Health Plan of San Mateo
Health Plan of San Mateo is a county-organized, government-sponsored managed care plan serving 120,000+ Medi-Cal, Medicare dual-eligible, and HMO members across San Mateo County, California, through capitated contracts with state and federal payers.
- Company typePrivate
- Founded1987
- HeadquartersSouth San Francisco, United States
- Headcount101–250
- GTM typeB2C
- OfferingServices
What Health Plan of San Mateo does
Health Plan of San Mateo (HPSM) is a county-organized, government-sponsored managed care health plan headquartered in South San Francisco, California, serving more than 120,000 members across San Mateo County. It operates four core programs — Medi-Cal (California Medicaid), CareAdvantage (a Medicare Advantage Special Needs Plan for dual-eligible members), HealthWorx (an HMO option), and the ACE Program (care coordination for complex needs) — with members paying $0 cost-sharing under capitated arrangements with state and federal payers.
HPSM's product portfolio extends beyond core health coverage to include integrated HPSM Dental (100% covered benefits with 24/7 virtual dental care), the Baby + Me incentive program with Target, Doula Services, and HomeAdvantage for home-based care. The plan has also implemented California CalAIM-era programs — Enhanced Care Management (ECM) with dedicated care managers and Community Supports addressing social determinants of health (housing, food assistance). A Remote Patient Monitoring program extends into provider-facing digital health infrastructure. Member and provider engagement is conducted through web-based portals (built atop HealthTrio Connect for member authentication), with multi-language support (Spanish, Chinese, Tagalog) and accessibility tooling (WCAG 2.1, Section 508 conformance).
Revenue is generated through per-member-per-month capitation payments from California Medi-Cal and CMS Medicare, supplemented by incentive structures (e.g., Primary Care Provider Grants, nursing facility incentives) designed to expand provider network capacity. HPSM holds NCQA Health Plan Accreditation with a 4-star rating and complies with HIPAA and CMIA. As a county-organized entity, it operates without external venture or PE ownership, with leadership under CEO Patrick Curran. Its primary strategic positioning is as the only local health plan exclusively focused on San Mateo County, leveraging regulatory contracts, local provider networks, and community partnerships as its core moat.
Health Plan of San Mateo firmographics
Firmographics- Name
- Health Plan of San Mateo
- Legal name
- Health Plan of San Mateo
- Website
- https://hpsm.org
- Company type
- Private
- Founded year
- 1987
- Operating status
- Operating
- Headcount range
- 101–250 employees
- Short description
- Health Plan of San Mateo is a county-organized, government-sponsored managed care plan serving 120,000+ Medi-Cal, Medicare dual-eligible, and HMO members across San Mateo County, California, through capitated contracts with state and federal payers.
- Ownership category
- akta.pro rank
Health Plan of San Mateo industry classification
Industry- Product category
- Government-Sponsored Managed Care Health Plan
- SIC
- Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321)
- akta.pro primary industry
- Medicaid Managed Care HMOs (HLAEAMAI)
- akta.pro secondary industries
- Medicaid Expansion (ACA Adult) Managed Care Plans (HLAEAEAB), MA Chronic Condition Management & Supplemental Benefits (SSBCI) (HLAEACAI), D-SNP Behavioral Health Integration (HLAEAFAE)
Keywords
Where Health Plan of San Mateo is headquartered
LocationHeadquarters
- HQ city
- South San Francisco
- HQ country
- United States
- HQ region
- North America
Offices1 record
Markets served
Health Plan of San Mateo business model
Business model- GTM type
- B2C
- Offering type
- Services
- Cost components
- Personnel, Operations, Technology or R&D, Marketing or Sales, Others
Revenue model
- Government-Sponsored Health Plan Premiums: HPSM operates as a managed care health plan receiving capitated premium payments from government programs including Medi-Cal (California Medicaid) and Medicare. Revenue is generated through per-member-per-month capitation payments from state and federal programs, with the plan assuming responsibility for providing covered benefits to enrolled members.
