The federal change that took effect on October 1, 2026, concerns who the federal government will help pay for under Medicaid. It does not, by itself, decide who California covers. On that date the two questions came apart, and California has answered the second one with a timetable that runs through mid-2027.
The federal change
Primary recordBeginning October 1, 2026, states may no longer claim federal matching funds for full-scope Medicaid or the Children's Health Insurance Program for noncitizens outside a narrowed set of categories (CMS). As summarized from CMS's guidance to states, the federal baseline is now limited to lawful permanent residents, Cuban and Haitian entrants, and migrants from the Compact of Free Association nations. Refugees, asylees, parolees, survivors of trafficking and others now fall outside it (State Health and Value Strategies).
What did not change. Federal matching remains available for the treatment of emergency medical conditions. The statute does not affect the state option to cover lawfully residing children and pregnant women, or CHIP Health Services Initiatives. States may continue coverage with state-only funds, which CMS does not treat as Medicaid.
A second change, for emergency care. California's May Revision records that, beginning October 1, 2026, the federal match for emergency Medi-Cal for expansion-group adults with unsatisfactory immigration status falls from 90 percent to 50 percent (May Revision summary).
California's choice
Primary recordThe Department of Health Care Services states that people affected by the October federal change continue to receive state-funded full-scope Medi-Cal through June 30, 2027. On January 1, 2027, they move from Medi-Cal managed care to fee-for-service Medi-Cal, where Enhanced Care Management and Community Supports are not available. Beginning July 1, 2027, people in this group are eligible only for pregnancy-related and emergency services (DHCS, Medi-Cal changes). DHCS has mailed affected members a notice dated October 1, 2026, telling them they keep full-scope coverage for now (DHCS notice).
| Date | What happens to affected Medi-Cal members in California |
|---|---|
| October 1, 2026 | Federal match ends; full-scope coverage continues with state funds |
| January 1, 2027 | Move from managed care to fee-for-service; Enhanced Care Management and Community Supports end for this group |
| June 30, 2027 | State-funded full-scope coverage ends |
| July 1, 2027 | Pregnancy-related and emergency services only |
What patients should do
Keep using your Medi-Cal card. Read every notice from your county or from DHCS, and keep a copy. If you have questions, contact your county social services office or the DHCS Medi-Cal Helpline at 1-800-541-5555.
What practices should do
AnalysisPractices that see these patients through a Medi-Cal managed-care plan should confirm before January 1, 2027, that they are enrolled to bill fee-for-service Medi-Cal. Otherwise continuity of care will break at the plan transition, six months before eligibility itself changes. Care managers should plan now for the loss of Enhanced Care Management for these patients.