California Medicaid (Medi-Cal) 2026: Eligibility, Programs & Changes

Medi-Cal is California's Medicaid program, and CMS describes it as one of the nation's largest and most complex Medicaid systems. DHCS counted 13,910,180 certified eligibles in April 2026, and says about one-third of Californians receive health care services it administers.1

Medi-Cal pays for a newborn's first checkup, a senior's dialysis, an autistic teenager's behavioral therapy, and the personal care worker who lets a frail adult stay in her own apartment instead of moving to a nursing home.

It is also among the most layered state Medicaid programs in the country. Medi-Cal runs on overlapping federal authorities, contracts with managed-care plans whose footprint changes by county, processes eligibility through 58 county welfare departments rather than one state office, and absorbed two budget-driven reversals effective January 1, 2026. This guide is the foundation: what Medi-Cal is, who runs it, who qualifies, the major program tracks, what changed in 2026, and how to apply.

Who runs California Medicaid?

Medi-Cal is a layered federal-state-county program, and three levels matter for almost every question you will have.

The federal government. The Centers for Medicare & Medicaid Services (CMS) approves California's Medicaid state plan and the waivers that overlay it, so every change to eligibility, benefits, or financing requires CMS sign-off.

The state (DHCS). DHCS is California's federally designated single state Medicaid agency, within the California Health and Human Services Agency. It writes the rules, contracts with managed-care plans, oversees the county Mental Health Plans, and operates the Medi-Cal Member Helpline at 1-800-541-5555.1

The 58 counties. County Welfare Departments adjudicate eligibility. All 58 run on the shared CalSAWS back-end, and applicants everywhere use BenefitsCal to apply and manage their case.1

In most states eligibility is processed centrally. In California your application and your renewal both go to your county, so knowing which level handles which question saves real frustration.

The federal authorities underneath Medi-Cal

The difference between these authorities matters when you read about benefits, waitlists, or eligibility rules.

The CalAIM Section 1115 demonstration is the single most important authority for understanding Medi-Cal in 2026. CMS approved it December 29, 2021, effective through December 31, 2026, and CalAIM launched January 1, 2022. DHCS submitted its renewal application to CMS on May 11, 2026, seeking a five-year renewal that would run the demonstration through December 31, 2031. Everything tied to CalAIM, including Enhanced Care Management and Community Supports, is operating on that clock.3

The two 2026 budget reversals

California spent a decade expanding Medi-Cal. The 2025-26 budget undid two of the biggest expansions, and many older online guides have not caught up.

The asset-limit reinstatement (effective January 1, 2026)

California eliminated all non-MAGI Medi-Cal asset limits on January 1, 2024, becoming the first state to do so. That ended on January 1, 2026. Under AB 116 (Chapter 21, Statutes of 2025), implemented through DHCS All-County Welfare Directors Letter (ACWDL) 25-18, the non-MAGI asset test returned at:2

Read that second column before you plan around the first. DHCS's Medi-Cal Changes page states the $130,000 and $65,000 figures apply "Through June 30, 2027", and that from July 1, 2027 the limit is $21,000 for one person, $31,000 for two, plus $1,550 per additional person. A household that reorganizes its savings to sit just under $130,000 is not safe: it is roughly six times over the limit that arrives eighteen months later. Plan against that number, not today's.1

Implementation is rolling: new applicants filing on or after January 1, 2026 must report assets, while current beneficiaries report at their first annual renewal after that date. SSI-linked enrollees remain under SSI's $2,000 / $3,000 limits, which AB 116 did not change, and the Pickle, Disabled Adult Child, and Disabled Widow(er) programs stay exempt because their limits were eliminated under a separate federal waiver authority. If you hold liquid assets above the current limit, talk to a Medi-Cal planner about exempt-asset strategies well before your renewal date.2

The undocumented-adult enrollment freeze (effective January 1, 2026)

California had built full-scope Medi-Cal for income-eligible residents regardless of immigration status through a series of expansions, the last of which (adults 26 through 49) took effect January 1, 2024. As of January 1, 2026, DHCS says some adults can no longer sign up because of their immigration status, a change it heads "Enrollment Freeze."

