Medi-Cal Changes: Federal (H.R.1) and State Updates

Step 1.Work and Community Engagement Requirements

• Mandatory Participants: Adults aged 19–64 who get Medi-Cal through the new adult group coverage without children under 13 must complete at least 80 hours per month of qualifying activities

• Qualifying Activities: Includes working at a job earn at least $580 per month, or participating in one of the following for at least 80 hours a month: volunteering, community service, attending school, or participating in job training

• Exemptions: Qualifying individuals can bypass these work rules if pregnant, caring for a child age 13 or younger or a child with a disability, meeting the criteria for "medical frailty" (such as a severe disability, substance use disorder, or complex medical condition)

Follow Link to DHCS website for more details: https://www.dhcs.ca.gov/medi-cal/updates/medi-cal-changes/

Step 2.Reduction to Retroactive Medi-Cal Coverage 

• Shortened Opportunity: Medi-Cal will cover fewer months of past medical bills incurred before an applicant’s official application date. This is referred to as retroactive Medi-Cal coverage

• Who this Applies to:

  •  New Adult Coverage Group: Adults ages 19-64 who get Medi-Cal through the Affordable Care Act (ACA) expansions, including those affected by the immigrant-related changes addressed below will have their eligibility for retroactive coverage limited to one month

  • All Other Members: All applicants who get Medi-Cal and do not fall into the New Adult Coverage Group will have their eligibility for retroactive coverage limited to two months

Step 3.Transition to Fee-for-Service (FFS) Care

• Who it Applies to: Individuals who do not have satisfactory immigration status, certain green card holders within their initial five-year waiting period, and individuals considered Permanently Residing in the U.S. under Color of Law (PRUCOL)

• Coverage Impacts: Individuals will not lose coverage.  hey will transition out of receiving healthcare coverage through a Medi-Cal Managed Care Plans (MCP) such as Kaiser, CalVIVA, or Anthem and will be moved into Medi-Cal Fee-for-Service (FFS)

• What does this Mean: "Fee-for-Service” does not mean you pay. Medi-Cal still pays for your care.   Individuals will need to seek medical services through doctors or clinics that accept Medi-Cal FFS.  

Follow Link to DHCS and utilize the FFS Locator Tool to find a FFS provider in your area: https://www.dhcs.ca.gov/medi-cal/find-care/

Follow Link to DHCS to learn more about the FFS Transition: https://www.dhcs.ca.gov/medi-cal/updates/fee-for-service-transition/

Step 4.Six-Month Redeterminations for the New Adult Coverage Group

• Who this applies to: Adults in the New Adult Coverage Group, ages 19-64 who get Medi-Cal through the Affordable Care Act (ACA) expansions, including those affected by the immigrant-related changes.

*Individuals who do not fall within this coverage group will continue to be required to renew Medi-Cal coverage annually

• How it works: The redetermination process begins 2 months prior to the renewal due date, when redetermination packets and notices are sent to households whose Medi-Cal does not auto-renew. This means that individuals in the New Adult Coverage Group, who have renewal due dates of March 2027 forward, will be subject to the new six-month renewal period

Follow Link to DHCS for more information about the new renewal process: https://www.dhcs.ca.gov/medi-cal/updates/medi-cal-changes/#adults-age-19-64

Step 1.Transition to Restricted Scope for Non-Citizen Populations

• Who this applies to: Individuals granted withholding of deportation or removal, humanitarian parolees, and Visa holders under refugee, asylee, survivor of domestic violence or survivor of human trafficking

• The change: As of July 1, 2027, these individuals will only be eligible to restricted scope (emergency and pregnancy-related services only)

• Impact: These individuals will lose coverage for regular doctor or clinic visits, and prescription coverage.  They will be required to pay full out of pocket costs for any doctor, clinic or prescription to the medical provider.

Step 2.Monthly Premiums

Who this applies to: Individuals in the New Adult Coverage group who are not pregnant and are either undocumented or do not have satisfactory immigration status

The change: If individuals who meet these criteria wish to keep full scope coverage, they will be required to pay a monthly fee

Impact: Failure to pay the monthly premiums will result in coverage to drop to restricted scope services only

Follow the link to the DHCS website to learn more about these changes: https://www.dhcs.ca.gov/medi-cal/updates/medi-cal-changes/

Step 3.Asset Limit Reduction

Who this applies to: Adults age 65 or older, disabled (physical, mental, or developmental), living in a nursing home, or those in a family that makes too much money to qualify under federal tax rules

The change: Starting July 2027, the most you can own (asset limit) is $21,000 for one person; $31,000 for two people; for every extra person in your house (up to 10 people) add then $1,550

Countable Assets:  Bank accounts, cash, more than one house or vehicle

Assets that Don’t Count:  The home you live in, one vehicle, household items, some savings, like retirement accounts

Follow the link to the DHCS website to learn more about these changes: https://www.dhcs.ca.gov/medi-cal/updates/medi-cal-changes/#older-adults-and-people-with-disabilities

Step 4.Dental Benefit Changes