{"id":75635,"date":"2025-09-23T15:06:32","date_gmt":"2025-09-23T22:06:32","guid":{"rendered":"https:\/\/lapost.us\/?p=75635"},"modified":"2025-09-23T15:06:32","modified_gmt":"2025-09-23T22:06:32","slug":"medi-cal-rules-are-changing-what-to-expect","status":"publish","type":"post","link":"https:\/\/lapost.us\/?p=75635","title":{"rendered":"Medi-Cal Rules are Changing: What to Expect"},"content":{"rendered":"
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By<\/span>Selen Ozturk<\/a><\/div>\n<\/div>\n<\/div>\n
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Medi-Cal requirements are tightening next year through 2028 for many enrollees \u2014 particularly undocumented adults.<\/p>\n<\/div>\n<\/div>\n

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Image via Canva.<\/figcaption><\/figure>\n<\/div>\n<\/div>\n
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Medi-Cal requirements are tightening next year through 2028 for many enrollees \u2014 particularly undocumented adults.<\/p>\n

These new changes involve new work requirements, copayments, asset limits and renewal requirements, owing to budget cuts on the state level and new laws on the federal level \u2014 mainly\u00a0H.R.1.<\/a>, or the \u201cOne Big Beautiful Bill Act.\u201d<\/p>\n

Medi-Cal, California\u2019s version of Medicaid, is the largest Medicaid program in the nation, serving over one-third of the state, including around 1.6 million undocumented residents as of May 2025.<\/p>\n

Changes for undocumented enrollees<\/h2>\n

For undocumented adults aged 19 and older, new enrollments for full-scope Medi-Cal \u2014 including routine medical, dental, vision, mental health and prescription care \u2014 will freeze starting January 1, 2026, under state law.<\/p>\n

Those enrolled beforehand will not be affected, as long as they keep renewing coverage; children are also exempt, as are pregnant people through one year after their pregnancy ends.<\/p>\n

Furthermore, undocumented adults falling under the income limit will still be eligible for restricted Medi-Cal, \u201cwhich covers emergency care and pregnancy-related care, which includes delivery at labor,\u201d said Yingjia Huang, deputy director for health care benefits and eligibility at the Department of Health Care Services (DHCS), at a Thursday, September 11 briefing on Medi-Cal changes hosted by American Community Media.<\/p>\n

Starting July 1, 2026, routine dental coverage will also end for undocumented adults 19 and older, under state law.<\/p>\n

Pregnant people and children are exempt from this change, while low-income undocumented adults will still be eligible for emergency dental coverage, including services for intense pain, infections and extractions.<\/p>\n

As of July 1, 2027, undocumented adults aged 19 to 59 must pay a $30 monthly premium for full Medi-Cal coverage, under state law; pregnant people, children and adults 60 and over are exempt.<\/p>\n

\u201cFor the monthly premium, we will be sending multiple notices ahead of time, and there will be a monthly invoice sent to the member as well, on an ongoing basis, to let them know the payment is due and where to remit the payment,\u201d said Huang.<\/p>\n

She added that there will be a 90-day grace period for missed payments, \u201cso we allow individuals to stay on coverage for three months\u2026 If they do not make the payment after 90 days, we will be moving their scope of benefits from their current scope to emergency Medi-Cal.\u201d<\/p>\n

Beginning October 2028, under federal law, some adults on Medi-Cal with legal immigration status may additionally \u201cneed to pay a small fee for certain services like specialty care or certain tests,\u201d said Tyler Sadwith, state Medicaid Director at DHCS.<\/p>\n

\u201cCore services like emergency care, regular primary care, checkups, prenatal care, pediatric care, mental health services and substance use treatment remain free and there is no copayment,\u201d he continued.<\/p>\n

New rules to maintain coverage<\/h2>\n

Starting January 1, 2027, under federal law, adults on full Medi-Cal between ages 19 and 64 will be required to work, volunteer, attend school or to participate in job training to keep their Medi Cal coverage.<\/p>\n

