Last month, CalOptima Health hosted its first annual OneCare Wellness & Resource Fair at Delhi Center, bringing together nearly 400 participants for a day focused on health, connection and community support. Seniors enjoyed breakfast and lunch, participated in engaging presentations, and benefited from on-site vaccinations and dental, medical and vision screenings. Eight internal departments provided resources and support, while 13 community-based organizations (CBOs) shared information and connected members with additional services, which included:

• Mercy Health provided 29 flu, 19 COVID-19 and five shingles vaccines
• Central City Community Health Center Dental Mobile Unit conducted 23 dental screenings and provided dental education to 72 attendees
• Serve the People Community Health's Vision Mobile Unit conducted 11 vision screenings, provided 11 pairs of glasses, and scheduled three vision follow-ups and two vision exams
• Serve the People Community Health's Medical Mobile Unit conducted 20 medical screenings
• Pacific Health and Wellness, in partnership with CalOptima Health's medical management team, completed 10 Health Risk Assessments, 79 blood pressure screenings and 67 A1C screenings, resulting in 22 care gaps being closed
• SSA completed one CalFresh and four Medi-Cal applications
• Community Action Partnership OC distributed 1,075 pounds of eggs, 1,604 pounds of onions and 630 pounds of tortillas.

The Community Relations team, together with a dedicated group of 22 volunteers, played a pivotal role in assembling almost 600 insulated grocery carts. Their teamwork, enthusiasm and commitment ensured that every cart was ready for distribution. This collaborative spirit, along with other volunteers and CBOs, helped make the event successful and exemplified our mission to serve the community with excellence and dignity. Thank you to everyone who contributed their time and energy to make a meaningful impact.

Open enrollment for CalOptima Health Covered begins November 1, 2026, and will run through January 31, 2027. This is CalOptima Health's first line of business on the Covered California marketplace and is being launched to expand affordable health care in Orange County and ensure continuity of care for members transitioning from Medi-Cal. CalOptima Health Covered will be the lowest-cost Silver plan available in the county. At the beginning of October, the health plan began receiving enrollment files for renewing Covered California enrollees with January 2027 effective dates.

Staff has been diligently preparing for the product's January 1, 2027, start, including working with the Department of Managed Health Care (DMHC) to modify CalOptima Health's Knox-Keene Act license. On September 17, DMHC approved the CalOptima Health Covered awareness advertising campaign materials, and the general awareness marketing campaign is now live in the community. In addition, staff continues to develop educational materials for member and broker audiences and held a CalOptima Health Covered kick-off event on September 23 to educate brokers about the plan.

To learn more, please visit the CalOptima Health Covered page.

Medi-Cal Changes Toolkit Available

In September, CalOptima Health released a Medi-Cal Changes Toolkit, including flyers, posters and social media content, to raise awareness about the Medi-Cal changes that began January 1, 2026, and will continue in 2027 and 2028. The materials direct members to the Medi-Cal Changes webpage for more details. This page provides information that aligns with DHCS messages. Please share this toolkit widely, as it enables community stakeholders, providers and health networks to easily share information with their communities and urge action so members don’t lose their Medi-Cal.

CalOptima Health is pleased to announce that we have received 4 stars in the National Committee for Quality Assurance (NCQA) Medicaid Health Plan Ratings 2026. The rating, released on September 16, puts the health plan among the leading Medi-Cal plans in the state and is an improvement from CalOptima Health’s 3.5-star rating from 2025.

Following our rating last year, we implemented a data-driven, member-centric approach that included expanding at-home care testing for colorectal cancer and diabetes-related measures, launching the Cozeva PayerOne platform to get the most accurate, complete data possible, and deepening collaboration with our providers and health networks.

NCQA rates Medicaid plans nationwide on quality of care, member experience with their care and quality processes. NCQA aggregates these factors into a health plan rating on a scale of 1 to 5 stars. The rating reflects care delivered in 2025. We are one of nine plans in California to achieve a 4-star rating, with only four plans getting above a 4-star rating.

CalOptima Health, in partnership with NORC at the University of Chicago (NORC), has completed the Member and Population Health Needs Assessment (MPHNA) Final Report. Conducted from mid-2025 to mid-2026, this comprehensive assessment brought together voices from members, providers, focus groups and interviews, along with CalOptima Health administrative data and publicly available county reports and assessments. The final report provides insights into the strengths of our current health plans, provider network and initiatives, as well as opportunities for us, providers and community partners to further support Orange County’s vulnerable populations.

You can explore the full report on our website. Thank you to our members, providers and community partners for participating in this assessment.

Governor Finishes Signing Legislation

On September 30, Governor Gavin Newsom finished signing or vetoing all legislation passed by the California State Legislature before it adjourned on September 1. Notably, the governor signed into law Assembly Bill 2194, introduced by State Assemblymember Avelino Valencia, which implements staggered terms on the CalOptima Health Board of Directors and requires an external audit of CalOptima Health’s governance policies. In addition, the governor signed into law several budget-related bills that amend the Fiscal Year (FY) 2026–27 state budget enacted earlier this summer. A summary of the two bills impacting the Medi-Cal program can be found here. These bills did not include the proposal by the County of Santa Clara to assume control of the locally operated Medi-Cal plan, Santa Clara Family Health Plan, which the CalOptima Health Board had voted to oppose due to its harmful, precedent-setting implications for the other 16 locally operated Medi-Cal plans, including CalOptima Health.

Federal Funding Extended Through Midterm Elections

On September 2, President Donald Trump signed into law H.R. 6500: Continuing Appropriations and Extensions Act, 2027, a Continuing Resolution (CR) that extends existing FY 2026 federal funding levels from September 30, 2026, through December 11, 2026 — after the midterm general elections on November 3, 2026. The U.S. Senate and U.S. House of Representatives had previously passed the CR by bipartisan votes of 370-48 and 90-6, respectively. The CR also extends a few health care programs and authorities that were set to expire and delays implementation of a White House policy that would give political appointees more control over grantmaking. While the enactment of the CR avoids a government shutdown on September 30, it also sets up a very busy lame-duck session after the elections. Congress will need to address many issues, including finalizing FY 2027 federal funding and a possible bipartisan health care package, before the next session begins on January 3, 2027, with newly elected and reelected members.

In The News

• On October 1, we distributed a press release about CalOptima Health distributing $8 million for nine Housing and Homelessness Incentive Program grants, which was covered by the Orange County Business Journal.
• On September 28, we issued a press release about NCQA rating us as a 4-star Medi-Cal Plan.
• On August 28, CalOptima Health issued a press release about our first-of-its-kind $5.2 million City Health Improvement Grants, which were covered by the Orange County Register, My News LA and New Santa Ana.

Upcoming CME Provider Training to Focus on HPV Vaccination

This training is used to train health care professionals on how to strengthen HPV vaccine recommendations while saving clinical time. The California HPV Vaccination Roundtable is proud to offer this training for health care teams in a one-hour, interactive, virtual format taught by a trained physician facilitator.

• When: Wednesday, October 14
• Time: Noon–1:15 p.m.
• Location: Zoom
• Registration is required, please RSVP here.

For more information, please see this flyer.

If you have additional questions, please contact continuingeducation@caloptima.org

Happy National Dental Hygiene Month

Smile, California is celebrating National Dental Hygiene Month this October! Visit Smile California for 31 days of dental facts, dental information and tips to ensure members know how to care for their smiles.

Visit Smile, California, for more information or see the English and Spanish flyers.