Medi-Cal Changes in 2027: Work Rules and What Starts When

Medi-Cal Work Rules

ComingFrom January 1, 2027

To keep Medi-Cal, many adults 19 to 64 have to show that they work, go to school or volunteer. Each month, one of these is enough:

• Work at least 80 hours.
• Earn at least $580 (the pay for 80 hours at the federal minimum wage).
• Volunteer or do community service at least 80 hours.
• Take part in a job training program at least 80 hours.
• Go to school at least half-time.
• A mix of work, job training, volunteering and community service that adds up to 80 hours.

Who the Work Rules Are For

Adults 19 to 64 who get Medi-Cal through the Affordable Care Act expansion. Medi-Cal sends a letter to the people the rules apply to, so the letter tells you if you are one of them.

Who Does Not Have to Meet Them

• Parents and caregivers of a child 13 or younger, or of a person with a disability
• People who are pregnant, and for one year after a pregnancy
• People with a disability, a serious physical or mental health condition, or a substance use problem, and people in a substance use treatment program
• People who left jail or prison in the last 90 days
• People with Medicare Part A or Part B
• American Indians and Alaska Natives
• People under 26 who were in foster care on their 18th birthday
• Veterans with a disability rated total
• People who already meet the work rules of CalFresh or CalWORKs

Children and adults 65 and older are not part of this group. Your county decides who does not have to meet the rules: if one of these fits you, tell your county Medi-Cal office.

How Medi-Cal Checks the Work Rules

• If you had Medi-Cal before January 1, 2027: your county first checks the rules at your first renewal from then on, not before.
• If you apply on or after January 1, 2027: you show that you met the rules in the month before you apply, or that you do not have to meet them.
• At each renewal: you show that you met them for at least one month in the months before the renewal. If your work is seasonal, your income can be averaged over the last 6 months.
• Your county looks first: it checks the records it already has, such as wages, school enrollment or a CalFresh case. If it cannot confirm that you meet the rules, it sends you a letter asking for proof.
• If the county finds you did not meet them: it sends a notice, and you have 30 days to show that you did or that you do not have to. If you already have Medi-Cal, it continues during those 30 days.

Medi-Cal Renewals Every 6 Months

ComingFrom March 1, 2027

The same adults 19 to 64 who get Medi-Cal through the Affordable Care Act expansion renew their Medi-Cal every 6 months instead of once a year. At each renewal the county checks again that you qualify, and that you meet the work rules or do not have to.

Pregnant and postpartum people, American Indian and Alaska Native members, and people under 26 who were in foster care on their 18th birthday still renew once a year.

Your county may renew you on the records it has. If it needs more, it sends you a renewal form: return it by the date it gives, or your Medi-Cal can end even if you still qualify.

Other Medi-Cal Changes and When They Start

New federal and state laws change other Medi-Cal rules too, many of them for immigrants. DHCS says most Medi-Cal members will not see any changes to their coverage.

• In effectSince January 1, 2026

  Asset limit: $130,000 for one person, plus $65,000 for each additional person (up to 10), through June 30, 2027. The home you live in, one vehicle, household items and some savings, like retirement accounts, do not count. Income rules did not change.

  Who: People 65 and older, people with a disability, people in a nursing home, and families whose income is too high for the regular rules. Not most adults under 65, children or pregnant people, whose Medi-Cal looks at income only.

• In effectSince January 1, 2026

  Enrollment freeze: some adults can no longer sign up for full-scope Medi-Cal because of their immigration status. People who have it keep it if they renew on time; if it ends, they have three months to sign up again, and after that only restricted-scope Medi-Cal (emergency, pregnancy and nursing home care).

  Who: Adults 19 and older whose immigration status is not on DHCS's immigration status chart (for example, undocumented adults). Green card holders in the five-year waiting period and people with PRUCOL status, such as DACA, can still sign up, and so can children, pregnant people (during pregnancy and for one year after) and people under 26 who were in foster care on their 18th birthday.

• In effectSince October 2026

  Refugees and asylees without a green card, people granted withholding of deportation or removal, people paroled into the U.S. for at least one year, and survivors of domestic violence or human trafficking with a pending or approved immigration case (such as a VAWA petition or a T visa) lose federally funded full-scope Medi-Cal. California keeps them on state-funded full-scope Medi-Cal until June 30, 2027.

  Who: Adults with these immigration statuses. Youth under 21, pregnant people (during pregnancy and for one year after) and people under 26 who were in foster care on their 18th birthday keep full-scope Medi-Cal.

• ComingFrom January 1, 2027

  Fewer months of old medical bills: Medi-Cal will pay bills from one month before you applied for adults 19 to 64 without children under 19, and from two months before for everyone else.

  Who: People who apply for Medi-Cal.

• ComingFrom January 1, 2027

  Care through Fee-for-Service Medi-Cal instead of a health plan. This changes how these members get care, not whether they keep Medi-Cal.

