Changes to Medi-Cal ahead

Changes to Medi-Cal Ahead: What You Need to Know  

July 1, 2026

Breaking News! The California state budget has just been approved. The result is some positive changes for Medi-Cal beneficiaries!

Immigrants with certain statuses—such as refugees, victims of domestic violence, etc.—officially known as UIS, can now keep all their dental benefits through July 1, 2027.

In addition, the current asset limit for Medi-Cal eligibility remains at $130,000 for one person and an additional $65,000 for each additional household member through July 1, 2027.

The phase-out of full Medi-Cal coverage for vulnerable individuals on humanitarian grounds—including asylum seekers, survivors of human trafficking, survivors of domestic violence, and other similar groups referred to as “UIS” under the law—is postponed until July 1, 2027.

Some Medi-Cal members with certain immigration statuses will need to pay a monthly fee (called a premium) to keep their full-scope Medi-Cal starting July 1, 2027.  If you don’t pay, your Medi-Cal will change to restricted-scope, which only covers:

  • Emergency care
  • Pregnancy-related care
  • Nursing home care

You will not have to pay a premium if you are:

  • A child (0-18)
  • Pregnant (through pregnancy and up to one year after)
  • Under age 26 and were in foster care on your 18th birthday
  • Adults (age 19-64)

Some members with certain immigration statuses will get their Medi-Cal care through Fee-for-Service (FFS) Medi-Cal instead of a health plan starting July 1, 2027. This change affects how you get care, not whether you stay eligible for and covered by Medi-Cal.

Who this applies to:

  • People who are undocumented.
  • Some people with green cards who are in the five-year waiting period before they can get full-scope federal Medicaid.
  • People considered Permanently Residing in the U.S. Under Color of Law (PRUCOL), meaning they are allowed to stay in the U.S. even without formal immigration status.

Important to Know:

  • If you renew on time, you will stay covered. If you don’t, you may lose coverage and not be able to get it back.
  • With “Fee-for-Service” Medi-Cal will still pay for your care.
  • Your medicines will still be covered by Medi-Cal Rx.
  • You can choose any doctor or clinic that accepts FFS Medi-Cal, but you will no longer have a health plan managing your care.
  • DHCS will offer new care coordination and navigation support to help you during this change Some examples include:
    • A nurse advice line with trained staff 
    • Community-based navigators 
  • You will get more information before this change happens.

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In the coming months, many Medi-Cal beneficiaries will see changes in their eligibility process for coverage. This is based on new federal law enacted in 2025 in President Trump’s signature tax package. This section will discuss some of the key issues that beneficiaries should be aware of as the eligibility process occurs. 

1. Renewal notices and follow up requests for information.

Even under current law, Medi-Cal does not automatically renew each year. The process of renewal is called Medicaid redetermination. Under the new requirements states have the authority to require renewal of benefits every 6 months. It remains to be seen if Medi-Cal will follow that approach or maintain the one year window. Regardless, you may be required to provide the following information:

  • Income
  • How many people live in your household
  • Current address and phone number, email
  • Employment
  • Other insurance coverage

It is important that you respond to all notices from Medi-Cal seeking this information. Failure to respond could jeopardize your coverage. Please contact the state Medicaid program, your local chapter or the Bleeding Disorders Council of California if you need assistance with any request. Above all, do not ignore it.

2. Work Requirements

Under work requirements, beneficiaries are responsible to show that they qualify for Medi-Cal by working a certain number of hours (80 per month) and meeting several other criteria. These include:

  • If you are not working, are you actively looking for work?
  • If available, are you participating in any job training?
  • Are you engaged in volunteering or other “community engagement?”

Importantly, there are exemptions that you might qualify for: these include pregnancy, having a serious medical condition, and caring for young children. It is not yet known how having hemophilia or other bleeding disorders will be treated in determining whether you qualify for the serious medical condition exemption.

3. Special Life Changes

It has always been important to notify Medi-Cal of significant life events such as divorce, pregnancy, changes in income, loss of employment, and changes in household size. Notification will become even more critical later this year and into 2027 as new eligibility processes are implemented.

4. What happens if I lose coverage?

If you lose coverage under the new work requirements or for some other reason, you may have other options. These may include:

  • Qualifying under an alternate eligibility category
  • Eligibility for CHIP (under 18)
  • New employer coverage
  • Covered California (which may offer subsidized coverage depending on your income)

5. What You Can Do Now

These potential changes are causing much fear and anxiety among the bleeding disorders community about their Medicaid coverage. With regard to California, it is still unknown exactly how the Department of Health Care Services (DHCS) will implement the required changes. With that said, following the steps above will enhance the chances of keeping coverage. The last thing you want is to lose coverage because you did not keep your address up to date or failed to respond to a notice. The Bleeding Disorders Council of California continues to work with other rare disease organizations, DHCS, and national organizations to understand the final implementation of these changes. We stand ready to assist you with specific challenges you may face in your enrollment process.

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