The most significant changes to Medi-Cal in years are coming next year, and officials urge the 14 million Californians enrolled — over one-third of the state — to prepare.
The changes are many and include:
- New federal work or community service requirements
- Twice-yearly eligibility checks for some adults
- The shift of roughly 2 million mostly immigrant members from managed care to fee-for-service coverage
- Revisions to dental benefits
- New monthly premiums for certain immigrant adults
- And a federal reclassification limiting certain immigrants to emergency and pregnancy care.
Most Medi-Cal members (Medi-Cal is California’s version of Medicaid) will not be affected by many of the changes. Those who are will need to respond promptly to notices, keep their contact information current and complete renewals on time.
The changes will take effect on different dates throughout 2027, in part due to delays in this year’s state budget. That’s according to Tyler Sadwith, state Medicaid director at the Department of Health Care Services (DHCS), who spoke at an Aug. 11 American Community Media briefing.
The first major changes arrive Jan. 1, 2027.
Work requirements
Adults ages 19 to 64 enrolled in Medi-Cal through the Affordable Care Act (ACA) and who do not have children or disabilities will have to demonstrate that they are working, volunteering, attending school or participating in job training to obtain and keep their coverage under the recently passed H.R. 1, also known as the “Big, Beautiful Bill.”
Approximately 5 million Californians are enrolled in Medi-Cal through the ACA — roughly 34% of the total Medi-Cal population.
The work requirement can be met by earning at least $580 per month through work or participating in qualifying activities for at least 80 hours per month. This includes volunteering, attending school at least half-time or combining these.
There are various exemptions, including for pregnant people and those up to one year postpartum. Parents and caretakers of children aged 13 and under, people with disabilities or serious health conditions, people with Medicare, American Indians and Alaska Natives, certain former foster youth and people released from incarceration in the last 90 days are also exempt.
“We are prioritizing using all of the information that we have access to in our database and other databases, so that we can automatically determine if people meet the rule or if people are exempt, so that Medi-Cal members don’t have to take any action,” said Sadwith.
Even so, he estimated about 2 million members will receive mailed notices requesting proof of work, school, exemption or another qualifying status.
Eligibility checks
Another federal change begins March 1, 2027, when adults under the age of 65 and enrolled through the ACA will have their eligibility checked every six months instead of annually.
Certain groups, including pregnant and one-year postpartum people, American Indians and Alaska Natives and some former foster youth, will continue to receive annual eligibility checks.
Fee for service
Also beginning Jan. 1, approximately 2 million members — including undocumented people, green card holders still in their five-year waiting period for full-scope federal Medicaid and people classified as permanently residing in the United States under color of law — will move from managed care plans to fee-for-service Medi-Cal.
The shift does not mean these members will have to pay for covered services, and prescriptions remain covered; but it can change which doctors and services they can access. For instance, some managed care services including enhanced care management and certain community supports — like home modification and asthma remediation — will not be available in fee-for-service.
Whether members can continue seeing their current providers may depend on whether those providers accept fee-for-service.
“We encourage people to talk to their doctor, talk to their provider, and ask them ‘Can I keep seeing you? Will you accept fee-for-service Medi-Cal?” Sadwith said, adding that DHCS will offer a nurse advice line and community navigators during the transition.
A second set of changes takes effect July 1, 2027, when refugees, asylees, humanitarian parolees and some survivors of domestic abuse or human trafficking with pending immigration cases will be limited to pregnancy-related and emergency care rather than state-funded full-scope coverage.
Dental benefits
Separately, some adults with a federally classified “unsatisfactory immigration status” — including undocumented adults, green card holders in their five-year waiting period, DACA recipients and pending asylum applicants — will lose full dental benefits on that same date.
Emergency dental care — including treatment for severe pain, infection and extractions — will still be covered, and children, pregnant people, postpartum people and former foster youth under age 26 will keep full dental benefits.
New premiums
Come July 1, 2027, members in that same unsatisfactory immigration status group aged 19 to 59 will also need to pay a monthly premium to keep full-scope coverage, or move to restricted-scope Medi-Cal, which only covers pregnancy, postpartum and emergency services.
“The monthly premium is anywhere between $30 to $50, and this is to be determined as we near July 1,” said Yingjia Huang, DHCS deputy director for healthcare benefits and eligibility, noting the amount applies per individual within an affected household.
These changes do not apply to everyone, she added: Children 18 and under, pregnant people, those up to one year postpartum and former foster youth under 26 remain eligible for full-scope Medi-Cal regardless of immigration status.
A later federal change, effective Oct. 1, 2028, will require co-payments for ACA-enrolled adults under 65 who aren’t pregnant, aren’t on Medicare and earn more than $15,506 a year, for specialty care, treatments and tests — though emergency care, checkups, pregnancy care, pediatric care, mental healthcare and substance use treatment remain exempt.
‘Respond quickly’
For current undocumented adult enrollees, keeping coverage will depend partly on completing renewals on time.
Undocumented adults who were already receiving full-scope Medi-Cal before Jan. 1, 2026 are generally grandfathered into the program, but missing required documentation during a renewal may result in a loss of full coverage, said Huang.
Members should report address, phone or email changes to their county within 10 days, open renewal packets “in yellow envelopes” as soon as they arrive “and respond quickly” by the deadline printed on the first page, she continued.
Packets are available in 19 languages as well as large print and braille, and can be completed online at benefitscal.com.
County-based enrollment navigators exist in many counties, and DHCS is working to “fund and set up clinic navigators” at Federally Qualified Health Centers in the coming months, so members can bring their renewal materials to a local clinic for help, explained Huang.
The door ‘remains open’
For people without Medi-Cal who need emergency care regardless of immigration status, hospitals are required to treat life-threatening conditions.
A program called Hospital Presumptive Eligibility lets patients self-report income and name, without an immigration status question, for temporary coverage of 45 to 60 days while they pursue a full application, which usually takes up to 45 days by mail but often produces same-day results online.
“Please keep using your benefits,” said Sadwith. “If you have Medi-Cal, please keep your contact information up-to-date. And when you receive notices from Medi-Cal, please respond as quickly as you can, so we can keep you covered.”
Those unsure whether they qualify for Medi-Cal can find out through DHCS here, and apply through BenefitsCal or CoveredCA.
Despite the changes ahead, one of the most persistent misconceptions is that overall, “Medi-Cal is closing their doors to enrollment, no longer accepting new people into the program — that is obviously not true,” added Huang. “The door is not closed; it remains open.”
