Santa Clara Family Health Plan

What Santa Clara Family Health Plan does

Santa Clara Family Health Plan (SCFHP) is a public agency and county-organized health plan founded in 1997, headquartered in San Jose, California. It administers a Medi-Cal managed care plan for residents of Santa Clara County under contract with the California Department of Health Care Services (DHCS), and operates the DualConnect HMO D-SNP for individuals eligible for both Medicare and Medi-Cal. The organization's two core products — Medi-Cal and DualConnect — together cover government-program-eligible members across families, individuals with disabilities, and dual-eligibles, with benefits spanning medical, pharmacy (Medicare Part D), behavioral health, transportation, and care-coordination services. Supplementary offerings include Enhanced Care Management, Community Supports, doula services, the Healthy Moms Healthy Babies program, Wellness Rewards, and a 24/7 Nurse Advice Line integrated with MDLIVE telehealth.

SCFHP's platform architecture is built around conventional, non-AI operational infrastructure: a mySCFHP Member Portal and a separate Provider Portal for claims, prior authorizations, and referrals, complemented by mobile applications, a public-facing website with a health library, and two physical Community Resource Centers (Blanca Alvarado and South County). Distribution is community-led, leveraging partnerships with more than ten community-based organizations — including the YMCA of Silicon Valley (Diabetes Prevention Program), Breathe California (in-home asthma assessments), Indian Health Center, multiple hospitals, Kick It California, and the City of San Jose — to drive enrollment, retention, and health-education delivery.

Revenue is generated almost entirely through capitation payments from DHCS for Medi-Cal members and from CMS for DualConnect members; no member-facing premiums are disclosed and health-education programs are provided at no cost to eligible members. As a public agency, SCFHP is not venture-backed or PE-owned, and reports no parent company or subsidiaries. The organization operates within the geographic restriction of Santa Clara County and is actively repositioning for the 2026–2028 Medi-Cal policy changes, having earned a 4-out-of-5 NCQA Medicaid Health Plan Rating for 2025.

Name

Santa Clara Family Health Plan

Legal name

Santa Clara Family Health Plan

Website

https://scfhp.com

Company type

Private

Founded year

1997

Operating status

Operating

Headcount range

251–500 employees

Short description

Santa Clara Family Health Plan is a public agency administering Medi-Cal managed care and DualConnect (HMO D-SNP) plans for government-program-eligible residents of Santa Clara County, California. Revenue is generated via capitation contracts with DHCS and CMS.

Ownership category

akta.pro rank

Product category

Managed Health Care Plans

NAICS

Health and Welfare Funds (525120), Services for the Elderly and Persons with Disabilities (62412)

SIC

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

akta.pro primary industry

SNP Model of Care (MOC) & Care Management Programs (HLAEAGAE)

akta.pro secondary industries

SNP Supplemental Benefits & SSBCI Design (HLAEAGAK), MA Chronic Condition Management & Supplemental Benefits (SSBCI) (HLAEACAI)

Keywords

• Medi-Cal managed care
• Medicare-Medicaid dual coverage
• Health plan administration
• Community health programs
• County-organized health plan

Headquarters

HQ city

San Jose

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2C

Offering type

Services

Cost components

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

Revenue model

1. Medi-Cal Managed Care Administration: SCFHP administers a Medi-Cal managed care plan for residents of Santa Clara County under contract with the California Department of Health Care Services (DHCS). Revenue is generated through capitation payments from the state government for providing healthcare coverage to Medi-Cal beneficiaries.

Pricing tiers

Go-to-market motion1 record

Distribution channels4 records

Marketing channels4 records

Core offering

Santa Clara Family Health Plan (SCFHP) is a public agency that administers Medi-Cal managed care and DualConnect (HMO D-SNP) health plans for residents of Santa Clara County under contract with the California Department of Health Care Services. The plan combines core health insurance coverage with supplementary services including case management, community resource centers, health education programs, a member portal, a provider portal, and a 24/7 nurse advice line.

Product overview

Santa Clara Family Health Plan (SCFHP) is a public agency administering Medi-Cal managed care plans for Santa Clara County residents. The organization offers two core health insurance products: DualConnect (HMO D-SNP combining Medicare and Medi-Cal for dual-eligible members) and Medi-Cal (California Medicaid managed care). Beyond insurance coverage, SCFHP provides supplementary services including the mySCFHP Member Portal for member self-service, a Provider Portal for healthcare provider management, a Health Library with educational content, and a Diabetes Prevention Program in partnership with YMCA. Additional offerings include Health Education Programs (chronic disease management, prenatal education, smoking cessation), Community Resource Centers, and a 24/7 Nurse Advice Line. SCFHP integrates with MDLIVE for telehealth services for VHP network members.

Differentiator

Problem solved

Functional benefit

Brands

• DualConnect: SCFHP DualConnect is an HMO D-SNP plan combining Medicare and Medi-Cal coverage for dual-eligible members.
• Community Resource Centers

Products and services

• Medi-Cal Plan
• DualConnect (HMO D-SNP)
• Community Resource Centers
• Diabetes Prevention Program
• Health Education Programs
• Nurse Advice Line
• Health Library

Quantifiable outcome

• NCQA Medicaid Health Plan Rating of 4 out of 5, ranking among top health plans in California for 2025

Named customers2 records

Segments3 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration1 record

Partnerships

Twelve partnerships are on record, tiered core and minor.

