Facing Medi-Cal Coverage Loss? Here’s What Californians Should Know Now

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When a county ends Medi-Cal coverage over missing renewal paperwork, the member has 90 days from the ending date to send it in. When the missing paperwork arrives within those 90 days and the member still qualifies, the county must restore coverage back to the day it ended, with no gap. A notice that coverage is ending is not always the last word.

What helps depends on the county’s reason for ending coverage: sending in missing renewal documents, appealing an incorrect decision, or arranging replacement insurance.

Start with the reason on the notice

Medi-Cal, California's Medicaid program, provides free or low-cost health coverage to people with limited incomes.

The county handles existing Medi-Cal cases, and eligibility depends on factors including income, household size, age, pregnancy and disability. Read the reason for the action, the effective date and the response instructions before choosing a remedy. Ask the county whether it needs a missing document, has found a change in eligibility, or is referring to a change in the health plan.

The Department of Health Care Services (DHCS), which runs Medi-Cal, says members who do not meet the new work rule or six-month eligibility checks will get a written notice explaining what to do before coverage ends and how to appeal. Answer a request for more information even when the rule seems not to apply, and contact the county to correct the case or establish an exception.

A missed renewal can be repairable

Counties can check information they already have, in eligibility systems and other benefit cases, to confirm that a member still qualifies without asking the member for more proof. DHCS says county letters tell members whether Medi-Cal was renewed automatically or more information is needed. If an automatic-renewal notice is accurate, the member does not need to sign and return it; inaccurate information must be reported.

BenefitsCal, the official benefits website, allows members to complete forms, report changes, upload documents and read notifications. The county may request renewal forms, pay stubs and other information, according to DHCS member guidance. Keep the county mailing address, phone number and email up to date, and check the actual request for what is missing. Save the submission confirmation or a copy of the receipt so there is a clear record for a follow-up conversation.

After coverage ends for failure to submit renewal paperwork or requested information, California allows up to 90 days from the effective termination date to supply what is missing. If the county receives the required information in that period and finds the person eligible, it must restore Medi-Cal back to the termination date without a break in coverage or a new application. That route fixes an incomplete renewal. It does not help if the completed review finds that income or another factor makes the person ineligible.

Challenge a wrong decision before coverage stops

A member who disagrees with an action by the county or DHCS can request a State Hearing within 90 days; after that, the member must show a good reason for asking late. The California Department of Social Services counts the ordinary 90 days from the agency action, often the date it mailed or gave the notice, usually shown as the notice’s Date or Mailing Date. For eligibility decisions made at renewal, including terminations, a temporary extension allows 120 days from the mailing date of the Notice of Action, as the written notice is called, and remains in effect until further notice. That extension does not cover new applications, medical exemption requests or requests concerning a particular treatment or service. Those deadlines are separate from the 90 days for missing renewal paperwork, and they decide only whether a hearing request is on time. Keeping coverage during the hearing depends on a different deadline, so the longer filing period is not a reason to wait if coverage is about to end.

When the agency sends the advance notice federal rules require, a member who requests a hearing before the action date, when the change takes effect, generally keeps services until the hearing decision. The exception applies when the hearing finds that the only issue is one of federal or state law or policy and the agency promptly says in writing that services will stop or be reduced while the decision is pending. If the hearing decision upholds the agency’s action, the same rule lets the agency seek repayment for services provided only because of the pending hearing. Request continued coverage, also called aid pending, when filing, and ask the hearing office how the rule applies to the notice. If the effective date has already passed, ask about available restoration and appeal options instead of assuming that every remedy is closed.

State Hearing requests can be made online, by calling 800-743-8525, or in writing using the back of the Notice of Action or a separate request. A requester who needs language assistance should identify the language and dialect so the hearing office can arrange help. Ask the office for help identifying the proper process if the notice concerns a plan service denial rather than county eligibility.

Which rules are changing, and when

Separate rule changes are also arriving in stages through 2027, among them asset limits, immigration-related limits, work requirements and six-month renewals, and each applies only to certain groups.

Age, immigration status or disability alone does not show which rules apply, so ask the county which group is recorded on the case.

Asset limits apply to particular eligibility groups

Asset tests, limits on what a member may own, returned on January 1, 2026 for traditional Medi-Cal eligibility groups, including many people age 65 or older, people with disabilities and nursing-facility residents. The Medi-Cal eligibility method called Modified Adjusted Gross Income, or MAGI, uses federal tax rules and countable income and has no property limit. Families with children under 21 whose income is too high for MAGI may qualify through the Medically Needy or Medically Indigent route, which uses other rules for income, household size and property. These limits do not apply to every Medi-Cal member.

The home a member lives in, one vehicle, household items and some retirement savings do not count toward that limit. Ask which assets count and which family members are included before comparing a bank balance or property value with a threshold.

