New work requirements, more frequent renewals, and premiums for undocumented immigrants will reshape the program between 2026 and 2028. State officials urge calm and emphasize that pregnant women and minors will remain protected.
The health of millions of people is once again at risk in the United States. New federal demands and budget adjustments could push up to 3.4 million Californians out of Medi-Cal. Despite efforts by state authorities and labor rights organizations, the outlook appears discouraging for certain groups.
At a conference organized by American Community Media, participants discussed the impact of these changes and proposed short- and long-term solutions to prevent people from losing coverage.
Federal changes: work requirements, renewals, and copays
Tyler Sadwith, California’s Medicaid Director at the Department of Health Care Services (DHCS), tried to offer a glimmer of hope. “We are working right now to establish the processes and systems needed to try to reduce that number,” he said. For him, the situation is unacceptable because “it not only involves the health of program beneficiaries, but it affects entire family and community structures.”
Sadwith stressed the importance of maintaining constant communication about Medi-Cal’s requirements, reminding the audience that this is not a minority issue: the program serves nearly 15 million Californians, or one-third of the state’s population.
One of the most significant changes will be the introduction of work requirements. Starting in 2027, adults between 19 and 64 will have to prove at least 80 hours per month of employment, volunteering, studies, or job training to keep their coverage. “Some options include working 80 hours a month; being temporary workers who have earned an average of $580 a month over the past six months; participating in training programs; or volunteering,” the official explained.
Another major adjustment will be requiring adults without children to renew Medi-Cal twice a year, increasing the risk of losing coverage due to bureaucratic hurdles. “Adults without children will need to renew Medi-Cal twice a year, which increases the risk of losing coverage due to paperwork,” he warned. To reduce this impact, Sadwith said DHCS would work to automate the process. “If the Department of Health Care Services can determine someone’s eligibility using available data systems, we will not need to request additional documentation,” he noted.
The director also addressed concerns over migrant data protection. “Immigration data from enrollees cannot be used for immigration enforcement purposes. Following recent court rulings, the federal government is barred from sharing Medi-Cal information with agencies such as the Department of Homeland Security,” he emphasized.
Finally, Sadwith announced the introduction of copays for certain specialized and emergency services. Although pediatric and prenatal care will remain free, he warned that even minimal charges could harm vulnerable households. “Even if small, these fees can be an obstacle for low-income Californians,” he acknowledged.
He added that DHCS would send notifications 90 days in advance, work with community organizations, and provide resources in multiple languages to prevent families from losing coverage. “Our department prioritizes protecting families, and we want people to know their options” he concluded.
State changes: restrictions and premiums for undocumented immigrants
Yingjia Huang, DHCS Deputy Director for Benefits and Eligibility, outlined the state-level measures that will take effect between 2026 and 2028, in addition to federal modifications.
The first adjustment will be a freeze on new enrollments for undocumented adults, beginning January 1, 2026. From that date on, first-time applicants will only be eligible for emergency coverage. The exceptions will be pregnant women and minors. “Undocumented women during pregnancy will be able to keep access to emergency Medi-Cal and receive full coverage throughout pregnancy and up to one year postpartum,” Huang clarified.
Starting July 1, 2026, undocumented adults will lose access to routine dental coverage, though they will still be eligible for urgent care, infections, or severe pain.
The most controversial measure will arrive on July 1, 2027, when undocumented adults over 19 will be required to pay a $30 monthly premium to maintain full coverage (except dental). “We want to be clear: if they do not pay within 90 days, their coverage will be reduced to emergency Medi-Cal,” Huang warned.