CalOptima (Orange County)
CalOptima is a public health program organized and run by Orange County. This program provides adults and children with disabilities access to a variety of basic medical services. You may not get to choose your service provider under this plan.
Restrictions: This plan is limited to Orange County.
Community: transportation
Health: chiropractic, disease management, durable medical equipment, early and periodic screening, diagnosis and treatment, family planning, health education, hearing, hospice, immunization, hospital, laboratory, long-term care, pharmacy, physical therapy, physician, podiatry, skilled nursing facility, speech therapy, vision, x-ray
Home: home health care
Social Services: case management
Central California Alliance for Health (Merced, Monterey, and Santa Cruz Counties)
This program provides services to adults and children with disabilities in the selected counties. You may not always get to choose your provider under this plan.
Restrictions: This plan is limited to Merced, Monterey, and Santa Cruz counties.
- Community: developmental day treatment, transportation
- Health: chiropractic, disease management, durable medical supplies, family planning, health education, hearing, hospice, immunization, hospital, laboratory, pharmacy, physical therapy, physician, podiatry, skilled nursing facility, speech therapy, vision, x-ray
- Home: home health care
- Social Services: case management
Sacramento Dental Geographic Managed Care (Sacramento County)
Adults and children with disabilities are eligible for dental services under this plan. You may not always get to choose your service provider under this plan.
Restrictions: limited to Sacramento County.
- Health: dental
Health Plan of San Mateo (San Mateo County)
This program provides adults and children with disabilities access to basic medical services. You may not always get to choose your provider under this plan.
Restrictions: This plan is limited to San Mateo County.
- Community: transportation
- Health: chiropractic, disease management, durable medical equipment, early and periodic screening, diagnosis and treatment, family planning, health education, hearing, hospice, immunization, hospital, laboratory, pharmacy, physical therapy, physician, podiatry, skilled nursing facility, speech therapy, vision, x-ray
- Social Services: case management
Medi-Cal Specialty Mental Health Services Consolidation
This program provides specialty treatment to California residents from all counties with certain mental health diagnoses including developmental disorders (excluding autism) that cause or might cause trouble in one or more areas of daily living. You may not get to choose your service provider under this plan.
Partnership Health Plan of California (Marin and Mendocino Counties)
This plan provides adults and children with disabilities with access to basic medical services. You may not always get to choose your provider under this plan.
Restrictions: This plan is limited to Marin and Mendocino counties.
- Community: transportation
- Health: chiropractic, durable medical equipment, early and periodic screening, diagnosis and treatment, family planning, health education, hearing, hospice, immunization, hospital, mental health, laboratory, long-term care, counseling and social support, pharmacy, physical therapy, physician, podiatry, skilled nursing facility, speech therapy, vision, x-ray
- Social Services: case management
CenCal Health (Santa Barbara and San Luis Obispo Counties)
This plan provides adults and children with disabilities access to a variety of basic medical services. You may not always get to choose your provider under this plan.
Restrictions: This plan is limited to Santa Barbara and San Luis Obispo counties.
- Community: transportation
- Health: chiropractic, disease management, durable medical equipment, family planning, health education and counseling, hearing, hospice, immunization, hospital, laboratory, pharmacy, physical therapy, physician, podiatry, rural health clinic services, skilled nursing facilities, speech therapy, vision, x-ray
- Home: home health care
- Social Services: case management
Sacramento Geographic Managed Care (Sacramento County)
This plan provides basic medical services to adults and children with disabilities. It does not cover people living in intermediate care or nursing facilities or some who are also eligible for Medicare.
Restrictions: This plan is limited to the Sacramento area.