Pricing tiers
| Model | Billing | Price |
|---|---|---|
| Subscription | Pay-as-you-go | Zero cost-sharing for all covered services |
Go-to-market motion2 records
Distribution channels4 records
Marketing channels5 records
Health Plan of San Mateo product offering
Product offeringCore offering
Health Plan of San Mateo operates as a county-organized managed care health plan that administers government-sponsored health coverage programs — Medi-Cal, CareAdvantage (Medicare-Medicaid dual-eligible SNP), HealthWorx (HMO), and the ACE Program — for eligible San Mateo County residents. The plan delivers covered medical, dental, mental health, prescription, and transportation benefits through a contracted local provider network serving 120,000+ Medi-Cal members. Integrated care coordination (Enhanced Care Management, Community Supports) and member incentive programs (Baby + Me, doula services, HomeAdvantage) round out the offering.
Product overview
Health Plan of San Mateo operates as a portfolio of health coverage programs and integrated services. The core offerings include Medi-Cal (California Medicaid), CareAdvantage (Medicare Advantage SNP for dual-eligible members), HealthWorx (HMO plan), and the ACE Program (care coordination). These are supplemented by HPSM's integrated dental plan providing 100% covered dental benefits. Digital access is provided through Member and Provider Portals, with care management enhanced through CalAIM programs including Enhanced Care Management and Community Supports. Additional member benefits include ride transportation services, the Baby + Me incentive program, doula services, and HomeAdvantage for home-based care. The portfolio also includes Remote Patient Monitoring technology for providers. The company is NCQA Accredited and serves over 120,000 Medi-Cal members in San Mateo County.
Differentiator
Problem solved
Functional benefit
Brands
- CareAdvantage: Medicare Advantage plan for members who have both Medicare and Medi-Cal
- HealthWorx
- ACE Program
Products and services
- Medi-Cal California Medicaid health coverage program providing comprehensive medical benefits to eligible low-income individuals and families in San Mateo County.
- CareAdvantage Medicare Advantage Special Needs Plan for individuals who have both Medicare and Medi-Cal (dual-eligible), offering combined health coverage with additional benefits such as a medical alert device.
- HealthWorx HMO health plan option for San Mateo County residents, providing managed care coverage through a network of providers.
- ACE Program Program for San Mateo County ACE (Assisted Care for the Elderly) participants providing coordinated care management for members with complex health needs.
- HPSM Dental Integrated dental plan offering 100% covered dental benefits for Medi-Cal and CareAdvantage members, including 24/7 virtual dental care.
- Ride Benefit Non-emergency medical transportation service providing rides to healthcare appointments for eligible members.
- Enhanced Care Management (ECM) CalAIM initiative providing comprehensive care management for members with complex needs, assigning dedicated care managers.
- Community Supports CalAIM initiative offering social determinants of health services such as housing support, food assistance, and other community-based resources.
- Baby + Me Program Program supporting pregnant members and new parents, offering up to $100 in Target GiftCards for completing prenatal visits (in partnership with Target).
- Doula Services Emotional and physical support services provided to pregnant members before, during, and after pregnancy.
- HomeAdvantage Program helping members receive care in their homes, supporting independent living and reducing institutional care.
- Remote Patient Monitoring Technology program allowing providers to monitor patients' health data remotely for better chronic disease management.
Quantifiable outcome
- NCQA Accredited health plan demonstrating quality standards
Companies that use Health Plan of San Mateo
Customer profileNamed customers4 records
Segments4 records
Ideal customer profiles2 records
Health Plan of San Mateo technology and API
TechnologyTechnology focussed No
API detail
- Has API
- No
- API docs
- API detail
Core technology
AI maturity
App detail
Integration10 records
Feature4 records
Health Plan of San Mateo partnerships and signals
Strategic signalPartnerships
One partnership is on record.
- TargetminorTarget participates in HPSM's Baby + Me Program, providing Target GiftCards as incentives for pregnant members who complete prenatal visits with their pregnancy care provider. Members can earn up to $100 in Target GiftCards for attending two visits.
Scale indicators2 records
Recent moves6 records
Expansion highlights5 records
Health Plan of San Mateo competitors and assessment
Company assessmentDirect peers
- Partnership HealthPlan of California: County-organized Medi-Cal managed care plan serving 14 Northern California counties. Similar public-purpose model and Medi-Cal HMO focus, though broader geographic footprint than HPSM.
- Alameda Alliance for Health: Local, community-based health plan serving Alameda County Medi-Cal members. Highly comparable to HPSM in size, Bay Area context, county-affiliated model, and Medi-Cal managed care focus.
- CalOptima: County-organized health plan in Orange County providing Medi-Cal, OneCare (D-SNP/MA), and PACE. Closely parallels HPSM's product portfolio including dual-eligible focus.
