MedicaidAdministrativeMedium impact
[California] Medicaid 2027 work requirements: What care providers need to know
Anthem BCBS·CA·Government Programs
Effective date
Jan 1, 2027
We identified it
Sep 2, 2026
Summary
Effective January 1, 2027, certain Medi-Cal (California Medicaid) members ages 19-64 in the expansion population must report an average of 80 hours per month of work, school attendance, community service, or a combination thereof to maintain eligibility. Members must also renew benefits more frequently. Most Medi-Cal members are exempt, including pregnant/postpartum women, caregivers, medically frail individuals, disabled veterans, and foster youth. Eligibility will be verified using available data sources when possible; members unable to be verified will receive direct communication requiring manual reporting.
Action Required
By November 1, 2026: Billing and front desk staff should educate Medi-Cal patients (particularly ages 19-64 in expansion population without disabilities or qualifying conditions) about new work requirements and the need to maintain current contact information with Medi-Cal. Staff should direct affected members to expect communications from Medi-Cal several months before January 1, 2027, and advise them to report work/school/community service hours when required. Billing team should monitor for coverage denials related to non-compliance and flag affected members during eligibility verification processes. Update patient education materials to explain exemptions and reporting requirements. No billing code or documentation changes are required at this time—this is primarily a member eligibility/enrollment administrative change rather than a clinical billing change.