The National Committee for Quality Assurance (NCQA) has officially awarded CalOptima Health an “Accredited” status in our first submission for Health Equity Accreditation (Medicaid HMO). This recognition took effect on December 16, 2025, and remains valid through December 16, 2028. The NCQA Report Card will be updated by January 15, 2026, to reflect our new status. CalOptima Health met all standards and received 100% (full points). This accomplishment is a testament to our collective commitment to advancing health equity and delivering high-quality, inclusive care to the communities we serve. Achieving full points in every category reflects the dedication, collaboration and hard work of our entire team.

Mandated by the Department of Health Care Services (DHCS), Transitional Rent is the 15th CalAIM Community Support. Launched on January 1, 2026, this new service provides up to six months of rental assistance in interim and permanent settings to members who are: 1) experiencing or at risk of homelessness, 2) have certain clinical risk factors, and 3) have either recently undergone a critical life transition or who meet other specified eligibility criteria. CalOptima Health is contracted with the Orange County Health Care Agency as the sole provider for the Transitional Rent benefit. The initial rollout of this service will be specifically for members with significant behavioral health needs, aligning with the Behavioral Health Services Act interventions.

To support providers and community partners in understanding and utilizing this new resource, we will be hosting an informational session covering:

• Member eligibility requirements
• Steps to take when a member qualifies
• Guidance for making accurate and effective referrals

Date: January 22, 2026

Time: 11 a.m.

Zoom Link: https://us02web.zoom.us/meeting/register/pRSTOH-WSIyGOE3wAldnhA

We encourage all interested providers and partners to attend this session to learn how to best support members through the Transitional Rent program.

The United States Congress continues to consider several differing proposals to address the expiration of the enhanced Advance Premium Tax Credits (eAPTCs) on December 31, 2025. Last month, in alignment with our Board-approved Fiscal Year 2025–26 Public Policy Priorities, CalOptima Health led a coalition letter to Orange County’s federal delegation that advocates for at least a one-year clean extension of the eAPTCs. With 2026 open enrollment already well underway, a clean extension would avoid any further uncertainty for Orange County residents — especially as we prepare for Covered California marketing and enrollment activities next year ahead of our January 1, 2027, plan launch. Other signatories of the coalition letter include the Hospital Association of Southern California (HASC), Orange County Medical Association (OCMA), Orange County Business Council (OCBC), and several individual hospital systems, including Providence, MemorialCare, UCI Health, KPC Health, Anaheim Community Hospital, and Pomona Valley Hospital Medical Center. Rady Children’s Health (formerly Children’s Hospital of Orange County [CHOC]) confirmed its participation in the coalition after the letter was distributed. Government Affairs staff will continue to monitor the ongoing eAPTC negotiations.

As of January 1, Medi-Cal eligibility and benefits are changing for some adults who will no longer be able to sign up for full-scope Medi-Cal coverage based on their immigration status. To help educate the community about the new rules and how coverage is affected, we’ve added a banner to our home page linking to information on the DHCS website on Medi-Cal changes.

To address the shifting environment and reassure members about their coverage, we recently launched the Get Care Now campaign to encourage members to continue seeking care. The campaign features print ads, digital and social media ads, radio ads, outdoor transit shelter and bus interior ads, as well as place-based ads. Ads for this campaign will run through March 2026. Further, this campaign will serve as a bridge to our future Medi-Cal eligibility campaign. In addition, CalOptima Health created a toolkit for use by community partners to help us spread the message that members have options for care, including virtual doctor visits and medicine home delivery. A flyer, FAQ and social media content can be downloaded here. Staff is raising awareness about the toolkit with community partners and providers, asking for support in distributing the messages.

CalOptima Health’s Board of Directors has elected its new leadership for a one-year term beginning January 1, 2026. Orange County Supervisor Vicente Sarmiento, who joined the Board in March 2023 and served as Vice Chair, is Chair. Member Representative Maura Byron, who has served on the Board since December 2023, is Vice Chair. Please see the press release here.

CalOptima Health’s Member Health Rewards Program has transitioned to a digital platform to improve member experience. The new digital forms are now live on our website.

• Medi-Cal: The provider-attestation process is now fully digital. No paper forms, signatures, stamps, mailing or faxing required.
• OneCare: No changes. Members will continue using the online self-attestation form.

Everyone Counts OC is a part of a national effort to better understand homelessness. The Point In Time Count is a federally mandated biennial count conducted in communities across the country to estimate the number of people experiencing unsheltered homelessness on a single night. Volunteers are needed to support the event during early morning and late evening shifts. Volunteer to help make a difference here in Orange County.

SoCal Filipinos, in collaboration with CalOptima Health and the County of Orange Social Services Agency, is hosting a Resource Fair. The event will focus on bridging services, wellness and connection to community resources.

Event Highlights:

• Dental and vision screenings
• Food distribution (while supplies last)
• Medi-Cal and CalFresh Enrollment

When: Saturday, January 24

Time: 9 a.m.–1 p.m.

Location: Poong Nazareno Filipino Catholic Church, 3700 W. Orange Ave., Anaheim

See flyer for additional event details.

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 presentation: 

CalOptima Health | 505 City Parkway West, Orange

• Wednesday, January 14, 1–2:30 p.m.
• Monday, January 26, 1–2:30 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.  

CalOptima Health OneCare (HMO D-SNP), a Medicare Medi-Cal Plan, now offers members a flex card (OneCare &more card) to purchase over-the-counter items (and in some cases, groceries) in-store and online. Additionally, the health rewards members have been able to earn in the form of a physical gift card in previous years are now added to the flex card instead. Members can earn rewards by completing certain health care tests or screenings and submitting an online form on this page.

To use the flex card, a member must first activate the card by texting ACTIVATE to 53746, calling 1-855-263-6673 (TTY 711), or visiting andmorehealth.com/onecare. Many members have not yet activated their cards and are missing out on the benefits. If members need help, please encourage them to call OneCare Customer Service at 1-877-412-2734 (TTY 711).