• Community-Based Organizations (Santa Clara County)coreStrategic or Co-development PartnerSCFHP partners with community organizations in Santa Clara County to support residents in enrolling and retaining Medi-Cal coverage. This includes expanded hours and targeted outreach to help eligible residents navigate enrollment processes and maintain coverage, with efforts focused on specific populations affected by upcoming 2026 regulations.
• YMCA of Silicon ValleycoreStrategic or Co-development PartnerYMCA of Silicon Valley partners with SCFHP to offer the Diabetes Prevention Program (a CDC-approved one-year lifestyle change program) and fitness memberships for SCFHP Medi-Cal and DualConnect members at no cost.
• Breathe CaliforniacoreImplementation/ SI/ Consulting PartnerBreathe California provides in-home asthma assessments to identify triggers and suggest air quality improvements for SCFHP members, available in English and Spanish formats.
• Indian Health CenterminorImplementation/ SI/ Consulting PartnerIndian Health Center offers Group Diabetes Refresher sessions for SCFHP members assigned to their organization, providing focused diabetes management education.
• ACT for Mental HealthminorImplementation/ SI/ Consulting PartnerACT for Mental Health provides online anger management, stress management, and parenting/co-parenting group classes for SCFHP members.
• Healthier Kids FoundationminorImplementation/ SI/ Consulting PartnerHealthier Kids Foundation runs the '10 Steps to a Healthier You' family nutrition education program focused on preventing childhood obesity for adults with children ages 0-12.
• Good Samaritan HospitalminorImplementation/ SI/ Consulting PartnerGood Samaritan provides childbirth preparation, breastfeeding, and infant CPR/first aid classes for SCFHP members.
• El Camino HospitalminorImplementation/ SI/ Consulting PartnerEl Camino Hospital offers maternal-child education classes including childbirth preparation, breastfeeding, and infant care education for SCFHP members.
• Santa Clara Valley Medical CenterminorImplementation/ SI/ Consulting PartnerSanta Clara Valley Medical Center provides maternal and infant health education classes including childbirth preparation, infant care, and CPR/first aid training for SCFHP members.
• The Crane CenterminorImplementation/ SI/ Consulting PartnerThe Crane Center offers no cost or low-cost, anonymous and confidential HIV and STD testing services for SCFHP members in multiple languages.
• Kick It CaliforniaminorImplementation/ SI/ Consulting PartnerKick It California (formerly 1-800-No Butts) provides smoking cessation counseling through personalized coaching and self-help tools via telephone or chat for SCFHP members.
• City of San Jose Aquatics ProgramminorImplementation/ SI/ Consulting PartnerCity of San Jose Aquatics Program provides summer swimming lessons for children ages 3.5 to 12, offered at various pools within San Jose for SCFHP members.

Scale indicators3 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• Kern Health Systems: County-organized Medi-Cal managed care plan serving Kern County, California. Closely mirrors SCFHP's public-agency structure, exclusive DHCS contract, and community-based GTM in a single county.
• Inland Empire Health Plan (IEHP): One of the largest not-for-profit Medi-Cal and D-SNP plans in California, serving Riverside and San Bernardino counties. Directly comparable in product mix (Medi-Cal + D-SNP) and non-profit governance to SCFHP.
• Central California Alliance for Health: Regional Medi-Cal managed care plan serving Santa Cruz, Monterey, and Merced counties. Non-profit governance and Medi-Cal focus make it a strong operational and structural peer to SCFHP.
• Health Plan of San Joaquin: County-organized Medi-Cal managed care plan serving San Joaquin and Stanislaus counties in California. Closely comparable to SCFHP in structure, public-agency governance, and exclusive DHCS contract for Medi-Cal administration.
• CalOptima: County-organized Medi-Cal managed care plan serving Orange County, California. Like SCFHP, CalOptima is a public agency administering Medi-Cal (and also operates OneCare, a D-SNP) under an exclusive DHCS contract for a single county.
• Alameda Alliance for Health: Public agency Medi-Cal managed care plan serving Alameda County, California. Highly comparable to SCFHP in mission, governance, and product scope (Medi-Cal managed care).
• Contra Costa Health Plan: County-operated Medi-Cal managed care plan serving Contra Costa County. Comparable to SCFHP as a local public agency administering Medi-Cal under DHCS contract.

Broad incumbents

• Health Net (Centene): Large multi-state health plan with significant Medi-Cal presence in California. As a for-profit, publicly-traded incumbent with broad product portfolio, Health Net competes with SCFHP for Medi-Cal members in adjacent California counties.
• L.A. Care Health Plan: Largest publicly operated Medi-Cal health plan in the US, serving Los Angeles County. Same public-agency model as SCFHP, but at significantly greater scale; useful for benchmarking but operates in a different geography.
• Kaiser Permanente: Integrated managed care organization with a substantial Medi-Cal footprint in California. Competes with SCFHP for Medi-Cal enrollment in Santa Clara County and operates its own D-SNP, making it a relevant incumbent peer.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat5 records

Key risks6 records

Key highlights6 records

Customer concentration

• Xx.com/scfhp
• YouTubeyoutube.com/channel/scfhp
• Facebookfacebook.com/scfhp
• LinkedInlinkedin.com/company/santa-clara-family-health-plan
• Instagraminstagram.com/scfhp

Compliance1 record

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 Santa Clara Family Health Plan