MedicaidCoverageHigh impact
25-1406m Upcoming Medi-Cal Eligibility and Benefits Changes: What Providers Need to Know
Health Net·CA·Provider News
Effective date
Jan 1, 2026
We identified it
Jun 20, 2026
Summary
Starting January 1, 2026, Medi-Cal will implement significant eligibility changes including asset tests for older adults and disabled patients, enrollment freezes for adult immigrants, work requirements, and more frequent renewals. These changes will affect patient coverage and may result in coverage gaps or restrictions for various patient populations over the next several years.
Action Required
Before January 1, 2026: Billing team must update patient verification processes to check asset limits ($130,000 for individuals, $65,000 per additional household member) for patients 65+ and disabled patients. Front desk staff should inform affected patients about annual asset reviews, work requirements starting 2027, and shorter renewal periods. Update patient communication protocols to advise immigrant patients about completing annual renewals and potential coverage restrictions. Monitor Medi-Cal communications for eligibility updates to prevent claim denials.