- Contra Costa Health Plan: County-operated health plan in Contra Costa County providing Medi-Cal managed care. Directly comparable to HPSM as a Bay Area county-organized plan with similar product offerings.
- Inland Empire Health Plan (IEHP): County-organized Medi-Cal and D-SNP plan serving Riverside and San Bernardino Counties. Comparable to HPSM in operating model, dual-eligible focus (IEHP DualChoice), and community-based mission.
- LA Care Health Plan: California's largest county-organized Medi-Cal managed care plan (Los Angeles County), sharing HPSM's public mission, county-organized governance structure, and Medi-Cal HMO model. Most directly comparable peer by structure and product mix.
- CenCal Health: County-organized Medi-Cal managed care plan serving Santa Barbara and San Luis Obispo Counties. Closely matches HPSM's structure, scale, and product mix as a community-based Medi-Cal plan.
- Central California Alliance for Health: County-organized Medi-Cal managed care plan serving Merced, Monterey, and Santa Cruz Counties. Comparable to HPSM in governance, mission, and Medi-Cal focus.
Broad incumbents
- Health Net (Centene): Major California Medi-Cal managed care plan owned by Centene, with significant statewide Medi-Cal and Medicare presence. Competes with HPSM in California Medicaid managed care but as part of a national portfolio.
- Kaiser Permanente: Large integrated payer-provider with significant Medi-Cal and Medicare Advantage presence in San Mateo County, including D-SNP. Overlaps with HPSM's product portfolio but competes as a much larger vertically integrated system.
Market position
Strengths5 records
Weaknesses5 records
Competitive moat4 records
Key risks5 records
Key highlights7 records
Customer concentration
Health Plan of San Mateo social profiles
Digital presenceHealth Plan of San Mateo compliance and trust
Trust signalCompliance5 records
Health Plan of San Mateo financial estimates
Financial estimateRevenue estimate
Valuation estimate
Health Plan of San Mateo leadership team
Management profileNumber of profiles
Profiles8 records
Health Plan of San Mateo funding detail
Funding detailFunding overview
Funding rounds
Investors
Funding detail is available on the Subscription and Enterprise plan.Contact sales →
Health Plan of San Mateo M&A and investment
M&A and investmentM&A
Investments
M&A and investment is available on the Subscription and Enterprise plan.Contact sales →
Frequently asked questions about Health Plan of San Mateo
What does Health Plan of San Mateo do?
Health Plan of San Mateo operates as a county-organized managed care health plan that administers government-sponsored health coverage programs — Medi-Cal, CareAdvantage (Medicare-Medicaid dual-eligible SNP), HealthWorx (HMO), and the ACE Program — for eligible San Mateo County residents. The plan delivers covered medical, dental, mental health, prescription, and transportation benefits through a contracted local provider network serving 120,000+ Medi-Cal members. Integrated care coordination (Enhanced Care Management, Community Supports) and member incentive programs (Baby + Me, doula services, HomeAdvantage) round out the offering.
Is Health Plan of San Mateo a public or private company?
Health Plan of San Mateo is a private company. It is classified as state government owned and is currently operating.
When was Health Plan of San Mateo founded?
Health Plan of San Mateo was founded in 1987. It employs 101 to 250 people.
Where is Health Plan of San Mateo based?
Health Plan of San Mateo is headquartered in South San Francisco, United States, in the North America region.
How does Health Plan of San Mateo make money?
One revenue line is on record: government-Sponsored Health Plan Premiums.
Who are Health Plan of San Mateo's main competitors?
Direct peers on record are Partnership HealthPlan of California, Alameda Alliance for Health, CalOptima, Contra Costa Health Plan, Inland Empire Health Plan (IEHP), LA Care Health Plan, CenCal Health and Central California Alliance for Health. Broad incumbents are Health Net (Centene) and Kaiser Permanente.
Does Health Plan of San Mateo have an API?
No public API is recorded for Health Plan of San Mateo.
What industry is Health Plan of San Mateo in?
Health Plan of San Mateo's product category is Government-Sponsored Managed Care Health Plan. Its primary akta.pro industry code is HLAEAMAI, Medicaid Managed Care HMOs, with a secondary code of HLAEAEAB, Medicaid Expansion (ACA Adult) Managed Care Plans. Its SIC code is 6324.