On Medi-Cal? When to Expect New Rules, Higher Costs and Enrollment Freezes

Weeks before President Donald Trump signed into law the massive spending and tax plan known as the One Big Beautiful Bill, California officials warned about its potential impacts on Medi-Cal, the state’s Medicaid program that covers over 15 million lower-income Californians.

Gov. Gavin Newsom called Trump’s budget plan “reckless, cruel and damaging,” citing state estimates that up to 3.4 million Medi-Cal recipients could lose their coverage if the legislation moved forward. While the White House insists that the OBBB will not kick people off their health care plan, the back-and-forth has sown confusion among many Californians about their Medi-Cal coverage.

“What we’re hearing from members is: One, is my information protected? And two, have there been any changes to my benefits and when can I expect a change?” said Michael Hunn, CEO of CalOptima Health, which serves Medi-Cal patients in Orange County.

Hunn said that his team has been assuring members that their personal health information is protected and that “there have been no changes to either benefits or eligibility right now in California.”

“We don’t want any of our members to think that somehow their coverage or their health insurance has gone away because it has not,” he said. “Please continue to get the care you need.”

While Medi-Cal remains the same for the time being, the OBBB — along with other state and federal legislation — is expected to bring big changes to the program in the coming years, impacting different groups of recipients.

Keep reading for a timeline of when these changes will kick in and how to prepare. We will be updating this guide as more information becomes available.

Dec. 31, 2025:

End of subsidies for those who bought health coverage through Covered California

In 2021, Congress approved additional tax credits for people who bought health insurance through an Affordable Care Act marketplace, with Covered California being one.

The subsidies include both Medicare and market-rate plans, making it easier for millions of Americans to buy health insurance. But when the credits expire, it will be more expensive for folks to keep their current coverage.

According to the Kaiser Family Foundation, a San Francisco-based public health research nonprofit, the average annual premium payment for Medicaid in 2024 decreased from $1,593 to $888 — a difference of $705.

Two income groups could see the biggest changes in their premiums, said Dylan Roby, professor of health, society and behavior at UC Irvine. “When people start getting their renewals this year for coverage, they will probably see their premiums skyrocket if they make under 150% of the federal poverty level or above 400% of the federal poverty level,” he said.

• CHART: See where your income falls according to the federal poverty level

Without enhanced subsidies, people above 400% of the federal poverty level may have to pay the full monthly premium for their insurance. On the other hand, those under 150% of the federal poverty level who previously received enough subsidies to cover all their premiums would have to start paying for part of their coverage.

While Congress failed to renew the subsidies in the OBBB, it still has time to extend them this year before they end.

Jan. 1, 2026:

Medi-Cal begins to freeze new enrollment for undocumented Californians 

California has gradually expanded Medi-Cal enrollment to lower-income undocumented immigrants, adding new age groups every few years. About 1.6 million undocumented Californians are now covered by Medi-Cal, but the expansion cost the state $2.7 billion more than it originally projected, CalMatters reported.

As the state faces a growing deficit, Newsom and the state Legislature agreed to freeze Medi-Cal enrollment for undocumented immigrants who are 19 and older at the start of 2026. Then, on July 1, Medi-Cal will stop covering dental services for both undocumented individuals and those with an immigration status the state considers “unsatisfactory.”

These cuts put at risk the yearslong work to improve health care access among the state’s undocumented community, said Adriana Ramos-Yamamoto, senior policy analyst at the California Budget and Policy Center.

“All of this progress is now under threat because of our own state budget deficit,” she said, adding that lawmakers in Sacramento are now under greater pressure as the federal government cuts down on funding for state programs. “We currently do not have the funding to help backfill any loss in federal funds.

“We really need state leaders to take bold action to equitably raise revenues to help mitigate the impact of these federal funding cuts to our state and Medi-Cal specifically.

Dec. 31, 2026:

States begin to roll out new Medicaid eligibility rules

When then-President Barack Obama signed the Affordable Care Act in 2010, it allowed adults ages 19–64 with incomes below 138% of the federal poverty level to qualify for Medicaid. Since then, over 21 million adults have enrolled nationwide, including 5 million in Medi-Cal.

Under the OBBB, states must implement new eligibility requirements for this “expansion population”:

• Individuals will now have to go through the Medicaid renewal process with their county’s health and human services agency every six months, instead of once a year.
• Able-bodied adults without dependents must work, attend school classes or do community service for at least 80 hours each month. There are several exceptions, including if your state’s unemployment rate rises above 8%.

This will mean a lot more paperwork for both Medi-Cal recipients and the county offices managing these requirements, UC Irvine’s Roby said. “You could have somebody working two different jobs, but they don’t see the email coming from their eligibility office or maybe they changed addresses,” he said. “Because they don’t turn in proof that they’re working, they could lose their coverage.”

Individual states and counties will have two years to fully implement these changes, said Hunn from CalOptima Health, who added that his team will be working with Orange County officials to make sure that their members are aware of all the new forms they need to complete. “So they know when to look for certain envelopes,” he said, “and that they understand they have X number of days to complete that application redetermination package and turn it in.”

Jan. 1, 2027:

Higher premiums for undocumented immigrants on Medi-Cal

As part of this year’s state budget deal, Medi-Cal recipients ages 19–59 with an immigration status the state considers “unsatisfactory” — which includes both undocumented immigrants and those with a temporary status — will have to pay a $30 monthly premium starting in 2027.

Pregnant people will be exempt.

If someone misses three consecutive premium payments, they will be dropped from their coverage — and because of the 2026 enrollment freeze, they would be unable to reenroll.

Oct. 1, 2028: Minimum copays begin at the national level

The OBBB will also require Medicaid recipients in the “expansion population” to begin paying copays for medical care or services. States will set their own copays, but the OBBB requires the amount to be between $1 and $35 per service. There is an exception to this rule: copays are not required for primary care and services for mental health or substance use disorders.

Another caveat: The total amount that someone pays in copays in one year cannot exceed 5% of their income. This could make things confusing for individual states, Roby said.

“The state would have to track how much people are spending out of pocket on their cost sharing in order to make sure they don’t hit the 5% level,” he said.