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.
For further reference, you can visit the DHCS Medi-Cal website
