Medi-Cal eligibility: work or community engagement

The law defines who must meet the requirement and expands protections intended to prevent eligible people from losing Medi-Cal because of missing, conflicting, or unverified information.

What the law does ​

• Requires applicable Medi-Cal expansion adults to show, generally, 80 monthly hours of work, community service, or a work program; half-time education; a combination of those activities; or qualifying income.
• Excludes or deems compliant people in specified categories, including many caregivers, people with disabilities or serious health needs, pregnant people, certain American Indians, foster youth, people meeting TANF or SNAP work rules, and people affected by listed short-term hardships.
• Requires the State Department of Health Care Services to use available reliable data and allow consent-based information sharing to verify compliance while minimizing requests for documents.
• Requires counties to seek confirmation before taking adverse action when reliable data sources conflict and could harm eligibility.
• Requires counties to give a noncompliance notice, continue coverage during a 30-day response period, maintain eligibility through at least the end of that period for qualifying renewals, and consider other Medi-Cal or insurance-affordability eligibility before denial or disenrollment.
• Requires Medi-Cal work-requirement notices by mail or an elected electronic format plus additional communication methods, and treats a person's statement that they did not timely receive a notice as good cause for a late response.
• Makes implementation contingent on system readiness, federal approvals and funding, and allows delayed changes that need an unappropriated additional state budget allocation.

Who it affects ​

• Medi-Cal expansion adults ages 19 through 64 who are not otherwise excluded from the federal work or community-engagement requirement.
• Medi-Cal applicants and beneficiaries subject to county eligibility and renewal determinations.
• County welfare departments and the State Department of Health Care Services.

Context ​

The requirements operate only while the cited federal Medicaid work-requirement law remains in effect.