Provider Referrals

We partner with you to provide health education, promotion, and resource navigation/care coordination that complements your care plan and supports a healthy pregnancy, mom and baby.

Based on your recommended care plan for each patient, MOMS’ Nurse Case Managers, Maternal Child Health Workers, and Health Educators work together to support you and your patient’s goals. We offer virtual, in-home or in-person visits for perinatal health education and care coordination, as well as health education classes.

MOMS is proud to partner with CalOptima Health to provide perinatal Community Health Worker (CHW) services to eligible members.

CHW services are available to CalOptima Health members to help prevent diseases, disabilities and other health conditions or their progression. Services also help promote physical and mental health well-being and extend lifespan. CHW services include:

Health education to promote the member’s health or address barriers to physical and mental health care, including providing information or instruction on health topics. Health education may include coaching and goal setting to improve a member’s health or ability to self-manage health conditions.

Health navigation to provide information, training, referrals or support to help members:

• Access health care, understand the health care system, or engage in their own care.
• Connect to community resources necessary to promote a member’s health; address health care barriers, including connecting to medical translation and interpretation or transportation services; or address health-related social needs.

Screening and assessment that does not require a license and helps members connect to appropriate services to improve their health.

Individual support or advocacy that helps members prevent the start or worsening of a health condition or prevent injury or violence.

For more information, contact Janira Perez, Director, Strategic Program Development at: jperez@momsorangecounty.org, or by phone: 714.352.3430

MOMS also provides Enhanced Care Management (ECM) services through a partnership with CalOptima Health. ECM is a new statewide Medi-Cal benefit available to select populations of focus that addresses the clinical and non-clinical needs of the highest-utilizing members through intensive coordination of health and health-related services. ECM meets members wherever they are — on the street, in a shelter, in their doctor’s office or at home. Members have a single lead care manager who will coordinate care and services among the physical, behavioral, dental, developmental and social services delivery systems, making it easier for them to get the right care at the right time.

MOMS currently serves pregnant and postpartum members who also meet the criteria for the following populations of focus:

• Adults, Children and Youth Experiencing Homelessness
• Adults, Children and Youth at Risk for Avoidable Hospital or Emergency Department Utilization
• Adults with Serious Mental Health or Substance Use Disorder (SUD)
• Adults Transitioning from Incarceration
• Children and Youth Involved in Child Welfare (if infant is already being served by MOMS)
• Birth Equity, Adults, Children and Youth

We are able to accept referrals ECM referrals through CalOptima Connect.