Medi-Cal, California’s Medicaid program, will undergo significant changes starting January 1, 2027, affecting millions of members and their access to health care services.
Starting January 1, 2027, several federal and state policy changes will reshape Medi-Cal, California’s version of Medicaid, impacting how millions of members access essential health care benefits and services.
During an August 11 briefing hosted by the American Community Media (ACoM), experts from the California Department of Health Care Services (DHCS) outlined these upcoming changes and provided guidance on how members can maintain their coverage.
According to the experts, most members will continue to be covered for doctor and hospital visits, emergency care, preventive care, and long-term care. Tyler Sadwith, state Medicaid director at DHCS, emphasized, “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 from Medi-Cal.”
Full-scope coverage will remain in place for specific groups, including children aged 0 to 18, pregnant women throughout their 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.
Beginning January 1, 2026, a freeze will restrict new undocumented adult immigrants from enrolling in full-scope Medi-Cal. However, Sadwith noted that “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.” If an undocumented adult’s coverage lapses due to a late renewal, they will have a three-month grace period to resolve the issue. If they miss this window, they will be limited to restricted-scope coverage, which includes emergency care, pregnancy care, and certain nursing facility care.
Starting January 1, 2027, certain adult Medi-Cal members aged 19 to 64 without children or disabilities may need to report work requirements to maintain their coverage. This could involve volunteering, attending school, or participating in job training, with a requirement of working 80 hours per month and earning at least $580 per month. Exemptions apply to pregnant or 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 qualify for exemption.
Experts indicated that the state would utilize internal data to automatically determine which members meet the requirements or qualify for exemptions, minimizing the need for members to take 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,” Sadwith explained.
Starting March 1, 2027, some adults aged 19 to 64 will have their eligibility checked twice a year instead of the standard annual review. However, pregnant individuals, former foster youth, and American Indian members will continue with the annual renewal schedule. Experts urged members to open notices from Medi-Cal and respond promptly to avoid losing coverage due to missing information or paperwork.
Approximately two million Medi-Cal members, including undocumented individuals and those with various 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 require members to pay for services and that they can continue to see doctors and clinics that accept fee-for-service. Medi-Cal will still cover prescriptions, and specialty mental health and substance use disorder care will continue to be provided through the county’s behavioral health plan. However, services like enhanced care management and community support will not be available to those transitioning out of managed care plans. DHCS will offer transition support, including a nurse advice line and community navigators to assist members during this shift.
Beginning July 1, 2027, federal rules will alter how certain immigration statuses are classified under federal Medicaid funding. This includes refugees, asylees, humanitarian parolees, and trafficking survivors with pending immigration cases, who will be funded entirely via state-funded full-scope Medi-Cal through June 30, 2027. After this date, individuals in these categories will generally see their coverage limited to pregnancy-related care and emergency services. Huang assured that individuals affected by these changes would receive letters from the departments explaining how to navigate the transition.
Some adults will lose full Medi-Cal dental benefits due to their immigration status, although emergency dental services will remain available for all. Children aged 0 to 18, pregnant individuals (up to one year postpartum), and former foster youth under 26 will continue to receive full dental benefits. Certain immigrants aged 19 to 59 will be required to pay monthly premiums of $30 to $50 to maintain their full-scope coverage, with failure to pay resulting in restricted-scope Medi-Cal coverage. Children, pregnant individuals, and former foster youth are exempt from this change.
Adults aged 19 to 64 who are not pregnant and not on Medicare and earn more than $15,560 annually may face small co-payments for specific types of care, such as specialty care and treatments. Co-payments will not apply to pregnancy care, emergency care, regular checkups, pediatric care, or mental health treatments received at rural clinics and community health centers.
To navigate these changes effectively, experts recommend that Medi-Cal members take several crucial steps. Members should update their contact information with their county office within 10 days of any move or change. They should also review renewal packets thoroughly, which are mailed in large yellow envelopes and contain pre-populated historical information. Any missing information must be filled out, and the final page should be signed and dated. These packets are available in 19 languages, and members can request alternative formats such as large print or Braille. Those with a BenefitsCal account can also renew their coverage online.
If members find the paperwork overwhelming, they can contact local county offices for assistance from application counselors and navigators. The DHCS is deploying funded clinic navigators in the coming weeks to provide in-person support. Members can find their local county offices for assistance with Medi-Cal.
In cases of medical emergencies, undocumented immigrants without Medi-Cal will still be eligible for treatment 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 their stay for up to 60 days.
For more information on the hospital presumptive eligibility program, visit the DHCS website.
These changes to Medi-Cal are significant and will require members to stay informed and proactive to ensure they maintain their coverage and access to necessary health services.
According to India Currents.