Medi-Cal Changes Set to Reshape Coverage and Eligibility in 2027

-Editorial 

Federal and state policy changes will alter eligibility requirements, health care delivery, and some benefits for certain Medi-Cal members beginning in 2027, while state officials said most members will not be affected.

Medi-Cal, California’s Medicaid program, will implement new federal work requirements, more frequent eligibility reviews, changes to the delivery system and new requirements affecting some immigrant members.

Tyler Sadwith, state Medicaid director at the California Department of Health Care Services, said the implementation timeline was revised following adoption of the state’s 2026-27 budget.

“Some of the dates of implementation that we previously shared with you all have been updated,” Sadwith said during a DHCS media briefing.

Beginning Jan. 1, 2027, some Medi-Cal members ages 19 to 64 without children or disabilities will have to meet new federal work and community engagement requirements. Members can qualify by working and earning at least $580 per month, or by completing at least 80 hours per month of qualifying activities, including volunteering, attending school at least half-time, or participating in job training.

Exemptions include certain pregnant and postpartum people, parents and caretakers of children ages 0 to 13, people with disabilities or serious health conditions, Medicare recipients, American Indians and Alaska Natives, certain former foster youth and people recently released from incarceration.

Beginning March 1, 2027, some adults ages 19 to 64 will have their Medi-Cal eligibility reviewed twice a year instead of annually. Certain groups, including pregnant and postpartum people, American Indians and Alaska Natives, and some former foster youth, will continue with annual reviews.

On Jan. 1, 2027, some Medi-Cal members, including certain immigrants, will also transition from managed care plans to fee-for-service Medi-Cal.

Sadwith said the change affects how members access care but does not require them to pay for covered services. Members will be able to continue seeing providers that accept fee-for-service Medi-Cal.

Some services available through managed care, including enhanced care management and certain community supports, will no longer be available to members who transition to fee-for-service. Other services, including community health worker and doula services, will remain available.

DHCS plans to provide transition assistance, including a nurse advice line and community navigators.

Additional changes are scheduled for July 1, 2027.

Yingjia Huang, deputy director for health care benefits and eligibility at DHCS, said the state budget delayed several previously announced changes.

Beginning July 1, 2027, certain immigrants, including some refugees, asylees, humanitarian parolees and survivors of domestic violence or human trafficking with pending immigration cases, will generally be limited to pregnancy-related care and emergency services under changes to federal Medicaid funding rules. They will continue receiving state-funded full-scope Medi-Cal through June 30, 2027.

Some adults will also lose full dental benefits based on immigration status, although emergency dental care will remain covered. Children ages 0 to 18, pregnant people through one year after pregnancy, and former foster youth under age 26 will continue receiving full dental benefits.

Certain immigrant Medi-Cal members ages 19 through 59 also will be required to pay monthly premiums of $30 to $50 to maintain full-scope coverage. Those who do not pay could have their coverage changed to restricted-scope Medi-Cal, which generally covers emergency and pregnancy-related services.

Children, pregnant people through one year after pregnancy, and certain former foster youth will not be subject to the premiums.

Officials also reminded members that some immigrant eligibility changes already took effect Jan. 1, 2026. Certain undocumented adults who were not enrolled in full-scope Medi-Cal at that time can no longer enroll in the program. Those already enrolled can remain covered if they continue to meet eligibility requirements and renew on time.

Members are encouraged to keep their contact information current with their county Medi-Cal office, respond promptly to notices, and renew coverage by the deadline. Renewal packets continue to arrive in yellow envelopes, and members can renew online through BenefitsCal.

“Medi-Cal is still here,” Huang said. “Most members will actually not see the changes that we talked about.”

Members who are unsure whether the changes apply to them should consult DHCS or contact their county Medi-Cal office.