Adult immigration changes do not have one result

Unsatisfactory immigration status, or UIS, means a member’s immigration status does not meet the federal criteria for full-scope Medicaid.

Since January 1, 2026, new applicants age 19 or older without satisfactory immigration status who are not pregnant generally receive restricted-scope Medi-Cal rather than full-scope coverage, the broad set of Medi-Cal benefits. Restricted-scope Medi-Cal is narrower coverage that includes emergency care, emergency dental services, maternity and postpartum care, and long-term care. Adults already enrolled in full-scope coverage can remain covered if they renew on time and continue meeting eligibility rules. If coverage ends, they have a three-month grace period from the date listed on the Notice of Action to re-enroll in full-scope Medi-Cal. After that grace period, an affected member must submit a new application and may qualify only for restricted-scope Medi-Cal.

Children ages 0 through 18, pregnant people through one year after pregnancy, and people under 26 who were in foster care on their 18th birthday can still receive full-scope coverage regardless of immigration status. A parent and child can therefore face different results, and a family should check each person's coverage rather than assume one adult decision applies to everyone.

Under a separate federal change beginning October 1, 2026, the federal government, with limited exceptions, will no longer help pay for full Medicaid benefits for some qualified noncitizens, including refugees, asylees, parolees and trafficking victims, unless they have another immigration status that qualifies. California's enacted budget delays until July 1, 2027 the transition to restricted-scope coverage for people affected by that federal eligibility change.

Non-emergency dental benefits are scheduled to end July 1, 2027 for some adults with unsatisfactory immigration status, while emergency dental coverage remains available. Children, those former foster youth under 26, pregnant members and members within one year after pregnancy are among those who retain full dental coverage. A dental-benefit change should not be read as an end to all medical coverage.

The 2025 state budget had already set a $30 monthly premium for the affected group beginning July 1, 2027; the May 2026 budget revision proposed increasing it to $50 for that same date. For affected adults ages 19 through 59 with unsatisfactory immigration status, the enacted state budget plans a $50 monthly premium beginning July 1, 2027, subject to a determination in the May Revision for the 2027-28 state budget. The May Revision is the governor's updated budget proposal to the Legislature. That conditional $50 premium is not a bill for any renewal before July 1, 2027.

Starting January 1, 2027, some members will move from a health plan to fee-for-service Medi-Cal: members who are undocumented, some green-card holders in the five-year waiting period before they can get full-scope federal Medicaid, and people allowed to stay in the United States without formal immigration status. That transition changes how care is delivered, not whether the member can keep Medi-Cal. Fee-for-service does not mean the member pays: members can go to any doctor or clinic that accepts it, and Medi-Cal still pays for their care. Some services available only through health plans, including Enhanced Care Management and Community Supports, will not continue in fee-for-service Medi-Cal. Confirm that the doctors and clinics used by the member accept fee-for-service Medi-Cal before the transition.

Work rules and more frequent renewals affect expansion adults

A new federal law requires certain adults in Medicaid to meet an 80-hours-a-month work requirement as a condition of eligibility. The requirement generally covers adults ages 19 through 64 in Medicaid’s expansion adult group who are not pregnant and are not entitled to or enrolled in Medicare. That group, adults who qualify through the Affordable Care Act’s expansion of Medicaid, is an eligibility category, not a description of every adult receiving Medi-Cal. Federal law sets January 1, 2027 as the start for the work requirement and six-month renewals in the affected expansion group. DHCS starts moving current members to the six-month schedule with renewals due in March 2027, because the county begins those reviews two months earlier, in January. For members moving to the six-month schedule at their March 2027 renewal, the first six-month renewal is in September 2027.

Major exceptions include pregnancy and the postpartum period, disability or medical frailty, care of a child under 14 or a person with a disability, and American Indian or Alaska Native status. California instructs counties to check case files and electronic information for exclusions or exemptions before asking members for additional information. An exemption needs to be recognized in the case, so answer a request for missing information even when the family believes it qualifies.

Members can meet the requirement with 80 hours a month of work, community service or certain work programs, or by being enrolled in education at least half-time. They can also meet it by earning at least 80 times the federal hourly minimum wage, $580 a month in 2026; seasonal workers use a different earnings calculation. The federal framework requires existing members to show one or more qualifying months between renewals. Do not assume every member must submit a new work record every month; follow the county's instructions about the period it is checking.

The six-month renewal rule applies to adults ages 19 through 64 covered through the Affordable Care Act expansion. Annual renewals continue for other eligibility groups, pregnant or postpartum members, American Indian or Alaska Native members, and former foster youth who were in care on their 18th birthday and are younger than 26. A work-rule exception and a once-a-year renewal exception are separate checks, so confirm both instead of treating one as proof of the other.

