Caloptima seeks to launch Covered California plan

ORANGE, Calif. – To better support continuity of care for current members and to provide an additional coverage option for Orange County residents, CalOptima is working, for the first time, toward offering a health plan option through Covered California, the state’s health insurance marketplace where residents can find affordable, quality coverage and potentially qualify for financial help to reduce their monthly premiums.

CalOptima’s Board of Directors formally requested that the Orange County Board of Supervisors to consider changing a county ordinance enacted in 2012, before California’s health insurance marketplace began. A hearing is currently set for August 9 to amend the ordinance to allow for development of this new plan option. Once approved, CalOptima’s Covered California plan would start in January 2024.

“Currently, CalOptima is the single largest health insurer in Orange County, providing Medi-Cal coverage for one in four residents. Yet our members often experience changes in employment or in family circumstances that make them ineligible for Medi-Cal,” said Michael Hunn, CalOptima Chief Executive Officer. “By offering a Covered California plan as a bridge from Medi-Cal, CalOptima can provide the continuity of care that is essential to member health — members can choose to stay with the CalOptima network of contracted providers even as their circumstances change.”

CalOptima’s 911,000 members currently have access to a network of more than 10,600 primary care doctors and specialists, as well as 34 community health centers and 41 acute and rehab hospitals. Established in 1995, CalOptima has been serving Orange County’s vulnerable, low-income population for decades, and its local health plan perspective ensures responsiveness to the community’s diverse needs and commitment to caring for the whole person.

There are six Covered California plans offered by private health insurers in Orange County, and CalOptima’s proposed plan would be the first from a public agency. CalOptima is a mission-driven organization that serves member health and does not have financial obligations to stockholders.
“CalOptima’s participation in Covered California will strengthen the safety net by bringing in a new revenue stream to reinvest in community health,” Hunn added. “The goal is to provide affordable and comprehensive coverage to as many Orange County residents as possible while increasing access to quality care.”