- Community: transportation
- Health: chiropractic, disease management, durable medical equipment, emergency services, early and periodic screening, diagnosis, and treatment, family planning, health education, hearing, hospice, immunization, hospital services, mental health treatment, laboratory, occupational therapy, pharmacy, physical therapy, physician, podiatry, tuberculosis, vision, x-ray services
- Home: home health care
- Social Services: case management
San Diego Geographic Managed Care (San Diego County)
This plan provides basic medical services to adults and children with disabilities, including some who are also eligible for Medicare. It does not provide coverage for people residing in nursing or intermediate care facilities. Services covered are standard Medicaid services.
Restrictions: This plan is limited to the San Diego area.
- Community: transportation
- Health: chiropractic, disease management, durable medical equipment, emergency services, early and periodic screening, diagnosis and treatment, family planning, health education, hearing, hospice, immunization, hospital services, outpatient mental health treatment, laboratory, occupational therapy, pharmacy, physical therapy, physician, podiatry, tuberculosis, vision, x-ray
- Home: home health care
- Social Services: case management
Two-Plan Model
This plan is implemented county by county in twelve counties in California. It was designed to expand Medicaid coverage to people who were not being served by existing county or local plans, including many adults and children with disabilities and some who are also eligible for Medicare. It does not cover people who are covered under an HCBS waiver or those residing in nursing or intermediate care facilities.
Restrictions: This plan is limited to Alameda, Contra Costa, Fresno, Kern, Los Angeles, Riverside, San Bernardino, San Francisco, San Joaquin, Santa Clara, Stainslaus, and Tulare counties.
- Community: transportation
- Health: disease management, durable medical equipment, emergency services, early and periodic screening, treatment, and diagnosis, family planning, health education, hearing, hospice, immunization, hospital services, laboratory, occupational therapy, pharmacy, physical therapy, physician, podiatry, preventive health screening, specialists, speech therapy, vision, x-ray
- Home: home health care
- Social Services: cultural/linguistic support, case management
Prepaid Health Plan Program
This program provides comprehensive benefits to adults and children with disabilities eligible for California Medicaid as an alternative to plans where you pay each time you use a service. People receiving in-home care, those participating in the HCBS waiver or a nursing facility waiver, and some who are also eligible for Medicare are not covered.
- Community: transportation
- Health: durable medical equipment, emergency services, early and periodic screening, diagnosis, and treatment, family planning, health education, hearing, hospice, immunization, hospital services, laboratory, occupational therapy, mental health, pharmacy, physical therapy, physician, tuberculosis care, vision, x-ray, dental
- Home: home health care
- Social Services: case management
Senior Care Action Network (SCAN) (Riverside, San Bernardino, and Los Angeles Counties)
The SCAN program is a non-profit health care plan designed to meet the needs of older adults, including those with disabilities. To qualify for this plan, applicants must be at least 65 years old and qualify for both Medicare and Medicaid.
Ages: 65 and older
Restrictions: You must be Medicaid and Medicare dual eligible. This plan is limited to Riverside, San Bernardino, and Los Angeles counties.
- Community: adult day care
- Health: chiropractic, dental, durable medical equipment, health education, hearing, hospice, immunization, hospital services and hospitalization, mental health, substance abuse treatment, laboratory, occupational therapy, pharmacy, physical therapy, physician services, podiatry, skilled nursing facilities, speech therapy, transportation, vision, x-ray
- Home: home health care, personal care
- Social Services: case management
Program of All-Inclusive Care for the Elderly (PACE)
PACE programs are designed for people 55 and older whose needs might require nursing home placement, which might include many people with disabilities. These programs provide care and support including a high level of preventive care. PACE programs must provide all services otherwise included in a person’s Medicaid or Medicare benefit, as well as all other services deemed medically necessary. Services are provided through PACE centers, so people must live close enough to an approved center to be eligible.
Ages: 55 and older
Restrictions: You must have access to an approved PACE center.
- Community: day care, health-related transportation
- Health: primary and specialty care, nursing, physical therapy, occupational therapy, speech therapy, recreation therapy, prescription drugs,
- Home: home health care, home and environmental modifications
- Social Services: social services
