sponsorships, educational programs, health resources, and events. Partnerships support CalAIM programs addressing social determinants of health.
• County of Orange Social Services AgencycoreChannel Partner/ Reseller/ DistributorThe County of Orange Social Services Agency conducts Medi-Cal eligibility determinations and enrollment, serving as the primary intake channel for CalOptima Health members. SSA sends renewal notices and processes eligibility changes for existing members.
• Health Networks and Medical GroupscoreChannel Partner/ Reseller/ DistributorCalOptima Health operates a delegation model with subcontractors including doctors, specialists, pharmacies, hospitals, health networks, and medical groups. Health networks and medical groups perform functions including authorizations, billing, provider credentialing, and care coordination.
• Vision Service Plan (VSP)coreStrategic or Co-development PartnerVision Service Plan (VSP) provides vision coverage for CalOptima Health members, including routine eye exams and eyeglasses coverage through the Medi-Cal vision benefit.

Scale indicators11 records

Recent moves6 records

Expansion highlights6 records

Direct peers

• L.A. Care Health Plan: Largest publicly-operated health plan in the US and California's other county-organized health system competitor. L.A. Care administers Medi-Cal, L.A. Care Covered (commercial), and Cal MediConnect plans in Los Angeles County, operating the same COHS regulatory model as CalOptima and serving a comparable low-income, dual-eligible population.
• Inland Empire Health Plan (IEHP): A local public Medi-Cal and D-SNP managed care plan serving Riverside and San Bernardino counties. IEHP is one of the largest not-for-profit Medicaid health plans in California and a direct COHS-style competitor with similar whole-person care orientation, making it highly comparable to CalOptima.
• Health Net: One of California's largest Medi-Cal managed care plans, operating commercial, Medicare Advantage, and D-SNP lines. Health Net directly competes with CalOptima in California Medicaid markets and offers similarly bundled Medicare-Medicaid products.
• Partnership HealthPlan of California: A county-organized health system serving Medi-Cal members across 14 Northern California counties. Partnership operates the same COHS regulatory structure as CalOptima and serves comparable low-income and dual-eligible populations.
• CenCal Health: A community health plan and COHS serving Santa Barbara and San Luis Obispo counties with Medi-Cal managed care. CenCal operates the same county-organized model as CalOptima and is highly comparable in structure, scale constraints, and regulatory positioning.
• Gold Coast Health Plan: A COHS administered by the Ventura County Health Care Agency serving Medi-Cal members in Ventura County. Gold Coast offers direct structural comparability with CalOptima through the same COHS regulatory framework.
• Kern Health Systems: A COHS serving Medi-Cal members in Kern County with a network-based delegated model. Kern Health Systems is comparable to CalOptima in structure and scale, representing one of the six California COHS plans operating under identical regulatory frameworks.
• Central California Alliance for Health: A local public Medi-Cal managed care plan serving Merced, Monterey, and Santa Cruz counties. The Alliance is a county-organized entity comparable to CalOptima in regulatory structure, mission orientation, and population focus.

Broad incumbents

• Molina Healthcare: National publicly-traded managed care company focused on government-sponsored healthcare, including Medicaid managed care, Marketplace, Medicare Advantage, and D-SNP plans across multiple states. Molina is one of the largest pure-play Medicaid managed care operators and competes with CalOptima in Medi-Cal contracts.
• Anthem Blue Cross Medi-Cal: A major commercial and government health plan operating Medi-Cal, Medicare Advantage, and dual-eligible products across California counties. Anthem competes with CalOptima for Medi-Cal contracts and represents a large, diversified incumbent in the same market.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• Xx.com/caloptima
• YouTubeyoutube.com/user/CalOptimaTV
• Facebookfacebook.com/caloptima
• LinkedInlinkedin.com/company/caloptima
• Instagraminstagram.com/caloptima

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

Investments19 records

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

Frequently asked questions about CalOptima