Who remains covered under Medi-Cal?
Starting January 1, 2027, several federal and state policy changes to Medi-Cal, California’s version of Medicaid, will reshape how millions of members access vital health care benefits and services.
At an August 11 briefing hosted by the American Community Media (ACoM), experts from the California Department of Health Care Services (DHCS) outlined these changes and shared what its members can do to keep their coverage.
Experts shared that most members will be covered for doctor and hospital visits, emergency care, preventive care, and long-term care.
“Services for mental health and substance use disorders, drug and prescription medication, transportation as well as vision and dental services will also be covered as long as members keep their contact information up to date and respond quickly to notices that they receive from Medi-Cal,” said Tyler Sadwith, state Medicaid director, DHCS.
Meanwhile, full-scope coverage will remain in place for children between the ages of 0 and 18, pregnant women during their entire pregnancy and up to one year postpartum, and former foster care youth under the age of 26, who were in foster care on their 18th birthday regardless of their immigration status.
Changes to Medi-Cal from Jan 1, 2027
- Freeze on new, undocumented immigrant enrollments
Beginning January 1, 2026, a freeze went into effect, restricting new undocumented adult immigrants from enrolling in full-scope Medi-Cal.
“Members (including undocumented immigrants), who have already enrolled in full-scope Medi-Cal before January 1, 2026, will retain their full coverage as long as they renew their membership on time,” said Sadwith.
If an undocumented adult’s coverage lapses due to a late renewal, they have a three-month grace period to resolve this issue. If missed, they cannot re-enroll in full-scope Medi-Cal and will be restricted to limited-scope coverage, which covers emergency care, pregnancy care, and certain nursing facility care.
- Work and Community Engagement Requirements
Starting Jan 1, 2027, certain adult Medi-Cal members aged 19 to 64 who do not have children or disabilities may need to report work requirements such as volunteering, attending school, or participating in job training to get Medi-Cal or to remain covered under Medi-Cal. This can be satisfied by working 80 hours per month and earning at least $580 per month.
Exempt individuals include pregnant/postpartum women, parents or caretakers of children aged 0 to 13, individuals with serious medical conditions, Medicare enrollees, American Indians/Alaskan Natives, and recently incarcerated individuals. Routine caregiving for an ill relative may also potentially qualify as an exemption.
Experts shared that the state would use internal data to automatically determine members who meet the requirements or are exempt from the changes to help members keep coverage without having to take any action. Only an estimated two million out of 14 million total members may receive mail requests to verify their work requirements.
“Medi-Cal or county social service offices will contact members if these new federal requirements apply to them or if more information is needed to help them keep Medi-Cal,” said Sadwith.
For details on the work requirements, go to Medi-Cal Changes:
- Eligibility Checks
Starting March 1, 2027, some adults aged 19 to 64 will have their eligibility checked twice a year instead of once a year. Pregnant individuals, former foster youth, and American Indian members will remain on the standard annual renewal schedule with eligibility reviewed once per year. The experts encouraged members to open notices from Medi-Cal and respond before the deadline to avoid losing coverage due to missing information or paperwork.
- Transition to Fee-for-Service
Roughly two million Medi-Cal members, including undocumented individuals and those with other immigration statuses, will transition from Medi-Cal managed care plans to Medi-Cal fee-for-service or traditional Medi-Cal.
Sadwith clarified that this change does not mean members have to pay for services and can continue to see doctors and clinics that accept fee-for-service. Medi-Cal will also continue to cover prescriptions, and specialty mental health and substance use disorder, or addiction care, will continue to be provided through the county’s behavioral health plan.
“But other services such as enhanced care management and community support will not be available to those transitioning out of a managed care plan. But DHCS will provide transition support, including a nurse advice line and community navigators to help members receive care as they move to a traditional care plan,” said Sadwith.
Changes to Medi-Cal from July 1, 2027
- Immigration status classification
Beginning July 1, 2027, federal rules will change how some immigration statuses are classified under federal Medicaid funding. These immigration statuses include refugees, asylees, humanitarian parolees, and trafficking survivors with pending immigration cases. They will be funded entirely via state-funded full-scope Medi-Cal through June 30, 2027.
“From July 2027, individuals in these categories will generally see their coverage limited to pregnancy-related care and emergency services. We will make sure that individuals impacted by these changes receive letters from the departments to tell them what they need to do to navigate this change,” said Yingjia Huang, deputy director for health care benefits and eligibility, DHCS
- Dental Changes and Monthly Premiums
Some adults will no longer receive full Medi-Cal dental benefits because of their immigration status. Emergency dental services, including treatment for severe tooth pain and infections, will remain covered for everyone. Children between the ages of 0-18, pregnant individuals (up to one year postpartum), and former foster youth under the age of 26 will receive full dental benefits.
Certain immigrants between the ages of 19 and 59 will also be required to pay a monthly premium of $30 to $50 to keep their full-scope coverage. Failure to pay the premiums will result in coverage being limited to restricted-scope Medi-Cal, which includes emergency and pregnancy-related services. Children, pregnant individuals, and former foster youth are exempt from this change.
- Federal co-payments
Adults between the ages of 19 and 64 who are not pregnant and not on Medicare and earn more than $15,560 a year may face small co-payments for certain types of care such as specialty care, treatments and tests. Co-payments will not apply to pregnancy care, emergency care, regular checkups, pediatric care, mental health treatments received at rural clinics and community health centers.
Renewing coverage for Medi-Cal members
The experts urged members to follow crucial steps to navigate the changes in their coverage seamlessly. These are:
- Updating contact information: Members are urged to update their current mailing address, phone number, and email with their county office within 10 days of any move or change.
- Reviewing pre-populated areas: The renewal packets are mailed in large yellow envelopes. These packets contain pre-populated historical information (submitted previously), which must be reviewed thoroughly, and any missing slots must be filled. Remember to sign and date the final page. Furthermore, these packets are translated into 19 distinct languages based on members’ language preferences. One can also request alternative formats, such as large font print or Braille. Members who have a BenefitsCal account can also go online and renew their coverage.
- Seek support from county offices: If a member finds paperwork overwhelming, he/she can contact local county offices to access application counselors and navigators. The DHCS is actively deploying funded clinic navigators in the coming weeks to provide in-person assistance. One can find their local county offices here to get assistance with Medi-Cal: County Offices | DHCS
Emergency Care Coverage
Huang said that undocumented immigrants who do not have Medi-Cal will be eligible for treatment regardless of status in a medical emergency, through the hospital presumptive eligibility program. Patients can fill out a simple one-page form at the hospital to have Medi-Cal cover the costs of that stay for up to 60 days.
For more information: Hospital Presumptive Eligibility Program | DHCS
