Medi-Cal is the state of California’s version of Medicaid, providing health care coverage for low-income residents of California. However, many people are losing their Medi-Cal coverage for various reasons. If you have lost your coverage, it’s important to understand your options so that you can get health care coverage for you and your family.
Why Are People Losing Medi-Cal Coverage?
During the pandemic, Medi-Cal suspended checking eligibility requirements for those enrolled in Medi-Cal. However, in 2023, they began to check eligibility requirements again. People enrolled in Medi-Cal received renewal packets which specified certain information they needed to provide to verify eligibility.
Unfortunately, many Medi-Cal enrollees failed to send in the required information on time, or made errors on the paperwork and eligibility documents, causing their Medi-Cal coverage to terminate.
Additionally, certain eligibility changes were made effective January 1, 2026, which are going to cause some people to lose coverage. The key changes made include:
- A reinstatement of asset limits that apply mainly to those over 65, disabled people, and people who live in nursing homes. Asset limits are $130,000 with an additional $65,000 for each additional household member.
- Immigration status eligibility changes.
Additionally, enrollees are required to verify their income twice per year under the new rules.
Eligibility Requirements 2026
It’s important to know the current eligibility requirements for Med-Cal so that you can determine if you are still eligible, even if you lost coverage.
Requirements are:
- Income Limits
- For adults, the limit is 138% of the federal poverty levels (FPL), which is $21,597 per year for one person, $44,367 per year for a family of four.
- For children 19 and under, the limit is 266% of FPL, which is $41,629/year for one, $85,519/year for a family of four.
- For pregnant women, the limit is 322% FPL, or up to 213% FPL depending on certain rules.
- Assets: In 2026, asset limits are $130,000 for one person, $195,000 for a couple. In some cases, there may be no asset limits.
- Immigration Status: You must be a citizen or meet certain immigration requirements. However, some benefits are available regardless of status, particularly for children and pregnant women.
What to Do if You Believe You’re Eligible but Lost Coverage
If you believe you’re eligible, but were disenrolled, you can take certain steps to try to get your coverage back.
You have the right to file an appeal by requesting a state hearing, usually within 90 days of the date you lost coverage. You can submit your request online, by phone, or by mail using the form included with your notice of action. If you file before your coverage ends, you can ask for “aid paid pending,” which may allow you to keep your benefits while your case is reviewed. After you request a hearing, you’ll receive a hearing date.
If it has been more than 90 days, you’ll need to reapply for Medi-Cal. You can apply online at CoveredCA.com, or with your county. You can also apply by phone at 1-800-300-1506, or by mail. You’ll need to submit the following documents:
- Driver’s license or I.D.
- Proof of citizenship including social security number and immigration documents.
- Income verification in the form of paystubs, W-2s, or tax returns.
- Asset verification such as bank statements and property records.
What Are My Options if I No Longer Qualify for Medi-Cal?
If you’re no longer eligible for Medi-Cal, you still have several options for getting health coverage. Many people transition to a low-cost plan through Covered California, the state’s health insurance marketplace, where you may qualify for premium subsidies based on your income.
If your job offers insurance, you can enroll in an employer-sponsored plan. Losing Medi-Cal usually triggers a special enrollment period for employer-sponsored plans so that you don’t have to wait until the regular enrollment period.
You may qualify for Medicare if you are age 65+ or have certain disabilities.
You can also look into community health clinics that provide low-to no cost services for low-income families.
Avoiding Disenrollment in the Future
To avoid losing Medi-Cal coverage in the future, make sure you stay up to date on eligibility requirements, which may change periodically. Also, always pay attention to your Medi-Cal mail so that you don’t miss renewal dates, or eligibility verification requests. Always meet these requirements on time.
In Closing
Medi-Cal is a valuable program that provides health care coverage for many people, but to keep coverage active you have to fulfill certain requirements and remain eligible. If you are having issues with your Medi-Cal but have medical needs, Health Service Alliance is here to help. We can work with you to get coverage or to find other options without delaying your medical care. We are dedicated to providing compassionate, personalized, and accessible care regardless of your ability to pay. Reach out today to learn more.
