{"id":75652,"date":"2025-07-19T15:07:20","date_gmt":"2025-07-19T15:07:20","guid":{"rendered":"https:\/\/www.europesays.com\/us\/75652\/"},"modified":"2025-07-19T15:07:20","modified_gmt":"2025-07-19T15:07:20","slug":"on-medi-cal-when-to-expect-new-rules-higher-costs-and-enrollment-freezes","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/us\/75652\/","title":{"rendered":"On Medi-Cal? When to Expect New Rules, Higher Costs and Enrollment Freezes"},"content":{"rendered":"<p>As the state faces a growing deficit, <a href=\"https:\/\/calmatters.org\/politics\/2025\/06\/california-budget-newsom-democrats\/\" rel=\"nofollow noopener\" target=\"_blank\">Newsom and the state Legislature agreed<\/a> 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 <a href=\"https:\/\/www.dhcs.ca.gov\/Budget\/Documents\/DHCS-TBL-Policy-Changes-to-Individuals-with-UIS-Fact-Sheet.pdf\" rel=\"nofollow noopener\" target=\"_blank\">state considers<\/a> \u201cunsatisfactory.\u201d<\/p>\n<p>These cuts put at risk the yearslong work to improve health care access among the state\u2019s undocumented community, said Adriana Ramos-Yamamoto, senior policy analyst at the California Budget and Policy Center.<\/p>\n<p>\u201cAll of this progress is now under threat because of our own state budget deficit,\u201d she said, adding that lawmakers in Sacramento are now under greater pressure as the federal government cuts down on funding for state programs. \u201cWe currently do not have the funding to help backfill any loss in federal funds.<\/p>\n<p>\u201cWe 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.<\/p>\n<p><strong>Dec. 31, 2026: <\/strong><\/p>\n<p><strong>States begin to roll out new Medicaid eligibility rules<\/strong><\/p>\n<p>When then-President Barack Obama <a href=\"https:\/\/www.kqed.org\/news\/tag\/affordable-care-act\" rel=\"nofollow noopener\" target=\"_blank\">signed the Affordable Care Act<\/a> in 2010, it allowed adults ages 19\u201364 with incomes below 138% of the federal poverty level to qualify for Medicaid. Since then, <a href=\"https:\/\/www.kff.org\/medicaid\/issue-brief\/medicaid-expansion-is-a-red-and-blue-state-issue\/\" rel=\"nofollow noopener\" target=\"_blank\">over 21 million adults<\/a> have enrolled nationwide, including 5 million in Medi-Cal.<\/p>\n<p>Under the OBBB, states must implement new eligibility requirements for this \u201cexpansion population\u201d:<\/p>\n<ul>\n<li>Individuals will now have to go through the Medicaid renewal process <a href=\"https:\/\/www.kqed.org\/news\/11944543\/on-medi\" rel=\"nofollow noopener\" target=\"_blank\">with their county\u2019s health and human services agency<\/a> every six months, instead of once a year.<\/li>\n<li>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\u2019s unemployment rate rises above 8%.<\/li>\n<\/ul>\n<p>This will mean a lot more paperwork for both Medi-Cal recipients and the county offices managing these requirements, UC Irvine\u2019s Roby said. \u201cYou could have somebody working two different jobs, but they don\u2019t see the email coming from their eligibility office or maybe they changed addresses,\u201d he said. \u201cBecause they don\u2019t turn in proof that they\u2019re working, they could lose their coverage.\u201d<\/p>\n<p>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. \u201cSo they know when to look for certain envelopes,\u201d he said, \u201cand that they understand they have X number of days to complete that application redetermination package and turn it in.\u201d<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-12047349\" src=\"https:\/\/www.europesays.com\/us\/wp-content\/uploads\/2025\/07\/GettyImages-2216476723-2000x1363.jpg\" alt=\"\" width=\"2000\" height=\"1363\"  \/>US Speaker of the House Mike Johnson (R-La.) speaks to the media after the House narrowly passed a bill forwarding President Donald Trump\u2019s agenda at the US Capitol on May 22, 2025, in Washington, DC. (Kevin Dietsch\/Getty Images)<br \/>\n<strong>Jan. 1, 2027: <\/strong><\/p>\n<p><strong>Higher premiums for undocumented immigrants on Medi-Cal<\/strong><\/p>\n<p>As part of this year\u2019s state budget deal, Medi-Cal recipients ages 19\u201359 with an immigration status <a href=\"https:\/\/www.dhcs.ca.gov\/Budget\/Documents\/DHCS-TBL-Policy-Changes-to-Individuals-with-UIS-Fact-Sheet.pdf\" rel=\"nofollow noopener\" target=\"_blank\">the state considers \u201cunsatisfactory\u201d<\/a> \u2014 which includes both undocumented immigrants and those with a temporary status \u2014 will have to pay a $30 monthly premium starting in 2027.<\/p>\n<p>Pregnant people will be exempt.<\/p>\n<p>If someone misses three consecutive premium payments, they will be dropped from their coverage \u2014 and because of the 2026 enrollment freeze, they would be unable to reenroll.<\/p>\n<p><strong>Oct. 1, 2028: Minimum copays begin at the national level<\/strong><\/p>\n<p>The OBBB will also require Medicaid recipients in the \u201cexpansion population\u201d 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.<\/p>\n<p>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.<\/p>\n<p>\u201cThe state would have to track how much people are spending out of pocket on their cost sharing in order to make sure they don\u2019t hit the 5% level,\u201d he said.<\/p>\n","protected":false},"excerpt":{"rendered":"As the state faces a growing deficit, Newsom and the state Legislature agreed to freeze Medi-Cal enrollment for&hellip;\n","protected":false},"author":3,"featured_media":75653,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[35],"tags":[210,1141,1142,67,132,68],"class_list":{"0":"post-75652","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-health-care","8":"tag-health","9":"tag-health-care","10":"tag-healthcare","11":"tag-united-states","12":"tag-unitedstates","13":"tag-us"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@us\/114880528020999518","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/75652","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/comments?post=75652"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/75652\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media\/75653"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media?parent=75652"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/categories?post=75652"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/tags?post=75652"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}