25-1405m Upcoming Medi-Cal Eligibility and Benefits Changes: What Providers Need to Know

January 1, 2026

Reinstatement of asset test for older adults and people with disabilities

• Asset limit: $130,000 for one person; add $65,000 per additional household member (max. 10 people).
• Countable assets: bank accounts, cash, multiple homes or vehicles.
• Excluded assets: primary residence, one vehicle, household items, certain savings (e.g., retirement accounts).
• Impacted individuals will have assets reviewed annually at renewal.

• Adults ages 65 and older who meet household income limits.
• Individuals with disabilities.
• Nursing home residents.
• Families whose income exceeds federal tax rules.

• Be aware of annual asset reviews at patient renewal; and
• Inform affected patients about the new asset review requirement.

Enrollment freeze for adult immigrants

• Patients who currently have Medi-Cal can maintain coverage if they renew annually and meet Medi-Cal rules.
• Failure to renew or meet rules may result in restricted coverage for emergency, pregnancy-related, or nursing home care.
• Children under age 19 and pregnant individuals remain eligible for full-scope
  Medi-Cal.
• Adult immigrant who newly apply after January 1, 2026, qualify for restricted scope coverage only.

Undocumented adults or lawfully present adults ages 19 and older who are not pregnant.

Advise patients to complete annual renewals and follow Medi-Cal rules.

July 1, 2026

Loss of dental coverage for adult immigrants

• Urgent dental care (serious pain, infections, extractions) remains covered.
• Pregnant individuals retain full dental coverage during pregnancy and for one year postpartum.

Lawfully present adults ages 19 and older who are not pregnant or postpartum. This includes those in certain immigration categories (e.g., green-card holders for less than five years, permanent residence under color of law (PRUCOL), state-funded or humanitarian programs).

Inform patients about upcoming dental coverage changes and explain that only urgent dental care will remain covered.

January 1, 2027

Work requirements for adults

• Patients may need to work, volunteer, attend school or participate in job training to maintain eligibility.
• Noncompliance could result in loss of Medi-Cal coverage.

The following are exempt:

• Children, older adults (ages 65 and older).
• Pregnant/postpartum individuals.
• Parents of children ages 13 or younger.
• Persons with disabilities.
• Individuals with serious health conditions.
• Recently released from incarceration.
• Medicare beneficiaries.
• American Indians/Alaska Natives.
• Foster youth under age 26.

Adults ages 19–64 who are not exempt.

• Inform patients about meeting requirements before renewal dates; and
• Advise them to watch for letters from
  Medi-Cal regarding work requirements.

January 1, 2027

Six-month eligibility checks for adults

• Patients will need to renew Medi-Cal every six months.
• Failure to submit forms on time may result in coverage loss.

Adults ages 19–64 without dependent children under age 19.

Remind patients to submit forms promptly to avoid coverage loss.

Reduced retroactive coverage for adults

Retroactive coverage for past medical bills decreases from three months to one month.

Adults ages 19–64 without dependent children under 19 on or after January 1, 2027.

Advise patients that retroactive Medi-Cal coverage will pay up to one month.

Reduced retroactive coverage for all others

Retroactive coverage for past medical bills decreases from three months to two months.

Patients ages 0–18 or 65 and older on or after January 1, 2027.

Advise patients that retroactive Medi-Cal coverage will pay up to two months.

July 1, 2027

Monthly premiums for adult immigrants

• Patients may need to pay a small monthly premium to maintain full-scope
  Medi-Cal.
• Nonpayment may result in restricted coverage (emergency, pregnancy, nursing home).

Adult immigrants ages 19–59 who are not pregnant and in certain immigration categories.

Inform patients about monthly fee obligations.

October 1, 2028

Copayments for adults

• Small copayments may apply for certain specialty services and treatments.
• Annual copayments capped at 5% of household income.
• No copayments for: Community health centers, emergency care, routine checkups, prenatal/pediatric care, mental health, and substance use disorder treatment.

Adults ages 19–64 who:

• Are not pregnant.
• Are not enrolled in Medicare.
• Have income above $15,560 per year.

Review copayment policies with patients.