Orange County Allows CalOptima to Increase Insurance Coverage


Last week, the Orange County Board of Supervisors amended a county law to allow CalOptima, the county’s largest health insurer, to offer private insurance plans directly to consumers.

CalOptima is the largest county-organized health care system in California, providing health care to low-income residents. The system serves about 911,000 members, or about one in four county residents.

Currently, six covered California plans are available in the county, offered by private health insurers. With the board’s approval vote on Aug. 23, CalOptima would become the first public agency to propose a plan.

Although the federal government has not yet announced the end of the country’s COVID-19 state of emergency, the end of the emergency declaration will require states to determine whether individuals continue to be eligible for Medicaid, a public insurance program that provides free or low cost. costs of medical services for low-income people.

This review would follow a decision to end federal reporting, which is extended every 90 days. The current declaration expires on October 13 but will likely be extended at least until early next year, according to Policy and other media sources.

When completed, up to 20% of Californians could be left without health insurance coverage.

CalOptima is looking to expand health coverage in anticipation of this, through Covered California, the state’s health insurance marketplace connecting more than 2 million people statewide to branded health insurance.

In May, CalOptima CEO Michael Hunn asked the supervisory board to make this amendment.

“The goal is to provide affordable, comprehensive coverage to as many Orange County residents as possible while improving access to quality care,” Hunn said in a July 21 statement.

The council originally approved the amendment to a county ordinance on May 24. The August 23 vote confirming the change allows CalOptima to offer this plan. The organization aims to have it in place by January 2024 to serve former Medicaid clients.

“I truly appreciate the CalOptima Board of Directors partnering with the County…to provide better services and more services to our most underserved in our community,” Supervisor Katrina Foley commented during the board meeting. administration.

Part of the organization’s goal is to help multilingual, multi-generational and multi-cultural members get better coverage, its directors say.

Providing a covered plan in California would allow its members to retain their health network and doctors through a CalOptima trade-in plan, which would close the gap members face when they are no longer eligible for Medi-Cal and must switch to another covered plan in California.

As part of the CalOptima network, members have access to more than 10,600 primary care physicians and specialists, 34 community health centers and 41 acute care and rehabilitation hospitals.

CalOptima was founded in 1993 by the Orange County Board of Supervisors as the county’s organized health system. Managing both state and federal programs, it is governed by a board of directors comprised of members, vendors, business leaders and local government representatives.


Micaela Ricaforte



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