New work requirements, eligibility checks and immigration rules take effect through 2028

The California Department of Health Care Services (DHCS) confirmed this week that a wave of federal and state changes to Medi-Cal, the state’s Medicaid program, will begin rolling out in January 2027, after the 2026–27 state budget pushed back several implementation dates originally expected this year.

Speaking during a media briefing, State Medicaid Director Tyler Sadwith and Deputy Director for Healthcare Benefits and Eligibility Yingjia Huang walked reporters through a revised timeline of changes that will affect millions of the program’s roughly 14 million members, while stressing that most enrollees will not be impacted and that Medi-Cal “is still here.”

“Please keep using your benefits, please keep your contact information up to date, and please respond quickly to notices that you receive from Medi-Cal,” Sadwith told reporters, describing it as the single most important message for members going forward.

Changes beginning January 2027

Starting January 1, 2027, some adult members ages 19 to 64 without children or disabilities will need to report or demonstrate work, school, volunteering or job-training activity to keep their coverage under a new federal requirement. Officials said the state is prioritizing automatic verification using existing databases so that most members will not need to take any action, though roughly 2 million people are expected to receive notices requesting additional information.

That same month, approximately 2 million members will transition from Medi-Cal managed care plans to fee-for-service Medi-Cal because of a federal mandate. Officials emphasized the shift changes how members access care but does not require them to pay for services; however, members will lose access to certain managed-care-only benefits, such as enhanced care management and community supports, while retaining others like community health worker and doula services.

Huang, who leads healthcare benefits and eligibility policy at DHCS, said the state timeline itself has shifted to give families breathing room. “The updated timeline gives our Medi-Cal members more time before these changes do go into effect,” she said, adding that the department wants families to “understand the new dates and what, if anything, that they need to do.”

Beginning March 1, 2027, some adults ages 19 to 64 will have their Medi-Cal eligibility checked twice a year instead of once.

Changes beginning July 2027

Huang outlined a second set of changes taking effect July 1, 2027:

• Federal reclassification of certain immigration statuses — including refugees, asylees, humanitarian parolees and certain trafficking survivors — will limit affected members to pregnancy-related and emergency services only, after a year of state-funded full-scope coverage.
• Some adults will lose full Medi-Cal dental benefits based on immigration status, though emergency dental care will remain covered.
• Certain immigrant members ages 19 to 59 will be required to pay a monthly premium of $30 to $50 to keep full-scope coverage; nonpayment could result in a shift to emergency- and pregnancy-only coverage.

A further federal change taking effect October 1, 2028, will introduce co-payments for certain non-pregnant adults ages 19 to 64 earning more than $15,560 a year, applying to specialty care, treatments and tests, but not to emergency care, checkups, pregnancy care, pediatric care, or mental health and substance use treatment.

Protections that remain unchanged

Officials reiterated that children ages 0 to 18, pregnant people (through one year postpartum) and former foster youth under age 26 remain eligible for full-scope Medi-Cal regardless of immigration status and are exempt from the new work requirements, premiums and dental restrictions.

Since January 1, 2026, undocumented adult immigrants can no longer newly enroll in full-scope Medi-Cal, though those already enrolled will retain coverage as long as they renew on time. Members who miss a renewal have three months to correct the issue before being moved to restricted-scope coverage covering only emergency, pregnancy and certain nursing-facility care — a status DHCS says cannot later be upgraded back to full scope.

What members should do

DHCS urged members to:

• Keep mailing address, phone number and email current with their county Medi-Cal office, reporting changes within 10 days.
• Open and respond promptly to letters, emails and text messages — especially renewal packets, which arrive in yellow envelopes.
• Renew coverage on time, either by mail or online at BenefitsCal.com.
• Check the DHCS Medi-Cal Changes website to determine whether specific changes apply to them.

Officials said county-level navigators and, soon, federally qualified health clinic navigators will be available to help members complete renewal paperwork, which is offered in 19 threshold languages as well as large print and braille.

Addressing misinformation, Sadwith said the most damaging myth circulating in communities is that Medi-Cal has closed to new enrollment altogether. “The door is not closed. It remains open,” Huang added, encouraging eligible individuals to apply through BenefitsCal.com or Covered California.

Asked what single message she most wanted to send to Medi-Cal members, Huang pointed back to correspondence from the state: “Make sure if Medi-Cal sends you anything, whether it be through mail, text messages, or email, please make sure you’re opening it and reading it thoroughly.” She added that members who need materials in another language should “call the county so that you can access the information.”

For more information, members can visit the DHCS Medi-Cal Changes website or contact their county Medi-Cal office.