What's at stake?
Big state and federal changes to Medicaid are coming in 2026 and 2027. If you rely on Medi-Cal, you could face new monthly costs, lose benefits, or have to prove you’re working every six months to keep your coverage.
Fresnoland spoke with numerous experts, officials and people directly affected on the looming state and federal cuts that will impact low-income, immigrant, and rural communities, among many others among the 52% of local residents who depend on the program.
Below you can find a practical guide to help prepare and a timeline for when changes are expected to take effect. You can also check out the full story here.
Who will be affected?
More than half of Fresno County residents—about 52%, or over half a million people—are on Medi-Cal. Health experts say these changes could hit low-income, immigrant, and rural communities the hardest.
You may be directly affected if you:
- Are 65 or older, have a disability or long-term care.
- Do not have “satisfactory immigration status” (this includes many undocumented residents).
- Can’t work or can’t prove work hours with documents.
- Get full dental coverage through Medi-Cal.
Even if you are currently covered, you will have to requalify every six months versus a year or meet new work requirements to stay in the program.
What’s changing and when?
January 2026
- No new Medi-Cal enrollment for undocumented adults over 19 who are income-eligible but not already enrolled.
July 2026
- End of full dental benefits for undocumented immigrants and others without satisfactory immigration status. Only emergency dental care will be covered after this date.
January 2027
- $30 monthly premium for Medi-Cal if you do not have satisfactory immigration status.
- Work-reporting requirements begin. You will have to show proof that you are working a set number of hours or that you qualify for an exemption.
- Renewals every six months instead of once a year.
- Possible co-pays of up to $35 per doctor’s visit.
- Asset limits return for seniors and people with disabilities, which could make some people ineligible if they have savings or property above the new limits.
Why this matters for immigrant communities
Some Medi-Cal data is shared with federal agencies like the Centers for Medicare & Medicaid Services (CMS) for processing. CMS recently shared information with the Department of Homeland Security, which has allowed immigration authorities to access some health care data, further escalating concerns over safety and privacy.
The sweeping changes, coming with increased immigration enforcement, make things harder in communities that have always struggled to find enough doctors.
Be aware of two state-level changes:
- Medi-Cal enrollment freeze beginning in January 2026, which bars income-eligible undocumented adults over 19 from enrolling if they are not already covered.
- Elimination of full-scope dental coverage for certain immigrants with “unsatisfactory” immigration status in July 2027, covering only emergency dental care afterward.
If you are undocumented or worried about your status, get advice from legal aid or advocacy groups before making changes to your Medi-Cal enrollment.
What qualifies as work requirements?
- 80 hours per month of work, community service, and/or “work program” participation.
- Enrolled in education at least half time.
- Any combination of the above totaling 80 hours.
- Seasonal workers with an average monthly income of 6 months of minimum wage multiplied by 80 hours.
- Monthly income of minimum wage multiplied by 80 hours.
Some states will offer optional short-term hardship exceptions for people. A list can be found at this link.
Who is exempt from work requirements?
You won’t have to prove work hours if you:
- Have dependent children under 13.
- Are pregnant or within the postpartum coverage period.
- Foster youth/former foster youth under age 26
- Have a disability.
While the work requirement is a federal law, Medicaid programs are regulated and operated at the state level. More about federal exemptions can be found at the link.
What counts as ‘proof of work’?
The state has not finalized exact details, but you will likely need:
- Pay stubs.
- Employer letters stating your job title and hours.
- Self-employment receipts or tax forms.
If you work informal or cash jobs—like gardening, housekeeping, or day labor—you will need to find other ways to prove your hours. That might mean signed letters from people who hire you or keeping your own work logs.
How to prepare now
- Get organized: Keep ID, proof of income, proof of residence, and any disability paperwork together in one folder.
- Stay ahead of deadlines: With renewals every six months, missing one could mean losing coverage.
- Apply to Medi-Cal either online at BenefitsCal, pick up an application, or find trusted health care providers to help you apply.
- Finish dental work early if you might lose full coverage in 2026.
- Fill prescriptions for 90 days at a time if possible.
- Schedule all check-ups and lab work now to avoid delays later.
- Find trusted health care providers who can guide you through these changes.
Where to get help in Fresno County
These organizations offer free Medi-Cal application and renewal help.
- United Health Centers of the San Joaquin Valley
- Cultiva la Salud
- Clinica Sierra Vista
- Family HealthCare Network
- Fresno County Department of Social Services
How to stay informed
- Follow local advocacy groups and health organizations for updates.
- Attend city or county meetings where health policy is discussed.
- Avoid relying only on social media or word-of-mouth; verify with trusted sources.
Health experts say that if you already have Medi-Cal, it will be easier to keep it than to reapply under the new rules. Start gathering your documents now, stay on top of deadlines, and use local organizations for help navigating the changes.
General Resources for Medi-Cal Changes:
- California Budget & Policy Center report on the federal and state budget cuts (see the health care section for impacts to Medi-Cal).
- California State Department of Health Care Services resource on what Medi-Cal members need to know about Medi-Cal program changes due to state budget cuts.
- California State Department of Health Care Services resource explaining “unsatisfactory immigration status.”
- California Department of Health Care Services for up-to-date information about Medi-Cal.
- CalMatters explainer about how the federal and state cuts will affect Californians.
- Central Valley Immigrant Integration Collaborative and the Protecting Immigrant Families coalition for up-to-date information, resources, and support in preparing for these changes for immigrant communities.
- California Budget & Policy Center table on how federal cuts will affect Californians.
Comments are closed.