The Centers for Medicare & Medicaid Services issued an interim final rule carrying out the requirement on June 1, 2026, and the regulations became effective July 31, 2026. The regulation’s effective date and the member’s renewal date are different milestones.

Massachusetts, California and other states sued federal health officials over the interim final rule’s medical-frailty definition, its 12-month lookback for that exception, and its emergency-declaration hardship exception. In that case, Commonwealth of Massachusetts v. Oz, the U.S. District Court for the District of Massachusetts denied the states’ request for a preliminary injunction without prejudice on July 29, 2026. On October 8, 2026, the court scheduled argument on both sides’ summary-judgment motions for October 22, 2026. The court left the states free to renew their request if later circumstances warranted it. The order addressed temporary relief while the case proceeds, rather than finally deciding whether the challenged provisions are lawful. A lawsuit does not by itself suspend a requirement, so follow the county’s instructions and check for later orders when a notice raises that issue.

Medi-Medi plans combine two programs

A Medi-Medi plan is a voluntary arrangement that pairs a Medicare Advantage special-needs plan with a Medi-Cal managed-care plan for people eligible for both programs. Members must have Medicare Parts A and B and Medi-Cal, be at least 21, and live in a county offering the plans. Medicare Part A helps cover inpatient hospital care; Part B helps cover doctor visits, outpatient care, medical equipment and preventive services. A dual-eligible special-needs plan, or D-SNP, is a Medicare plan for people entitled to Medicare and state Medicaid assistance.

A change to one of these plans is a separate question from whether the member still qualifies for Medi-Cal. For anyone asking whether Medi-Medi plans are shutting down, DHCS scheduled them to launch in additional counties on January 1, 2026. IEHP DualChoice, a plan offered by Inland Empire Health Plan, issued a member handbook for coverage through December 31, 2026. A notice about one insurer’s plan should therefore not be treated as a statewide end to dual-program coverage, though nothing guarantees that a particular plan or provider network will stay the same next year. DHCS has issued Medi-Medi policy requirements for the 2027 contract year. That guide lists operation in 41 counties as of January 1, 2026, including Los Angeles, Orange, Riverside, Sacramento and San Diego. Members with UIS who are in a Medi-Medi plan will no longer qualify for that aligned plan on January 1, 2027, when they move to fee-for-service Medi-Cal.

DHCS lists options for dual-eligible members in 2026 that include Original Medicare with a Medi-Cal plan, a Medi-Medi plan, or another Medicare Advantage plan with a Medi-Cal plan. The Medicare Medi-Cal Ombudsman Program takes plan complaints at 1-855-501-3077. Before changing enrollment, ask for help checking available plans and how the choice affects the doctors and services the member uses. Avoid abandoning coverage just because the name or organization of the plan changes.

A parent's medical-support case cannot cut off the child

Medical support is help paying for a child’s health coverage: a court can order a parent to provide insurance or contribute a specific amount toward it.

Under federal Medicaid rules, adults with legal capacity who apply for Medi-Cal must sign over to the state their rights to medical support and payments. They must also cooperate in establishing who the child’s legal father is, obtaining support for medical care and providing relevant information. This is a rule about medical support and the adult’s cooperation in enforcing it. California resumed applying these requirements at application and renewal on July 1, 2025, according to DHCS county guidance.

A parent, guardian or caretaker who fails to cooperate without good cause may lose Medi-Cal eligibility, but the child's eligibility is not affected by that noncooperation. A notice suggesting that the parent's failure alone ends the child's Medi-Cal warrants immediate clarification and, if necessary, a challenge.

The county must grant established good cause when cooperation is expected to cause physical, sexual or emotional harm to the child, or abuse to the parent or caretaker with whom the child lives. Ask about the good-cause process when cooperation raises a safety concern; do not assume the only choices are pursuing an absent parent or losing all family coverage.

If eligibility really ends, arrange the next coverage

Covered California, where people losing Medi-Cal can get a health plan, allows enrollment for up to 90 days after Medi-Cal ends, but warns that waiting can leave a coverage gap. Its guidance says to select a plan within one month of the Medi-Cal end date to avoid a gap. Start the coverage discussion as soon as the ending date is known, and confirm the new plan's effective date and any payment needed to activate it.

Household size and estimated annual income affect Covered California eligibility and financial help. DHCS warns that loss of Medi-Cal for failure to meet the new work requirements can also mean losing access to Covered California financial help. Ask the enroller to assess the actual reason for the loss rather than assuming that every former Medi-Cal member receives a subsidized plan.

Licensed insurance agents and certified enrollment counselors can help apply and enroll for free, using Covered California's Find an Enroller service or 800-300-1506. For managed-care access problems, the Medi-Cal Managed Care and Mental Health Office of the Ombudsman offers free assistance at 1-888-452-8609.