Two major federal policy changes are set to reshape Medi-Cal in 2027, and they will affect the same population at nearly the same time.

Starting in January 2027, California will begin implementing a new work and community engagement requirement for certain Medi-Cal expansion adults. Then, beginning March 1, 2027, affected adults will begin moving from annual eligibility checks to six-month redeterminations.

California accounts for roughly 20% of the entire nation’s Medicaid enrollment so this chang is going to affect millions. It creates more work for members and the organizations helping them navigate coverage.

In 2027 Californians will experience a different Medi-Cal experience, one that requires more frequent documentation, more deadlines, and more opportunities for an eligible member to lose coverage because a required step wasn't completed.

What's Changing

The One Big Beautiful Bill Act, also called H.R. 1, requires states to implement new work and community engagement requirements for certain Medicaid expansion adults beginning January 1, 2027.

Members generally must work and earn at least $580 per month, participate in qualifying education or job training, volunteer or perform community service for at least 80 hours per month, or combine qualifying activities to meet the requirement.

At the same time, H.R. 1 requires some states to redetermine eligibility for the ACA expansion population every six months rather than annually. Under the state's implementation plan, new members will receive a six-month eligibility check, while existing members will transition to the new schedule at their next renewal after March 1, 2027.

For members, that means more frequent deadlines, more documentation, and more opportunities to need help understanding what is being asked of them.

For the organizations supporting them, it means scaling enrollment to twice a year, keeping track of who needs to act, what they need to submit or verify, whether they qualify for an exemption, and when each step is due.

California's Numbers Show the Scale

Medi-Cal covers more than one-third of California's population. As of April 2026, approximately 13.9 million Californians were certified eligible for Medi-Cal, including 4.68 million adults ages 19 to 64 in the ACA expansion population.

California's Legislative Analyst's Office estimates that approximately 3.5 million people will initially be subject to the new Medi-Cal work requirement after accounting for exemptions.

The state expects the impact to be significant.

The Legislative Analyst's Office estimates that the work requirement and six-month renewals together could result in about 2.1 million fewer people enrolled in Medi-Cal by June 2028, compared with what enrollment would have been without those changes.

Those estimates aren't predictions of exactly how many eligible Californians will lose coverage. They reflect the expected overall enrollment impact, including people who may no longer meet the requirements and people who may lose coverage because of the additional administrative burden.

The Real Risk Isn't Just Eligibility. It's Administration.

The challenge with these new requirements will be turning communication into ongoing, personalized engagement that helps members complete each required step before a missed deadline becomes a loss of coverage.

The Legislative Analyst’s Office specifically warns that some otherwise eligible people could lose Medi-Cal because of the heightened administrative burden of proving eligibility.

Its analysis notes that processes requiring manual verification or direct interaction with enrollees create additional opportunities for eligible people to be disenrolled when required steps aren't completed.

That creates a much more continuous engagement challenge.

A member might be working but not know how their hours will be verified. They might qualify for an exemption but not understand what documentation is needed. Their employment, caregiving responsibilities or health status could change. A renewal notice could arrive while they're moving, changing jobs or dealing with another life event.

The policy may be federal. The day-to-day burden of navigating it will be local.

The scale of the change means organizations will need to move from one-time notification to ongoing engagement:

• Identifying which members are likely to be affected

• Explaining requirements and exemptions in plain language

• Helping members understand what action they need to take

• Following up when required information hasn't been submitted

• Reaching members through the channels they actually use

• Re-engaging members when circumstances change

• Prioritizing staff intervention for people who need additional help

The organizations closest to members, health plans, health systems, FQHCs, community organizations and care teams, will be critical to making that possible.

Keep Eligible Californians Covered

Millions of adults will face new requirements, and the organizations supporting them will have to manage more frequent eligibility checks, more documentation and more member follow-up.

Can systems keep up with demand to help eligible members successfully navigate the requirements needed to keep their coverage?

Blooming Health helps health plans, health systems, and community organizations put Care Enablement Workflows (CEWs) to work as Medicaid requirements grow more complex.

CEWs automate personalized outreach, guide members through each step, answer questions, collect required information, follow up when action is incomplete, and prioritize people who need additional support. helping organizations manage more frequent requirements without putting the entire burden on staff.

Care Enablement Workflows read the signals that show who needs support and reach those members proactively, then deliver activity, engagement, and outcomes back into the same tools for full visibility into progress, results, and next steps.

Give your teams the right tools to support Medicaid populations. See how Blooming Health’s Care Enablement Workflows can help you prepare for what’s next.