From enrollment freezes to dental care cuts, here’s how upcoming Medi-Cal changes could affect the state’s most vulnerable
It began with a call for clarity and a plea for compassion. Hosted by American Community Media (ACOM), a recent media briefing laid bare the most consequential changes to Medi-Cal in recent memory. With nearly 15 million Californians, a full third of the state relying on this public health lifeline, these changes are not merely bureaucratic. They are seismic. And for immigrant families, especially those undocumented, the ground is already starting to shift.
The session brought to two key experts including Tyler Sadwith, State Medicaid Director at the California Department of Healthcare Services (DHCS), and Yingjia Huang, DHCS Deputy Director for Healthcare Benefits and Eligibility who explained the upcoming federal and state changes to Medi-Cal and how they would affect the very communities represented on that call.
From the outset, Sadwith set the tone. “You are the trusted voices in your communities,” he told ethnic media outlets. And in the face of upcoming upheaval, those voices will be more important than ever.
The Federal Shockwave
At the heart of the changes is a new federal law known informally as HR1 or the “One Big Beautiful Bill.” Set to take effect between 2026 and 2028, the law imposes work requirements, increases paperwork through biannual eligibility checks, and introduces copayments for certain services. While the language is policy-heavy, the consequences are painfully human.
Starting January 1, 2027, adults between 19 and 64 may be required to work, volunteer, or be in school at least 80 hours per month to retain Medi-Cal coverage. There are exemptions—for parents of young children, people with disabilities, and pregnant individuals, but for many, this requirement poses a serious challenge.
“Seasonal workers, caregivers, and those in precarious jobs will be hardest hit,” Sadwith admitted. And that’s just the start.
Also beginning in 2027, those without dependent children will have to reverify their eligibility every six months instead of annually. It’s a simple change on paper but one that doubles the risk of administrative errors, missed deadlines, and lost coverage.
By 2028, select services will come with copays. Though core services like emergency care, mental health, and pediatric visits will remain free, specialty care and certain tests may now come with a price tag, one that low-income families may struggle to pay.
The state estimates that up to 3.4 million Californians could be at risk of losing coverage under these new requirements.
State-Level Storms
While the federal changes loom, California is also making tough decisions due to state budget constraints. These decisions disproportionately affect undocumented immigrants—especially those who are not pregnant, elderly, or children.
Starting January 2026, Medi-Cal will pause new full-scope enrollments for undocumented adults 19 and older who don’t qualify under federal Medicaid rules. Those already enrolled will be “grandfathered in,” as long as they continue to meet eligibility requirements and complete their renewal paperwork.
By July 2026, this same group will lose access to Medi-Cal dental benefits, a critical service often already underutilized due to stigma and misinformation. Emergency dental care will remain, but routine check-ups and preventive services will be off the table.
Then comes July 2027. Undocumented adults aged 19 to 59 will be required to pay a monthly premium of $30 to maintain their Medi-Cal coverage. Miss a payment? You get a 90-day grace period. After that, your coverage could revert to emergency-only.
Lastly, California will reinstate the asset test which was a previously eliminated rule that caps how much wealth one can hold while remaining eligible. The new threshold will be $130,000 for an individual, much higher than the outdated $2,000 limit, but still a notable barrier for some aging immigrants and those with disabilities.
Reassurance and Reality
Huang, who followed Sadwith, made a concerted effort to reassure families. Children and pregnant people, regardless of immigration status, will remain eligible for full-scope Medi-Cal, including dental and vision. Transitional rent supports and mental health services are expanding. But the looming loss of dental care, new fees, and work mandates still cast a long shadow.
That shadow is personal for many families. Take Maria, a 38-year-old undocumented mother of three in San Diego. Her children qualify for full-scope Medi-Cal, but she fears her own coverage will disappear once the new requirements kick in. “I work two jobs and volunteer at my church. But proving 80 hours? That’s more paperwork than I can keep up with.”
And then there’s Roberto, a seasonal farmworker in Fresno who has relied on Medi-Cal for routine check-ups and prescriptions. “When I’m not working during the winter, how do I prove I’m working enough? Will they just cut me off?”
These stories aren’t anomalies. They are signals. They echo across immigrant households that have already learned to be wary of systems that promise much but deliver conditionally.
The Role of Ethnic Media
In the final stretch of the briefing, a powerful theme emerged: partnership.
Ethnic media was not just in the room to report; they were there as co-navigators in a storm. With multilingual interpretation provided throughout the briefing, it was clear that this outreach was intentional.
Sadwith and Huang reiterated the department’s commitment to working with grassroots and ethnic media outlets to get accurate, timely information into communities. As misinformation and fear threaten to widen health disparities, that collaboration could prove life-saving.
Organizations like The Immigrant Magazine, Korean Daily, La Opinión, and others are being called upon to do what government mailers cannot: explain, contextualize, and translate policy into lived experience.
The Bigger Picture
California is not alone. As Sadwith noted, states across the nation are grappling with budget pressures and the same federal law. Some are reducing benefits, cutting provider rates, or freezing enrollment. But California’s expansive Medi-Cal program and its inclusion of undocumented immigrants makes it a national bellwether.
How it navigates these changes and how well it shields its most vulnerable residents, will send a signal far beyond its borders.
At the briefing’s end, reporters asked whether the state planned to partner with trusted messengers to reach those most at risk. The answer was yes, but the details were still being developed.
That leaves a window of opportunity and urgency. Because policy doesn’t land in spreadsheets; it lands in kitchens, in crowded apartments, in underfunded clinics. It lands in the everyday lives of people who can least afford more red tape.
For now, families are urged to do three things: keep their contact info up to date, respond to renewal notices promptly, and continue using their benefits.
But beneath those practical steps lies a deeper truth: the battle over Medi-Cal is not just about paperwork. It’s about who gets to belong, who gets to heal, and who gets to hope.
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