With a strategic goal of improving performance on the Centers for Medicare & Medicaid Services (CMS) Star quality measures, CalOptima Health is accepting applications for the Quality Improvement Grant Program (QIGP) OneCare Program Year 1 (2024). This program is intended to provide support to health networks in planning and implementing quality improvement activities for services to members of CalOptima Health OneCare (HMO D-SNP), a Medicare Medi-Cal Plan. This grant program is designed to address the ongoing need for enhanced health care quality and patient outcomes, particularly in underserved communities. The program is designed to empower health networks to identify, implement and evaluate evidence-based practices that drive measurable improvements in health care quality. Grant funding will be for a one-year period starting from the grant issue date. Application forms can be requested by emailing the Quality Analytics team at qualitygrants@caloptima.org and are accepted until November 15 at 5 p.m.

The Children and Youth Behavioral Health Initiative (CYBHI) is a five-year, more than $4 billion initiative that is transforming the way California supports children, youth and families. On September 29, CYBHI published an article and accompanying video highlighting a new allcove center coming to Orange County in spring 2025. Allcove centers were developed by the Stanford Center for Youth Mental Health and Wellbeing, to offer a safe and supportive space and access to a broad range of potential services, including mental health, physical health, substance use disorder, peer support, family support, housing, supported education and employment, and linkage to other services. CalOptima Health supported the development of this new allcove center in San Juan Capistrano to advance the overall goal of reducing suicide and suicide ideation, homelessness, unemployment, and school failure. “CalOptima Health is very proud to be a part of this project because it’s going to be a place youth have created for other youth, a place where they can receive support and connection in the way they want to receive it,” said Carmen Katsarov, LPCC, CCM, CalOptima Health’s Executive Director of Behavioral Health Integration.

In recognition of Breast Cancer Awareness Month, CalOptima Health’s Chief Medical Officer Richard Pitts, D.O., Ph.D. (second photo, on right), was invited to speak at the City of Hope’s “Pink Is Powerful” breast health initiative media event on October 2. Dr. Pitts spoke about the urgent need for breast cancer screening amid rising incidence rates in younger people and communities of color and highlighted our campaign to help Orange County achieve the lowest incidence rate nationwide for late-stage breast cancer as well as cervical, colon and certain lung cancers. 

Substance use disorders (SUDs) are prevalent among patients in many care settings. Left unidentified and untreated, the outcomes of substance abuse can be devastating, so providers need to understand how to use appropriate tools to identify and address SUDs. Screening, Assessment, Brief Interventions and Referral to Treatment (SABIRT) provides a framework for using validated screening tools, completing and assessment, instituting brief interventions, and making proper referrals for treatment.

When: Wednesday, November 6

Time: Noon-1:30 p.m.

Location: Zoom Webinar

https://bit.ly/29tvO

1.5 CME and CE credits are offered.

Space is limited! Please RSVP by Monday, November 4 by clicking here.

For questions, contact Quynh/Bao Anh at continuingeducation@caloptima.org.

For more information, please see attached flyer.

The annual election period (AEP) for CalOptima Health OneCare (HMO D-SNP), a Medicare Medi-Cal Plan, opened on October 15 and runs through December 7.

To be eligible for CalOptima Health OneCare a member must be:

• Age 21 and older
• Living in Orange County
• Enrolled in Medicare Parts A and B
• Receiving Medi-Cal benefits

Starting in 2025, CalOptima Health OneCare members have two plan options they can select from:

• CalOptima Health OneCare Complete — Our original plan offers $0 copays on medical and hospital services and all covered prescription drugs. It includes many extras, such as a fitness benefit, comprehensive dental, more vision care, a flex card for over-the-counter (OTC) items and groceries and more.
• CalOptima Health OneCare Flex Plus — Our new low-cost plan is designed for flexibility, offering $0 doctor visits and hospital stays. It also includes generous extras such as a larger flex card allowance for OTC items, more vision care, comprehensive dental, a fitness benefit and more.

You can explore the benefits of each plan here.

Individuals who are covered by both Medi-Cal

and Medicare could qualify for CalOptima Health OneCare (HMO D-SNP), a Medicare Medi-Cal Plan. Learn more about this special plan at our upcoming in-person presentations: 

SBHIS Building | 801 N. Tustin Ave., Suite 104, Santa Ana

• Saturday, October 19, 10 a.m.-Noon and 1-3 p.m.
• Saturday October 26, 10 a.m.-Noon and 1-3 p.m. 

Superior Grocers | 1710 S. Main St. Santa Ana, 92705

• Tuesday, October 22, 10 a.m.-Noon and 2-4 p.m.
• Tuesday, October 29, 10 a.m. -Noon and 2-4 p.m.

Presentations are only offered in English, and light snacks will be served. To learn more, view event flyers in English, Spanish and Vietnamese. For questions and to RSVP, call CalOptima Health OneCare at 1-800-466-0524.

On January 1, a new law in California went into effect to allow adults ages 26 through 49 to qualify for full Medi-Cal regardless of immigration status. Other Medi-Cal eligibility rules, including income limits, still apply. This latest expansion of Medi-Cal means that all Californians now have access to coverage; prior expansions extended coverage to undocumented children, young adults and people over 50. Full Medi-Cal covers doctor visits, prescription medicines, vaccines, mental health care, vision care, dental care, emergency services, referrals to specialists and more. According to DHCS, when an individual applies for these state-funded benefits, their information is only used to determine if they qualify. State laws protect the privacy of their personal data.

To check eligibility for full-scope Medi-Cal, call the County of Orange Social Services Agency (SSA) at 1-800-281-9799. Share flyers about the Adult Medi-Cal Expansion and an informational video in Spanish from SSA.