Changes are coming to Medi-Cal: What you need to know

 Medi-Cal continued coverage - Courtesy health/consumer.org

California's Medi-Cal program, the state's version of Medicaid, is set to undergo sweeping eligibility and benefit changes beginning in January 2026.

State officials confirmed in a fact-filled briefing that the changes affecting the program will extend through 2028 and consist of a combination of federal requirements and state budget adjustments.

Medi-Cal currently covers over 14 million Californians and the upcoming changes will affect the way many of them access care, especially those in immigrant and mixed-status households.

In speaking to a group of journalists, during a September 2025 briefing hosted by American Community Media, Tyler Sadwith, state medicaid director, in the California Department of Health Care Services (DHCS) said that these changes involve a tightening of rules, most notably affecting undocumented adults, older beneficiaries and people with disabilities.

He called the Medi-Cal program “truly a lifeline for children, older adults, people with disabilities, pregnant women and millions of low income Californians. Medi-Cal benefits include services like visits with your doctor, hospital stays, emergency department care, mental health services, prescriptions, transportation to appointments and so much more.”

Federal changes coming to the program

There are two types of changes coming to the program. One group of changes is driven by the  federal government’s newly enacted  H.R.1- 119^th Congress (2025-2026) also known as the One Big Beautiful Bill, which Imposes new rules that mandates, beginning on January 1 2027 that some adults between the ages of 19 and 64 work, volunteer, be in school or participate in job training for at least 80 hours every month to keep their medical coverage.

Sadwith said that the participation in work or in volunteering or community engagement has to be documented in a way that the Department of Health Care Services can confirm it

 However, there are many exemptions in that children, age zero to 18 are not subject to these new requirements. Adults age 65 and older are not subject to these requirements. Pregnant women, new parents and mothers, for one year after the baby is born or the pregnancy ends, are not subject to these requirements. Additional exemptions include parents with children under the age of 14 and people with disabilities.

If a Medi-Cal member is required to work or volunteer under these new federal rules, and they do not meet the rules, they could lose their medical coverage.

“These are major shifts,” Sadwith said. “They are coming from the federal law that Congress passed and the president signed, and California is working to implement them in a way that protects members and minimizes the impact on members to the maximum extent that we can.”

There will also be six month renewal requirements instead of annual renewals, which Sadwith admitted, doubles the paperwork, and increases the chance that people lose coverage simply due to missing forms, not updating information or not receiving the paperwork in the mail

The second big change involves co-payments, which will require some adults to pay a small fee for certain services like specialty care or certain tests. However, core services like emergency care, regular primary care, checkups, prenatal care, pediatric care, mental health services and substance use treatment will not require a co-payment and will remain free.

State changes to Medi-Cal

Yingjia Huang, deputy director for Health Care Benefits & Eligibility for the DHCS discussed the state changes and she emphasized that most medical members are not impacted by the state level changes, but they're for the smaller group she said that is impacted.

Huang said that some changes apply to undocumented adults who do not have an immigration status that qualifies them for federal medical and who are not pregnant. The new state changes will affect undocumented adults 19 and older or newly applying to the program on January 1. 2026.

Starting on this date, the second change will affect undocumented adults or adults who do not have the immigration status that qualifies them for federal Medicaid. In other words, the dental benefit will be eliminated for undocumented adults, 19 and above. She stressed that  children and pregnant individuals are not impacted by this change.

However, those in these groups will still have access to emergency dental such as treatment for intense pain, infection or extractions. Those services are considered by the doctor's determination. They will still be covered under medical coverage. It’s just the regular routine dental visits that will not be covered.

Also undocumented adults 19 through 59 with certain immigration statuses that do not qualify under federal Medicaid will be required to pay a premium of $30 a month, which

will ensure continue access to benefits such as doctor's visits, prescriptions, hospital care, mental health treatment and vision.

The last change imposed by Medi-Cal new rules if the asset test. The new asset limit for eligibility is set at $130,000 for a single person, with an additional $65,000 allowed for each additional household member, up to a maximum of ten. Officials noted that many assets remain exempt and will not count toward this limit, including an individual's primary home, one vehicle, household goods, and certain retirement accounts.

Current members whose eligibility is based on age, disability, or long-term care needs will have their assets reviewed at their annual renewal date after the 2026 start date.

Again, both Sadwith and Huang emphasized that “children and pregnant people, regardless of their immigration status remain eligible for full scope MediCal .This includes medical care, full dental coverage, mental health care, prescription drugs and other essential services.

Children under 18 will continue to have full scope Medi-Cal including dental care, no matter their immigration status, pregnant people will also continue to have full scope dental, full scope MediCal, including dental care throughout their pregnancy and for one year after their baby is born or their pregnancy ends.

Assurances from state officials

Both officials also gave assurances that the Department of Health Care Services (DHCS) would provide needed assistance to keep eligible Medi-Cal members enrolled.

Sadwith said, “We will be providing members with advanced notices 90 days before upcoming changes, and will be working in partnership with trusted members of the community to spread information, make people aware of changes, and offer resources and tools to help people stay connected to care and keep their medical the department is committed to keeping members informed, to protecting families and to help making sure that people know their options.”

Huang said, “We want Medi-Cal members to know that we still highly encourage them to take advantage of their health care benefits, including preventative care like seeing a doctor really. The message here is, please go and use your benefits."

For most Medi-Cal members, she said that nothing will change.

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