Who is not caught by it matters as much as who is. Adults who already have full-scope Medi-Cal keep it regardless of immigration status, so long as they renew on time and still meet Medi-Cal rules. And three groups remain eligible to enroll regardless of status: children ages 0 to 18, pregnant people, and people under 26 who were in foster care on their 18th birthday. If you are pregnant or aged out of foster care, do not assume the freeze applies to you. If you are already enrolled, renew on time.1

California Medicaid eligibility (2026 figures)

Medi-Cal eligibility breaks into two universes: MAGI (Modified Adjusted Gross Income, for children, parents, pregnant people, and expansion adults) and non-MAGI (for seniors 65 and older, blind, disabled, and long-term care). Different math, different income limits, different asset rules.

MAGI Medi-Cal

The MAGI adult-expansion income limit is 138% FPL, and the figure DHCS currently publishes on its Eligibility by Federal Poverty Level chart is $21,597 a year for a household of one. That chart still runs on the 2025 poverty guideline, because Medi-Cal refreshes its FPL levels on their own schedule rather than the January federal one, so expect it to rise toward 138% of the 2026 guideline ($15,960 a year, $1,330 a month for one person) when DHCS updates it. Children, pregnant adults, and family-planning applicants qualify at higher percentages of FPL under separate categories. MAGI Medi-Cal has no asset test of any kind.2

Aged & Disabled and long-term care (non-MAGI)

Non-MAGI standards run off the federal SSI numbers and the reinstated asset test.

• SSI Federal Payment Standard: $994 per month for an individual, $1,491 for a couple, for 2026. SSI resource limits are $2,000 individual / $3,000 couple.2
• No gross-income cutoff for institutional long-term care. Do not assume a 300%-of-SSI income cap: California's own statute points the other way. Welfare and Institutions (W&I) Code Section 14005.13(a) treats a long-term-care resident's income above what is allowed for personal needs as a patient liability, a monthly Share of Cost, not a denial. If your income is high, the question is what your Share of Cost will be, not whether you are locked out.5
• Medically Needy maintenance need level (MNL): $600 per month for one person and $934 for two. Income above the MNL becomes the monthly Share of Cost. These dollar amounts are not printed in the statute itself, so confirm the current figure with your county before you rely on it.2
• Asset test: reinstated January 1, 2026 at $130,000 individual / $195,000 couple through June 30, 2027, dropping to $21,000 / $31,000 on July 1, 2027.2,1

Long-term care Share of Cost and spousal protections

A nursing-facility resident in care for an entire calendar month keeps $35 a month for personal and incidental needs, fixed in 22 CCR § 50605(a)(1), with the rest of countable income going to the monthly Share of Cost. An SSI recipient is on a different track: where Medicaid pays more than half the cost of care for a whole calendar month, the federal SSI benefit is limited to $30 a month plus any state supplement, and California's supplement brings the Title XIX Medical Facility standard to $62.00 a month for an individual and $124.00 for a couple as of January 1, 2026.6

Medicare and other health-insurance premiums and any community-spouse allowance also come off before the remainder goes to the facility. Treat that as a sketch, not a formula: the complete list of post-eligibility deductions comes from 42 CFR § 435.725 and your county's instructions, so have the county walk through your actual calculation.5

For spousal impoverishment, use California's own published numbers rather than the federal floors. DHCS publishes a single Community Spouse Resource Allowance and a single Minimum Monthly Maintenance Needs Allowance for the state, in ACWDL 26-02, effective January 1, 2026:5