Members have a few ways of documenting participation, Sadwith explained: \u201cThey can work 80 hours a month in a job; they can get paid at least $580 per month; they can be a seasonal worker who made an average of $580 per month over the last six months; \u2026 they can be in school at least half-time, which means taking a few classes each semester; or they can do a mix of volunteering, school work or job training for a total of at least 80 hours per month.\u201d<\/p>\n

Enrollees exempt from this requirement include youth aged 18 and younger; adults 65 and over; pregnant people through one year after the pregnancy ends; parents with children under age 14; people with disabilities; people with serious health or mental health conditions, including substance use disorder; people released from jail or prison within the last 90 days; American Indians and Alaska Natives; and foster youth under age 26.<\/p>\n

Also beginning January 1, 2027, full Medi-Cal members between ages 19 and 64 who do not have dependent children younger than age 19 will need to renew their coverage twice a year instead of once a year.<\/p>\n

\u201cIf this applies to you, Medi Cal will send you a letter \u2026 and advance notices 90 days before all upcoming changes,\u201d said Sadwith.<\/p>\n

DHCS \u201cseeks to minimize the impact of these new requirements by automating the process as much as possible,\u201d he explained. \u201cFor example, if DHCS can determine a person\u2019s eligibility by using available data systems that we have, we will not have to ask any members for additional paperwork. That\u2019s our goal.\u201d<\/p>\n

He added that \u201cspecifically looking at the work requirements and the six-month renewal requirements \u2026 up to 3.4 million Medi-Cal members would be at risk of losing coverage, and so we are working right now to set up the processes and systems in place to try to reduce that number, because that\u2019s unacceptable to us.\u201d<\/p>\n

Another major change is the return of asset limits \u2014 mainly for older adult members and those with disabilities.<\/p>\n

Starting January 1, 2026, under federal law, \u201cMedi-Cal will again begin looking at assets when we review your eligibility,\u201d said Huang. \u201cThis does not apply to most children, parents, pregnant individuals or single adults, where eligibility is largely based on income.\u201d<\/p>\n

Assets considered by DHCS include \u201cthe amount of money you have in your bank accounts, your cash savings and anything above one home and one vehicle,\u201d she explained. \u201cCertain household goods and retirement accounts do not impact your Medi-Cal eligibility \u2026 and if you\u2019re already a Medi-Cal member, assets will be reviewed at your renewal, which begins next year.\u201d<\/p>\n

The new asset test will be $130,000 for one person \u2014 still dramatically higher than the old limit of $2,000 per person. Each additional household member adds $65,000 to that new limit, for a maximum of 10 members per household.<\/p>\n

What members should do<\/h2>\n

\u201cThe most practical message is to keep your contact information updated and your coverage on time,\u201d said Huang.\u201d I cannot emphasize enough that renewal will be extremely important, so that you\u2019re retaining your current level of benefits.\u201d<\/p>\n

Members can update their mailing address, email and phone number with their county, on\u00a0BenefitsCal.com<\/a>\u00a0or on\u00a0<\/a>CoveredCA.com<\/a>, depending on how they apply for coverage.<\/p>\n

\u201cIf you do miss a deadline, remember that you have three months to send in your missing paperwork and keep your coverage,\u201d said Huang. \u201cMedi Cal is still here \u2026 Please keep using your benefits and make sure you renew coverage when you get that yellow envelope. When you get those text messages from your county, please respond.\u201d<\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

BySelen Ozturk Sep 23, 2025 Medi-Cal...<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[16,9],"tags":[],"class_list":["post-75635","post","type-post","status-publish","format-standard","hentry","category-health","category-opinion"],"_links":{"self":[{"href":"https:\/\/lapost.us\/index.php?rest_route=\/wp\/v2\/posts\/75635","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/lapost.us\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/lapost.us\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/lapost.us\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/lapost.us\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=75635"}],"version-history":[{"count":1,"href":"https:\/\/lapost.us\/index.php?rest_route=\/wp\/v2\/posts\/75635\/revisions"}],"predecessor-version":[{"id":75636,"href":"https:\/\/lapost.us\/index.php?rest_route=\/wp\/v2\/posts\/75635\/revisions\/75636"}],"wp:attachment":[{"href":"https:\/\/lapost.us\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=75635"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/lapost.us\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=75635"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/lapost.us\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=75635"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}