Q: I have Medi-Cal for my insurance, along with Medicare. What do I need to know about the changes coming to Medi-Cal?
A: Medi-Cal is what we call the Medicaid program in California. It is a vital healthcare program that provides free or low-cost health coverage to eligible low-income individuals, families, seniors, people with disabilities, and children.
There are several changes coming in phases to Medi-Cal beneficiaries, affecting both eligibility and requirements. These changes are a result of both the state’s budget and the federal government’s H.R. 1 Bill signed into law in July of 2025.
These changes are not happening all at once, however, and many do not affect eligibility or requirements for those who are age 65 and over.
The initial changes took effect on January 1st of this year. These include undocumented adult immigrants no longer being able to apply for full scope Medi-Cal. Asset limits were also reinstated for certain programs. They are set at $130,000 for an individual and go up from there, based on household size.
Additional changes will not take effect until January of 2027. It is important to be aware of and prepared for these upcoming changes, but they are not effective this year.
One of these future changes is that people aged 19-64 who receive Medi-Cal will have to show that they are working, providing community service, or going to school. People must participate in one of the qualifying activities for at least 80 hours per month.
There are exceptions to this requirement, including for people age 18 and under, age 65 and older, people who are disabled, and those who have young children or are pregnant. There is a complete list that can be found at https://www.dhcs.ca.gov/Medi-Cal/Pages/changes.aspx.
Another change effective in 2027 is that many will have to provide recertification every 6 months, rather than every year. This means you will have to complete eligibility paperwork every 6 months. As with the work requirement, this specifically applies to those between the ages of 19 and 64.
It is very important for Medi-Cal members to read all correspondence sent via mail or email from the Department of Health Care Services (DHCS) or the local county office. Responding to requests for information, such as recertification forms, by the deadline is essential to avoid potential loss of eligibility. Ensure your contact information is up to date with your county human services agency.
In Ventura County, you can create an account at https://benefitscal.com/Public/login to provide information directly to Medi-Cal.
In your case, you have both Medicare and Medi-Cal. This means you are considered a dual eligible person. Your Medicare insurance will act as your primary and pay your medical bills first. Then if your provider accepts Medi-Cal, your Medi-Cal insurance will pay second and cover things your Medicare does not. This can include co-pays, long-term care, vision, and dental.
Remaining informed about these evolving Medi-Cal regulations is crucial for maintaining continuous health coverage. While many people will see no immediate changes, proactively preparing for future requirements is highly recommended.
By staying informed and responding as requested, you can avoid unnecessary worry. Call your Medi-Cal worker if you have questions, and do not delay or avoid any healthcare needs.
Martha Shapiro can be reached at Senior Concerns at 805-497-0189 or by email at mshapiro@seniorconcerns.org.