The distinction matters in dollars. The underlying federal Section 1924 standards let a state set an MMMNA anywhere from a $2,705.00 floor (effective July 1, 2026) up to the $4,066.50 maximum, and a CSRA from $32,532.00 up to $162,660.00. California does not publish those lower floors at all: ACWDL 26-02 gives one CSRA and one MMMNA, both at the top of the federal range, DHCS rounding the maximum to a whole $4,067. A California community spouse who read a national guide and is bracing for $2,705 a month is short by more than $1,300. Medicare and other health-insurance premiums are deducted when her gross income is measured against the MMMNA.5

These protections reach beyond institutional care to home- and community-based services, including California's Section 1915(c) HCBS waivers, under the ACA's broadened definition of "institutionalized spouse" as implemented by DHCS ACWDLs 17-25 and 18-19. The MMMNA applies when the institutionalized spouse is in a skilled nursing facility, is on an HCBS waitlist, or is actively participating in an HCBS program. In HCBS community cases there is no $35 personal needs allowance.5

The transfer look-back

Per DHCS ACWDL 25-18, counties will not review or penalize transfers made between January 1, 2024 and December 31, 2025, because the asset test did not apply then. California's look-back period is 30 months, shorter than the federal 60 months that applies to disposals on or after February 8, 2006. Beginning July 1, 2026, the months reviewed increase by one each month until the full 30-month review applies to long-term-care applications and members entering long-term care on or after July 1, 2028. The maximum period of ineligibility is 30 months from the transfer date. The penalty divisor is the statewide Average Private Pay Rate, $14,440 a month for 2026; counties do not follow up when electronic asset verification shows transfers under that rate, or when you were within the asset limits on the transfer date.5

One caution about waivers, because this rule is easy to read backwards. ACWDL 25-18 says the period of ineligibility is the penalty for nursing-facility level of care, and "does not apply to Medi-Cal members enrolled in community-based Medi-Cal programs." That describes whom the nursing-facility penalty reaches. It is not a promise that an HCBS-waiver applicant escapes the look-back, so do not treat a gift as consequence-free because you intend to use a waiver rather than a nursing home. Confirm any past transfer with your county eligibility worker.7

Managed care under CalAIM

Most Medi-Cal members, roughly 90 percent, receive their care through a Medi-Cal managed care plan rather than fee-for-service. Effective January 1, 2024, managed care operates under five county models: County Organized Health System (COHS), Single Plan, Two-Plan, Geographic Managed Care, and Regional.8

County Organized Health System (COHS) counties

In a COHS county, DHCS contracts with a single county-run plan that is the sole plan in the county, and members have no plan choice. Six COHS plans, Partnership HealthPlan, CalOptima Health, CenCal Health, Central California Alliance for Health, Gold Coast Health Plan, and Health Plan of San Mateo, cover 22 counties.8

Commercial plans and Kaiser

California's 2024 statewide procurement reset commercial contracts effective January 1, 2024, awarding five commercial plans: Blue Cross of California Partnership Plan (Anthem), Blue Shield of California Promise Health Plan, Community Health Group Partnership Plan, Health Net Community Solutions, and Molina Healthcare of California. Kaiser Permanente holds a separate direct contract under AB 2724 and SB 510, serving 32 counties.8

Why your county and plan matter

A beneficiary in Los Angeles can choose among several plans; one in a single-plan COHS county has none. Networks, formularies, and Community Supports menus vary plan by plan and county by county, so this is one of the highest-leverage decisions you will make. See our Medi-Cal managed care plans guide for plan-by-plan comparisons.

CalAIM, what changed

CalAIM (California Advancing and Innovating Medi-Cal) is the structural backbone of every major reform Medi-Cal has rolled out since 2022.

