Are you on Medi-Cal? Here’s what to know about big changes coming in January

Beginning Jan. 1, 2027, many Medi-Cal enrollees will face new work requirements and eligibility checks — the result of sweeping federal changes that could affect more than 1 million L.A. County residents, according to organizers of a new countywide outreach campaign.

If you are a Medi-Cal enrollee between ages 19 and 64, you may soon need to show you're working, volunteering, going to school or in a job training program for at least 80 hours a month or otherwise earning income to keep your public health insurance coverage.

Some enrollees will also have to prove they’re eligible every six months instead of once a year.

Parents of children 13 and younger, pregnant women, older adults and people with disabilities are largely exempt from the requirements.

What to do to prepare

• Keep your address and phone number current with your county Medi-Cal office.
  
• Watch your mail, and respond promptly to Medi-Cal notices in yellow or white envelopes.
  
• If you're unsure what a notice means, community health centers and trained volunteers can help in person and in multiple languages, county officials said.

How we got here

Nearly 4 million L.A. County residents, or 41% of the population, rely on Medi-Cal — California’s version of Medicaid, a joint federal and state insurance program providing free or low-cost coverage to low-income people.

President Donald Trump, joined by Republican lawmakers, signs the "One, Big Beautiful Bill Act," a massive spending and tax bill, at the South Lawn of the White House in Washington, D.C. on July 4, 2025.

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Getty Images North America

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President Donald Trump signed the “One Big Beautiful Bill” — formally H.R. 1 — in July 2025, and it reduced federal Medicaid funding while adding a requirement that people who receive benefits work or show they are going to school, volunteering or seeking job training.

The new requirements and six-month renewal rules apply to adults 19-64 covered through Medi-Cal’s Affordable Care Act expansion, according to county officials.

In June, the federal Centers for Medicare & Medicaid Services issued the rule that implements the work requirement. CMS said in a news release that the framework is meant to promote economic stability and self-sufficiency.

“This rule helps Americans build skills and independence through work, education, job training, or community service, creating new opportunities for themselves and their families,” CMS Administrator Mehmet Oz said in a statement.

Later that month, states including California sued to challenge the changes. In July, a federal judge denied their request to pause the rules while the lawsuit continues.

Last week, L.A. Care Health Plan, which administers Medi-Cal benefits for many county residents and other partners, launched “Keep L.A. Covered,” a public campaign to train community leaders, including pastors, teachers and health workers, to warn Medi-Cal recipients about renewal notices. The first training is Oct. 27, hosted by Maternal Child Health Access.

County officials say people and organizations that want to get involved can sign up at www.keeplacovered.org.

Paperwork hurdles

Campaign leaders say people are more likely to lose coverage because a notice went to an old address or went unanswered than because they stopped qualifying for Medi-Cal.

"One missed notice, one missed deadline, one moment of confusion can mean them losing their coverage, and it's not because they're no longer eligible," Martha Santana-Chin, CEO of L.A. Care, said at a campaign launch last week. "It's simply because they haven't been able to navigate the paperwork that's ahead of them.”

The state of California is already mailing letters about the changes, Santana-Chin said.

If the state can't verify compliance, it must send a noncompliance notice and give the enrollee 30 days to prove compliance or an exemption. Otherwise, the application may be denied, or the person disenrolled.

Advocates say the risk is greatest for people without a stable mailing address. Statewide, most people experiencing homelessness are eligible for or already enrolled in Medi-Cal, according to the California Health Care Foundation.

The 2026 Los Angeles Homeless Services Authority homeless count estimated more than 73,000 people were experiencing homelessness in L.A. County. Many would qualify for medical exemptions that would allow them to receive Medi-Cal benefits without proof of work or other requirements, but claiming an exemption requires clinical documentation and regular contact with the healthcare system, the foundation said. Federal guidance doesn't let states exempt people from the requirements solely for being unhoused.

Some details of the 80-hour monthly work requirement remain unsettled. The federal government is still writing the details on what counts as qualifying work, volunteering or education, Santana-Chin said.

The Centers for Medicare and Medicaid Services projects the requirement will reduce Medicaid enrollment nationwide by more than 3 million people. The federal agency assumes about 15% of enrollees will lose coverage, about 9% because they don't meet the requirement and about 6% because of paperwork or other administrative barriers. The actual effect depends on how states carry out the rules, according to a recent report from the federal agency.

The Congressional Budget Office, which analyzed the law using different methods, estimated the requirement would leave 5.3 million more people uninsured in 2034.