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Medi-Cal Changes

As of January 2026, Medi-Cal eligibility for some immigrants are changing. Provide up-to-date information to your patients about Medi-Cal.

Who does the changes apply to:

In California, "Unsatisfactory Immigration Status" (UIS) is a technical legal term used by the Department of Health Care Services (DHCS). Whether or not the new changes will affect a patient is dependent on whether they are considered "unsatisfactory" or "satisfactory."

Please see the Immigration Status Categories Chart listed on the DHCS website.

Unsatisfactory Immigration Status

  • Undocumented Immigrants

  • DACA Recipients

  • Green Card Holders Under 5 YR Period*

  • PRUCOL Individuals

  • Temporary Visa Holders (21+)

  • Pending Legal Applicants

*Unless refugee/asylee status

Those under Satisfactory Immigration Status are entirely unaffected by the FFS transition, freezes, or premiums at this point in time. 

UIS with Full Coverage

UIS individuals within the 'Exempt Groups' still qualify for full scope Medi-Cal health plan (includes dental), regardless of whether they applied before the enrollment freeze in Jan 2026. Once they do not fulfill one of the following criteria, they may be eligible to renew their Medi-Cal for Fee-for-Service coverage (see more below). 

  • Children ages 0-18

  • Pregnant persons (including +365 days after pregnancy ends)

  • People under age 26 who were in foster care on their 18th birthday.

Those from this list will be under the Medi-Cal Fee-for Service (full scope) while they are eligible, and will not have to pay monthly premiums. 

Satisfactory Immigration Status

  • U.S. Citizens and Nationals

  • Green Card holders who passed the 5-year period

  • Approved Refugees, Asylees, and Cuban/Haitian Entrants

FFS vs. Medi-Cal?

Fee-for-Service and Medi-Cal Health Plans are both still paid for by Medi-Cal. Most services covered by health plans will also be covered by FFS. 

  • Enhanced Care Management and Community Supports will not continue in FFS Medi-Cal.

Fee-for-Service is a way Medi-Cal pays doctors and other care providers. The State of California will manage and pay providers for Medi-Cal benefits starting January 1, 2027. With exception to the monthly premium for certain individuals, the care itself is free and available to eligible members. This was a direct result of the new federal requirements that would disqualify some Medi-Cal members from the typical health plan. If you are in a Medi-Cal dental plan, you will stay in that Medi-Cal dental plan.

DHCS Notice of Additional Information: Fee-for-Service Transition âž”

Things to Know:

STARTING on January 1, 2027:

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While you are not in a Medi-Cal health plan anymore, you can go to ANY doctor or clinic take takes Medi-Cal Fee-for-Service. You must choose your own doctor, it will not be picked or assigned for you. 

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For Mental Health Care:

  • Therapy, counseling, medicine visits will be through Fee-for-Service.

  • Serious mental health care, or help with drug/alcohol use will still come from your county. 

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Medication stays covered through Medi-Cal Rx, and dental care stays the same. 

BEFORE January 2027

UIS members of Medi-Cal should ask their doctors: "Do you take Fee-for-Service?"

  • If YES: They can continue seeing their doctor, and they will be covered under Fee-for-Service by Medi-Cal.

  • If NO: They will need to find a different provider that takes Fee-for-Service. 

This includes whether or not a patient already scheduled an appointment in advance for January 2027 or after. If the provider does not accept Medi-Cal FFS, the patient will need to cancel the appointment and find a new provider who does accept FFS.

For help finding a new provider, call the Medi-Cal Helpline Monday – Friday, 8 a.m. to 5 p.m., at (800) 541-5555.

Patients can also search for Medi-Cal FFS providers through the online list provided by DHCS.

STARTING January 2027

UIS (and qualifying low-income members) members between the ages 19-64 will need to work, volunteer, go to school, or be in training to get or keep their Medi-Cal. Medi-Cal will send a letter to the member if this applies to them.

  • Pregnant people, parents/caregivers of children ages 0-13, people with disabilities, serious physical or mental health conditions, substance use problems, and more are excluded from this requirement.

To keep their Medi-Cal, they must do one or more of the following:

  • Work at a job and earn at least $580 a month

  • Be a seasonal worker and earn an average of $580 a month over the last six months

  • Be in a job training program (that helps you learn skills to get a job) for at least 80 hours a month

  • Volunteer or do community service for at least 80 hours a month

  • Go to school at least half-time (usually two or three classes, or about six to eight credits each semester)

  • Do a mix of the activities above so the total is at least 80 hours a month or at least $580 a month

Medi-Cal will also pay for fewer months of medical bills from before you applied. If this rule applies to you, Medi-Cal will send you a letter.

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  • Adults (ages 19-64) Without Children: Medi-Cal will only look back and pay for 1 month of bills from before the application month.

  • Everyone Else (Children, Parents, Pregnant Individuals, Seniors 65+): Medi-Cal will look back and pay for up to 2 months of bills from before the application month.

STARTING March 2027

The "Six-Month Eligibility Check" starts on March 1, 2027, which means that some Medi-Cal members (adults ages 19 to 64) will have their eligibility reviewed by the state twice a year instead of once a year.

Every six months, the county will check to confirm that:

  1. The household income is still below the limit.

  2. They are meeting the mandatory federal work/community engagement requirements.

January & February 2027: If the renewal happens during these months, members get a temporary pass. They will keep the 12-month eligibility cycle for 2027 and switch to the 6-month check in 2028. 

If their annual renewal is normally due in March 2027 or later, they will submit it as usual—but the next eligibility check will be scheduled just 6 months later.

Members will have a 90-day grace period before losing grandfathered status permanently and cannot get full-scope Medi-Cal back.

STARTING July 2027

With exception to the exempted UIS individuals mentioned above (children, pregnant people, fostered children), most UIS members will keep full Medi-Cal (under FFS) and move to emergency-only dental.​

These individuals will also be required to pay a monthly premium ($30) to keep their full-scope Medi-Cal FFS benefits.

  • If they miss any monthly premium payments, there is a 90-day grace period to pay the full amount. 

  • If they do not pay the full amount owed within 90 days, the will lose their full access Medi-Cal and be downgraded to "Restricted-Scope Medi-Cal," which only covers emergency medical services, pregnancy-related care, and long-term nursing home services.

STARTING October 2028 

Starting October 2028, the following adults may need to pay a copayment for some types of care, treatments, or tests. 

Adults (19-64) who:

  • Are not pregnant

  • Are not on Medicare

  • Make more than $15,560 a year

Under state bill AB 2208, the copayment will be set around $0.01 to protect low-income patients. Doctors and healthcare providers are also permitted to waive these copayments. 

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Regardless, members will not pay more than 5% of their household’s income in a year.

Important Steps to Keep Coverage 

  • Find out when Medi-Cal needs to be renewed.

  • Keep your contact information up to date with Medi-Cal to avoid missing important notices.

  • Watch your mail, phone, text messages and email. The county uses all of those ways to contact members, so it’s important to monitor them all.

  • Respond to any letters from your local county Medi-Cal office and any other reminders from your health plan, community groups, or other trusted sources of information.

  • Continue going to your regular doctor appointments and don’t skip check-ups.

For more resources that broadly serve TJI and LGBTQ+ immigrant patients, please refer to the "LGBTQ+" page under "For Families & Patients." It includes free and affordable gender-affirming care, legal assistance, and intersectional community groups.  

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