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Losing Medi-Cal? Your Complete Options Guide

If you're losing Medi-Cal coverage—whether due to income changes, redetermination, the unwinding process, or other reasons—this guide explains all your options, including how to appeal, your special enrollment rights, and how to transition to Covered California with subsidies.

Act Now: You have 60 days from your Medi-Cal termination date to enroll in Covered California. If you believe you were wrongly terminated, you may also appeal within 90 days (10 days to keep coverage during appeal).

Why People Lose Medi-Cal

Medi-Cal coverage can end for several reasons. Understanding why you're losing coverage helps determine your next steps and options.

The most common reason for losing Medi-Cal is earning too much. Income limits for 2025:

  • Single adult: $20,783/year (138% FPL)
  • Family of 2: $28,208/year
  • Family of 4: $43,056/year

Good news: If your income is above Medi-Cal limits but below 400% FPL, you likely qualify for substantial Covered California subsidies.

Medi-Cal requires annual eligibility renewal. You may lose coverage if:

  • You didn't respond to renewal paperwork
  • Renewal forms were sent to wrong address
  • Information provided was incomplete
  • County couldn't verify your information

Important: If you were terminated for procedural reasons (not responding, missing documents), you may be able to reinstate coverage by providing the information.

During COVID-19, federal rules prevented Medi-Cal disenrollment. Since April 2023, California resumed regular eligibility reviews:

  • Millions of Californians are being reviewed
  • Many are being "unwound" from continuous coverage
  • Some may still qualify but need to provide updated information
  • Others have income above current limits

Certain age-based eligibility categories:

  • Young adults turning 26: May lose parent-based Medi-Cal eligibility
  • Children turning 19: May transition to adult Medi-Cal (different income limits)
  • Seniors turning 65: May transition to Medicare (must apply separately)

Medi-Cal is state-specific:

  • Moving out of California: Medi-Cal ends; apply for coverage in new state
  • Moving within California: Must report to update county
  • Immigration status changes: May affect eligibility
First Step: Read your termination notice carefully to understand the specific reason for your coverage ending. This determines whether you should appeal, provide additional information, or transition to Covered California.

The Medi-Cal Unwinding Process

After the COVID-19 continuous coverage requirement ended, California began reviewing all Medi-Cal enrollees. Here's what you need to know.

What is Medi-Cal Unwinding?

During the pandemic, no one could be disenrolled from Medi-Cal regardless of income or eligibility changes. "Unwinding" is the process of returning to normal eligibility rules and reviewing all 15+ million Medi-Cal enrollees.

Unwinding Timeline

  • April 2023: Unwinding began
  • Through 2024: Counties reviewing all cases on a rolling basis
  • 2025+: Regular annual redetermination schedule resumes

Renewal Packets: What to Do

If You Receive a Renewal Packet

  • Respond immediately - don't delay
  • Update contact information
  • Provide all requested documents
  • Submit before the deadline
  • Keep copies of everything you submit

If You Didn't Receive Anything

  • Log into BenefitsCal.com to check status
  • Update your address with the county
  • Call Medi-Cal at 1-800-541-5555
  • Don't assume no news is good news
  • Proactively verify your eligibility
Many Terminations Are Due to Paperwork: Studies show over 70% of Medi-Cal disenrollments during unwinding are for procedural reasons (didn't respond, wrong address), not actual ineligibility. If you think you still qualify, contact your county immediately.

Your Special Enrollment Rights

Losing Medi-Cal coverage qualifies you for a 60-day Special Enrollment Period (SEP) to enroll in Covered California health insurance outside of Open Enrollment.

Medi-Cal Ends

Your 60-day window begins on your last day of Medi-Cal coverage

Days 1-60

Apply for Covered California and select a health plan

Coverage Starts

New coverage can begin as soon as the 1st of the following month

What You'll Need

  • Termination notice: Letter from Medi-Cal showing your coverage end date
  • Social Security numbers: For all household members
  • Income documentation: Pay stubs, tax return, or self-employment records
  • California ID: Driver's license or state ID

How to Apply

1

Start Your Free Application

Start your free application or work with a licensed agent at no cost to you.

2

Select "Lost Health Coverage" as Your Qualifying Event

Enter the date your Medi-Cal coverage ended.

3

Enter Your Household Information

Add all household members and estimated annual income.

4

Compare Plans and Enroll

Review available plans, check if your doctors are in-network, and select coverage.

5

Pay Your First Premium

Coverage doesn't start until you make your first payment!