  Who: Undocumented members, green card holders in the five-year waiting period and members considered Permanently Residing Under Color of Law (PRUCOL). DHCS's immigration status chart also lists refugees, asylees, humanitarian parolees and survivors of domestic violence, human trafficking or other serious crimes. Youth under 21 and pregnant people who are lawfully residing keep their health plan.

• ComingFrom July 1, 2027

  Lower asset limit: $21,000 for one person, $31,000 for two, plus $1,550 for each additional person (up to 10). It replaces the $130,000 limit.

  Who: People 65 and older, people with a disability, people in a nursing home, and families whose income is too high for the regular rules.

• ComingFrom July 1, 2027

  Refugees, asylees, humanitarian parolees, people granted withholding of deportation or removal and survivors of domestic violence or human trafficking who lost federally funded Medi-Cal in October 2026 can get only pregnancy-related care and emergency services; their state-funded full-scope Medi-Cal ends on June 30, 2027.

  Who: Adults with these immigration statuses. Youth under 21 who are lawfully residing, pregnant people (during pregnancy and for one year after) and people under 26 who were in foster care on their 18th birthday keep full-scope Medi-Cal.

• ComingFrom July 1, 2027

  Dental: only emergency dental care (bad tooth pain, infections, tooth removal). The 2026-27 state budget moved this from July 1, 2026.

  Who: Adults 19 and older with full-scope Medi-Cal who are undocumented, green card holders in the five-year waiting period, or PRUCOL. Children, pregnant people (and for one year after) and people under 26 who were in foster care on their 18th birthday keep full dental.

• ComingFrom July 1, 2027

  Monthly premium to keep full-scope Medi-Cal: $30 to $50 a month, the amount to be included in the Governor's May Revision of the 2027-28 budget. After no more than 90 days without payment, Medi-Cal changes to restricted scope (emergency, pregnancy-related and nursing home care).

  Who: Adults 19 to 59 with full-scope Medi-Cal who are undocumented, green card holders in the five-year waiting period, or PRUCOL. Not pregnant people (and for one year after), or people under 26 who were in foster care on their 18th birthday.

• ComingFrom October 1, 2028

  Copayments for some services, never more than 5% of household income a year. No copayments at community health centers or rural clinics, for emergency care, regular checkups, care during pregnancy, care for children, or mental health and substance use treatment.

  Who: Adults 19 to 64 with income above the poverty level who are not pregnant and not on Medicare.

What these changes mean for Covered California: financial help changes for lawfully present immigrants. The changes do not move Medi-Cal's income limits: see Medi-Cal income limits.

If Your Medi-Cal Ends

Losing Medi-Cal lets you enroll in a Covered California plan outside open enrollment. You have 60 days from the day your Medi-Cal ends, and you can apply up to 60 days before. Apply before it ends: your plan can then start on the first day of the month after your Medi-Cal ends, with no gap.

If your Medi-Cal ends because your income went up, you may qualify for financial help that lowers your monthly premium.

If you think your Medi-Cal ended by mistake, you can ask for a state hearing. Losing Medi-Cal explains appeals, deadlines and how to avoid a gap.

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Frequently Asked Questions

When do the Medi-Cal work rules start?

They start on January 1, 2027. If you had Medi-Cal before that day, your county first checks them at your first renewal from then on. If you apply on or after that day, you show them when you apply.

How many hours do I need to keep Medi-Cal?

80 hours a month of work, job training, volunteering or community service, or a mix of them. Instead of the hours, income of at least $580 a month or going to school at least half-time also counts.

Who does not have to meet the Medi-Cal work rules?

Parents and caregivers of a child 13 or younger, or of a person with a disability; people who are pregnant, and for one year after a pregnancy; people with a disability, a serious physical or mental health condition, or a substance use problem, and people in a substance use treatment program; people who left jail or prison in the last 90 days; people with Medicare Part A or Part B; American Indians and Alaska Natives; people under 26 who were in foster care on their 18th birthday; veterans with a disability rated total; and people who already meet the work rules of CalFresh or CalWORKs. Children and adults 65 and older are not part of the group.

How often do I renew Medi-Cal?

Adults 19 to 64 who get Medi-Cal through the Affordable Care Act expansion renew every 6 months from March 1, 2027. Pregnant and postpartum people, American Indian and Alaska Native members and former foster youth under 26 still renew once a year, as other Medi-Cal members do.

What can I do if I lose Medi-Cal?

You can enroll in a Covered California plan within 60 days after your Medi-Cal ends, and apply up to 60 days before so there is no gap. If your income went up, you may get financial help. If Medi-Cal ended because the work rules were not met, federal law does not allow the federal premium tax credit for that plan.

Sources

• DHCS, Medi-Cal Changes
• DHCS, Immigration Status and Changes to Medi-Cal Eligibility
• H.R. 1, the federal budget law of July 4, 2025: the work rules, the 6-month renewals and the premium tax credit
• Covered California, Enrollment Dates and Deadlines