Enhanced Care Management (ECM)

Enhanced Care Management is a statewide Medi-Cal benefit for eligible members with complex needs, organized around defined Populations of Focus and delivered by a single Lead Care Manager. If you fit a Population of Focus, ECM gives you one care manager who coordinates primary care, specialists, behavioral health, housing, and transportation. Ask your managed care plan whether you qualify.3

Community Supports

Community Supports are 14 pre-approved, cost-effective services (formerly In Lieu of Services) that managed care plans may elect to offer in lieu of State Plan services, such as housing transition navigation, recuperative care, medically tailored meals, and home modifications. Not every plan offers every Community Support, so ask your plan directly.3

Short-term rental assistance

Short-term rental assistance, which DHCS has also called Transitional Rent, provides up to six months of rent or temporary housing. It is often described as a fifteenth Community Support, but it is not one: its authority and schedule come from BH-CONNECT rather than the CalAIM Community Supports list. The CMS Special Terms and Conditions phase it in three steps: optional for plans no sooner than July 1, 2025; mandatory no sooner than January 1, 2026 for people meeting the access criteria for Specialty Mental Health Services, Drug Medi-Cal, or DMC-ODS, and still optional for everyone else; mandatory for all eligible populations no sooner than January 1, 2027. If you do not meet those behavioral health criteria, your plan may decline to offer it until 2027.3

Justice-involved pre-release Medi-Cal

On January 26, 2023, California became the first state in the nation approved to offer a targeted set of Medicaid services to incarcerated youth and adults for up to 90 days prior to release.3

Medi-Medi Plans for dual-eligibles

For people dually eligible for Medicare and Medi-Cal, California's Medi-Medi Plans (a type of Medicare Advantage plan that combines Medicare and Medi-Cal benefits in one plan) expanded effective January 1, 2026 from 12 counties to 41 counties, adding 29 counties. Many of these same beneficiaries also have their Medicare premiums and cost-sharing covered through a Medicare Savings Program.8

BH-CONNECT

CMS approved California's BH-CONNECT (Behavioral Health Community-Based Organized Networks of Equitable Care and Treatment) Section 1115 demonstration, effective January 1, 2025 through December 31, 2029. It runs on a longer clock than CalAIM itself, and it is the authority behind short-term rental assistance.3

Long-term services and supports

California delivers long-term services and supports (LTSS) through several distinct programs rather than one waiver. We cover each in depth in dedicated guides; the foundational map:

A few highlights worth knowing now:

IHSS does permit paid spouses. California is one of a small number of states that permits paid spousal caregivers in its main Medicaid personal-care program, through the IHSS-Plus Option under Section 1915(j) self-directed authority. The recipient must have full-scope Medi-Cal, be 65 or older or blind or disabled, live in their own home (facility residents are not eligible), and have an assessed functional need documented by a county social worker. Hours are capped at 283 a month for the severely impaired and 195 otherwise.9 See our How to get paid as a family caregiver in California guide.

Both flagship senior waivers are at capacity. On DHCS's December 2025 dashboards, the HCBA Waiver showed 10,760 enrolled against a 6,091-person waitlist, and the Assisted Living Waiver 14,847 enrolled against an 18,365-person waitlist, so ALW's waitlist now exceeds its enrollment. ALW has been waitlisted since it hit capacity in 2017, and slots go to Care Coordination Agencies as they open, with priority for institutionalized individuals. Get on a list early, and do not build a care plan that assumes a slot on a fixed date.10

The Assisted Living Waiver serves only 15 counties: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, and Sonoma. It pays for care in a Residential Care Facility for the Elderly, an Adult Residential Facility, or subsidized public housing, but not room and board, which the resident pays.7

PACE is closed to new organizations and service areas until at least late 2027. CMS says you can join if you are 55 or older, eligible for nursing home care, and able to live safely in the community. DHCS Provider Letter 25-02 paused the PACE application process from November 20, 2025 until November 19, 2027 at minimum, to manage the program's growth. That pause covers new organizations and expansions, so ask the PACE organization serving your county whether it is taking participants.7

MSSP's minimum age is unsettled. DHCS's MSSP page says clients must be 65 or older; the California Department of Aging, which administers it, publishes 60 or older. Two state sources disagree, so if you are between 60 and 65, call your local MSSP site rather than ruling yourself out.7

For deep dives, see our Medi-Cal HCBS waivers and In-Home Supportive Services (IHSS) guides.