Express Lane: If you applied for coverage through Covered California and were determined eligible for Medi-Cal, your application may still be on file. Contact us and our licensed agents can help you quickly convert to marketplace coverage.

How to Appeal a Medi-Cal Termination

If you believe you were wrongly terminated from Medi-Cal, you have the right to appeal. This is especially important if you were disenrolled for procedural reasons or disagree with the income determination.

Appeal Deadlines

When to File Result
Within 10 days of receiving notice Coverage continues during appeal (Aid Paid Pending)
Within 90 days of termination Can still appeal, but coverage doesn't continue
After 90 days Must reapply; cannot appeal original decision

How to File an Appeal

Online

Submit through your BenefitsCal.com account or the California Department of Social Services website.

By Phone

Call the State Hearings Division at 1-800-952-5253 to request a hearing.

By Mail

Complete the appeal form on your termination notice and mail it to the address provided.

What Happens at a State Fair Hearing

  • A state administrative law judge reviews your case
  • You can present evidence and witnesses
  • The county must prove you're ineligible
  • Decision typically within 90 days
  • If you win, coverage is reinstated retroactively
Apply for Covered California While Appealing: Even if you're appealing, consider applying for Covered California as a backup. If your appeal fails, you'll already have coverage in place. If you win, you can cancel the Covered California plan.

Transitioning to Covered California

If you no longer qualify for Medi-Cal, Covered California offers comprehensive health coverage with financial assistance based on your income.

Step-by-Step Transition Process

1

Note Your Medi-Cal End Date

Your termination notice shows when coverage ends. This is the start of your 60-day Special Enrollment Period.

2

Calculate Your Expected Annual Income

Estimate your household's Modified Adjusted Gross Income (MAGI) for the year. This determines your subsidy amount.

3

Apply for Covered California

Start your application or contact a licensed agent. Report "Lost health coverage" as your qualifying event.

4

Compare Plans and Networks

Check if your current doctors accept Covered California plans. Compare Bronze, Silver, Gold, and Platinum options.

5

Select Your Effective Date

Choose a start date that aligns with your Medi-Cal end date to avoid gaps.

6

Enroll and Pay

Complete enrollment and pay your first premium. Coverage begins only after payment.

Key Differences from Medi-Cal

Feature Medi-Cal Covered California
Monthly Premium $0 for most Varies; often $0-200 with subsidies
Deductible None $0-$6,000+ depending on plan
Copays $0-$5 for most services $10-$50+ depending on service
Provider Network Medi-Cal providers only Broader network, varies by carrier
Plan Choice Limited or assigned Choose from 10+ carriers
Budget for Premiums and Out-of-Pocket Costs: Unlike Medi-Cal, Covered California plans have monthly premiums and cost-sharing. However, Enhanced Silver plans (Silver 73, 87, 94) offer very low deductibles and copays if your income qualifies.

Subsidies You May Qualify For

If your income is above Medi-Cal limits but below 400% of the Federal Poverty Level (FPL), you likely qualify for substantial financial assistance through Covered California.

Two Types of Subsidies

Premium Tax Credits

Reduces your monthly premium. Available at all income levels up to 400%+ FPL. The lower your income, the higher the credit.

  • Applied directly to your monthly bill
  • Can make premiums as low as $0-$10
  • Based on estimated annual income

Cost-Sharing Reductions (CSR)

Lowers your deductible, copays, and max out-of-pocket. Only available with Silver plans up to 250% FPL.

  • Silver 73: 200-250% FPL
  • Silver 87: 150-200% FPL
  • Silver 94: Under 150% FPL

2025 Subsidy Income Ranges

Household Size Medi-Cal Limit Full Subsidies Some Subsidies
1 Person $20,783 $20,783 - $36,450 $36,451 - $60,240+
2 People $28,208 $28,208 - $49,300 $49,301 - $81,760+
4 People $43,056 $43,056 - $75,000 $75,001 - $124,800+

Example: Just Above Medi-Cal Limits

Scenario: Single adult, age 35, income $25,000/year (166% FPL)

What they qualify for:

  • Premium Tax Credit: ~$350/month
  • Enhanced Silver 87 Plan: Only $3,650 deductible (vs $6,400 regular Silver)
  • After subsidies: Premium as low as $10-50/month

Bottom line: While not free like Medi-Cal, this person would pay approximately $10-50/month for comprehensive coverage with low out-of-pocket costs.

