Independent healthcare navigation · Orange County
Most of what your family needs right now isn’t medical.It’s procedural.
Which appeal has a clock on it. What a health plan is obligated to do once you file in writing. When a denial stops being your plan’s decision and becomes somebody else’s. I spent my career measuring whether health systems do what they’re supposed to do. Now I tell families exactly what to do about it — you make the call, I tell you what to say.
Orange County in person. LA and San Diego by phone. Paid by you — never by a facility, agency, plan, or insurer.
You’re probably here because of one of these
The hospital says it's time to go.
A discharge date lands with no plan behind it. Someone has forty-eight hours to arrange a life that took eighty years to build.
The money doesn't reach.
You do the arithmetic on in-home care and realize that whatever you thought was enough isn't. Nobody warned you what this actually costs.
A letter arrives.
Medi-Cal wants asset documentation it never asked for before. Or a plan denied something the doctor said was necessary, and there's a deadline you can't find.
Hospice calls to say it's ending.
The benefit you thought was settled turns out not to be. The call lands like an eviction.
Nobody knows what he wanted.
The decisions arrive anyway. You make them in a corridor, at two in the morning, while disagreeing with your sister.
In every one of these you’re asked to make decisions you can’t take back, quickly, in a system with its own incentives, using words nobody taught you.
That is a solvable problem. It is just not one you should have to solve alone, in a hallway, at two in the morning.
What you’re up against
Nobody sends you these numbers in advance.
- $40per hour
Non-medical in-home care in California. Forty-four hours a week runs about $91,000 a year.
Source: CareScout 2025 Cost of Care Survey
- $12,167per month
A semi-private nursing home room in California — roughly $146,000 a year.
Source: CareScout 2025 Cost of Care Survey
- $130,000asset limit
Medi-Cal's asset limit returned on January 1, 2026 after two years with none. Renewals through 2026 require documentation for the first time.
Source: Justice in Aging
- 19.1%of hospice episodes
Ended in live discharge in FY2025 — the patient left alive, not through death. The share has risen every year since 2021.
Source: CMS Hospice Monitoring Report, April 2025
- 195 or 283hours per month
IHSS Protective Supervision, if you qualify. Routinely denied. Routinely won on appeal.
Source: Disability Rights California
Why being local matters here
Orange County has one Medi-Cal plan. Most counties have five.
Orange County is what's called a County Organized Health System, which means CalOptima Health covers every Medi-Cal member here — more than one in four residents — and it offers all fourteen of the state's Community Supports, where many counties offer a partial list.
That sounds like trivia until you need something. It means there is one grievance process to know, one set of benefits to check you against, and one plan whose habits I can actually learn. In Los Angeles I'd be guessing across five. Here I'm not.
Things families pay for privately
without ever being told they were covered
- Personal care and homemaker services
- Respite for the family member doing the caring
- Medically tailored meals after a hospital or nursing home stay
- Home modifications — grab bars, ramps, a walk-in shower
- Moving out of a nursing facility into assisted living, or back home
The part almost nobody knows
When a health system says no, that is very often not the end of it.
There are real, named places to take a decision you disagree with. Each one has its own trigger, its own evidence, and its own clock. Knowing which is which is most of my job.
Independent Medical Review
California Dept. of Managed Health Care
When · Your plan denied, delayed, or modified a service your doctor said you need — or refused to pay for emergency treatment.
A reviewer outside your plan decides. Most people have never heard of it.
Discharge appeal
Livanta — California's Medicare review organization
When · A hospital says it's time to leave and you disagree, or skilled nursing, home health, or hospice services are being ended.
It reviews thousands of these every week.
Facility complaint
California Dept. of Public Health
When · A hospital, clinic, nursing home, or subacute facility isn't meeting its obligations.
Licensing consequences get attention that phone calls don't.
Plan grievance
CalOptima Health, or your plan, in writing
When · Almost anything — and it's the required first step before most reviews.
In Orange County there's one Medi-Cal plan, so there's one process. I know it.
IHSS appeal
Orange County SSA, then a state hearing
When · Your in-home support hours were denied or cut — especially Protective Supervision.
The initial denial is very often not the final answer.
Every one of these has a deadline.
Most of them are short, most of them start without anyone telling you, and missing one is usually final. That is the whole reason to call early rather than once it has gone wrong.
How I work
Almost everyone offering to help your family is being paid by someone else.
Placement agencies are paid by the facilities they place you into. Agents are paid by carriers. The discharge planner works for the hospital. Usually nobody mentions it. So here is exactly where I stand, in public, before you call.
- 01
My rates are on this website
You should not have to call to find out what something costs, and a business that won't tell you is telling you something.
- 02
I take no referral fees. From anyone. Ever.
Not from facilities, agencies, insurers, plans, or providers — and I don't accept them for sending you somewhere either. Placement agencies are usually paid by the places they place you into. I'm paid by you.
- 03
I advise — you act
I don't file your appeal or make your calls. I tell you exactly what to file, by when, and what to put in it, then read what comes back. You have the authority; what you're missing is knowing which lever to pull. There's a whole page about where my competence stops.
- 04
I'll point you to the free option when it's the right one
HICAP does Medicare plan comparison free, and does it well. If that's what you need, that's where you should go.
If Medicare plan comparison is what you actually need, call HICAP at 714-560-0424. It’s free, it’s unbiased, and it’s good. Telling you that costs me a little and is the whole point.
Start with a conversation.
Thirty minutes, on the phone, free. You tell me what's happening and I'll tell you what I'd do — including if that's nothing, or someone else.