Behavioral health and other Medi-Cal carve-outs

Several benefits are delivered outside your managed care plan, which is why the plan is not always the right number to call:

• Specialty Mental Health Services for serious mental illness run through your county Mental Health Plan, under the Section 1915(b) managed-care waiver that runs alongside CalAIM.
• Substance use disorder treatment runs through the Drug Medi-Cal Organized Delivery System (DMC-ODS). Ask your county behavioral health department what it operates locally.
• Outpatient pharmacy is fee-for-service statewide under Medi-Cal Rx, administered by Magellan Medicaid Administration since January 1, 2022.
• Most dental care goes through Medi-Cal Dental rather than your plan.8

For everything else, including vision, hearing, and transportation, ask your plan for its Evidence of Coverage, since covered-service detail varies by plan.

How to apply (and renew)

DHCS presents four ways to sign up: online through BenefitsCal or Covered California, by phone on 1-800-541-5555 or through your county office, in person at a county office, or by mail using an application downloaded from DHCS.4

Key timelines and rules:

• Determination: Under 42 CFR 435.912, the county must determine eligibility within 45 days for most applicants and within 90 days for those applying on the basis of disability.4
• Retroactive coverage: Eligible applicants can receive up to three months of retroactive coverage for medical or dental bills in the months before applying, if they would have qualified then.4
• Plan selection: After approval, enrollees in managed-care counties choose a plan through Health Care Options at 1-800-430-4263; depending on the county, you must choose within 30 days or Medi-Cal assigns a plan for you.4
• Renewal: DHCS says your Medi-Cal is looked at once per year. The county renews by notice with no action needed when its own data and other government databases allow; otherwise it mails a renewal form or Request for Information. If it is less than 90 days from the date on that letter, you can turn in the form or missing information and keep coverage without a new application. After 90 days, you must reapply.4
• A note for seniors and disabled members: the federal renewal rule changed July 31, 2026. The "once every 12 months, and no more frequently" protection now applies only to members whose eligibility runs on MAGI. For the aged, blind, and disabled, the agency must redetermine at least every 12 months with no ceiling on frequency, the automatic ex parte step is conditioned on sufficient information being available, and the pre-populated form package is permissive for the state rather than required. Do not assume you cannot be asked to re-establish eligibility sooner.4
• Appeals: Denials, terminations, and reductions come by a Notice of Action, and you have 90 days to request a State Hearing. Aid Paid Pending is on a much shorter clock. Benefits continue during the appeal only if you request the hearing by the notice's effective date where 10-day notice is required, or otherwise within 10 days of the date on the notice. Waiting out the 90-day window preserves your hearing but not your coverage.4

For step-by-step guidance, see our How to apply for Medi-Cal guide.

The 2026 calendar

A chronological view of the changes to track, including the two that land after 2026 and matter most for planning:

• January 1, 2026: Non-MAGI asset limit reinstated ($130,000 individual / $195,000 couple).2
• January 1, 2026: Full-scope enrollment freeze begins for some adults based on immigration status.1
• January 1, 2026: Medi-Medi Plans expand from 12 to 41 counties.8
• January 1, 2026: Short-term rental assistance becomes mandatory for plans to provide to members meeting Specialty Mental Health, Drug Medi-Cal, or DMC-ODS access criteria.3
• July 1, 2026: The transfer-penalty look-back begins ramping toward the full 30-month review.5
• December 31, 2026: CalAIM Section 1115 demonstration term ends; renewal proposed through December 31, 2031.3
• January 1, 2027: Short-term rental assistance becomes mandatory for all eligible populations.3
• July 1, 2027: The non-MAGI asset limit drops from $130,000 to $21,000 for one person, and from $195,000 to $31,000 for two. This is the one to plan against.1

Your next step

For free help, these organizations serve Medi-Cal families statewide:

Learn more

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.