Enhanced Silver Plans Are Key: If your income is between 138-250% FPL, always choose a Silver plan to get Cost-Sharing Reductions. These plans have Medi-Cal-like low deductibles and copays.

Timeline and Deadlines

Acting quickly is essential when losing Medi-Cal. Here are the key dates and deadlines to track.

From Termination Notice to New Coverage

Day 1

Receive Termination Notice

  • Read notice carefully - understand why you're losing coverage
  • Note the termination effective date
  • Decide whether to appeal (10 days for Aid Paid Pending)
  • Start gathering documents for Covered California
10

Days - Appeal Deadline (If Applicable)

  • File appeal within 10 days to keep coverage during appeal
  • Request "Aid Paid Pending" status
  • Simultaneously apply for Covered California as backup
30

Days Before Medi-Cal Ends

  • Complete Covered California application
  • Calculate your estimated annual income
  • Compare available plans
  • Check if your doctors are in-network
15

Days Before - Enroll for Seamless Coverage

  • Select your Covered California plan
  • Choose effective date to align with Medi-Cal end
  • Complete enrollment
  • Pay first premium
60

Days After - SEP Deadline

  • This is your last day to enroll through Special Enrollment
  • After this, must wait for Open Enrollment
  • Don't cut it this close - gaps may occur
Critical: Your 60-day window starts from your Medi-Cal termination date, not from when you receive the notice. If coverage ends March 31, you must enroll by May 30.

Avoiding Coverage Gaps

A gap in health coverage can expose you to California's individual mandate penalty and leave you without protection. Here's how to maintain continuous coverage.

Coverage Start Date Rules

If your enrollment is submitted before the end of the month and your application and documents are in order, coverage starts on the 1st of the following month. Start your application online — it's the fastest way to get enrolled.

Strategies for Seamless Coverage

Apply Before Medi-Cal Ends

Don't wait for your Medi-Cal to actually terminate. You can apply for Covered California as soon as you receive your termination notice. Select a prospective effective date.

Align Your Dates

If Medi-Cal ends March 31, complete your Covered California enrollment before the end of March so coverage starts April 1. This ensures no gap.

Pay Immediately

Your Covered California coverage doesn't start until you pay the first premium. Pay as soon as you receive your bill to activate coverage.

Get Agent Help

Licensed agents can help coordinate your transition, ensure paperwork is complete, and verify your coverage start date. Free service!

California Individual Mandate: California requires health insurance. Gaps may result in a penalty of approximately $900 per adult and $450 per child when filing state taxes. Short gaps of less than 3 months may be exempt.

Mixed Households: When Some Stay on Medi-Cal

It's common for some family members to qualify for Medi-Cal while others qualify for Covered California. This is especially true for families with children.

Common Mixed Household Scenarios

Children qualify for Medi-Cal at higher income levels than adults. A family earning $60,000/year might have:

  • Adults on Covered California (income above adult Medi-Cal limits)
  • Children on Medi-Cal (income below child Medi-Cal limits ~266% FPL)

Tip: When you apply through Covered California, the system automatically determines if children qualify for Medi-Cal.

Pregnant women qualify for Medi-Cal at higher income levels (up to 213% FPL). A pregnant woman may keep Medi-Cal while her spouse is on Covered California.

  • Pregnancy Medi-Cal covers prenatal care, delivery, and 12 months postpartum
  • After postpartum period, reassess eligibility

If one spouse gets a job that increases household income but the other spouse has qualifying conditions (disability, age, etc.), one might lose coverage while the other keeps it.

Each spouse is evaluated individually for categorical eligibility.

Household members with different immigration statuses may have different coverage options:

  • U.S. citizens and qualified immigrants: Full Medi-Cal or Covered California
  • Undocumented adults: Emergency Medi-Cal only (though California is expanding full-scope Medi-Cal)
  • Undocumented children: Full-scope Medi-Cal in California

Managing Multiple Programs

  • One application: Apply through Covered California - the system determines Medi-Cal eligibility automatically
  • Separate ID cards: Each family member gets coverage through their respective program
  • Different renewal dates: Medi-Cal and Covered California have separate renewal processes
  • Report changes: Income changes affect all household members and may shift eligibility
Don't Split the Application: Even if you think some family members will be on different programs, complete one Covered California application for the entire household. The system will direct each person to the appropriate program.

Losing Medi-Cal Doesn't Mean Losing Coverage

Our licensed agents specialize in helping Californians transition from Medi-Cal to Covered California. We'll help you find affordable coverage with subsidies, navigate the application process, and ensure continuous protection - all at no cost to you.

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