If your parent has Medi-Cal in California, they are almost certainly enrolled in a managed care plan. And that plan — not the state directly — is the entity responsible for authorizing and coordinating the CalAIM services your family may be entitled to.
Understanding how managed care works is the key to actually getting what’s available.
What Is a Managed Care plan?
Rather than paying for healthcare services directly, California contracts with private managed care organizations to provide comprehensive coverage to Medi-Cal members. These plans receive a fixed monthly payment per member and are responsible for coordinating all care within that member’s benefit package.
In Orange County, the primary Medi-Cal managed care plan is CalOptima Health. If your parent has Medi-Cal and lives in Orange County, they are most likely a CalOptima member.
Why This Matters for Home Care
When you want to access CalAIM services like Enhanced Care Management or Community Supports, you’re not calling the state — you’re calling CalOptima. The plan has its own processes for identifying eligible members, conducting assessments, and authorizing services.
How to Work Effectively with the Managed Care plan
Know the member ID. Your parent’s CalOptima member ID is on their member card. Have it ready for every call.
Ask specifically about CalAIM programs. Ask: “Does my family member qualify for Enhanced Care Management? What Community Supports services does CalOptima offer, and how do we access them?”
Request a care manager. For complex cases, CalOptima can assign a care manager to help coordinate benefits and services. You can request this directly.
Document everything. Note dates, names of representatives, and what was said.
Escalate when necessary. If you’re told your parent doesn’t qualify for something you believe they should, you have the right to request a formal review.
How Care partners Fits In
Care partners works within the CalOptima ecosystem regularly. We understand the authorization processes, the Community Supports framework, and how to advocate effectively for the families we serve.
Call Care partners for a free consultation — we know how to work the system so you don’t have to.