Kev tsim nyog Medi-Cal
Cov kev hloov pauv ntawm tsoomfwv thiab lub xeev yuav cuam tshuam rau qee tus neeg California uas tsim nyog tau txais Medi-Cal thiab cov kauj ruam uas lawv yuav tsum ua kom khaws tau kev pov hwm. Cov kev hloov no suav nrog cov cai tshiab txog kev tsim nyog, cov kev cai ntsig txog kev nkag tebchaws, cov kev cai ua haujlwm, thiab kev rov ua dua tshiab ntau zaus.
Cov Kev Ua Tseem Ceeb ntawm Tsoom Fwv Tebchaws
Cov Kev Hloov Pauv Tseem Ceeb ntawm Medi-Cal raws li HR 1
- Kev Ceeb Toom Txog Kev Ua Kom Cov Cai Tsim Nyog Tau Txais Kev Pab Zoo Dua
- Txij li Lub Xya Hli 4, 2025, cov xeev yuav tsum ncua kev siv cov txheej txheem yooj yim thiab kev txuas ntxiv mus thoob plaws Medicaid, Txoj Haujlwm Pov Hwm Kev Noj Qab Haus Huv Rau Menyuam (CHIP), thiab Txoj Haujlwm Kev Noj Qab Haus Huv Yooj Yim, xws li daim ntawv thov luv dua lossis kev txuas ntxiv mus tas li. Yav tas los, muaj cov cai tswjfwm hauv tebchaws uas cov xeev yuav tsum tau txais cov txheej txheem yooj yim no.
- Cov Lus Txhais Hloov Kho ntawm Cov Neeg Tsis Yog Neeg Xam Xaj Tsim Nyog
- Txij li thaum Lub Kaum Hli Ntuj hnub tim 1, 2026, txoj cai lij choj hauv tebchaws tau txo qhov tsim nyog rau Medicaid tag nrho rau qee qhov xwm txheej nkag tebchaws, txhais tau tias qee tus neeg yuav tsis tsim nyog rau Medi-Cal tag nrho uas tau txais nyiaj los ntawm tsoomfwv. Cov tswv cuab uas raug kev cuam tshuam yuav tau txais Medi-Cal uas them tag nrho los ntawm lub xeev kom txog rau lub Rau Hli 30, 2027.
- Cov Kev Cai rau Kev Ua Haujlwm thiab Kev Koom Tes Hauv Zej Zog
- Txij li Lub Ib Hlis Ntuj hnub tim 1, 2027, cov neeg laus hnub nyoog 19–64 xyoo uas tsis muaj menyuam yaus hnub nyoog qis dua 13 xyoos yuav tsum ua raws li cov cai ntawm kev ua haujlwm, kev pab dawb, tsev kawm ntawv, lossis kev cob qhia kom thiaj li tau txais Medi-Cal. Cov kev zam siv rau kev cev xeeb tub, kev tsis taus, cov mob hnyav, thiab lwm yam xwm txheej. Nyeem ntxiv txog cov cai ua haujlwm ntawm nplooj ntawv Medi-Cal Changes.
- Thaum Lub Kaum Ob Hlis Ntuj xyoo 2025, CMS tau tshaj tawm cov lus qhia thawj zaug txog kev siv cov kev cai ua haujlwm thiab kev koom tes hauv zej zog.
- Thaum Lub Ib Hlis Ntuj xyoo 2026, CMS tau tshaj tawm cov ntawv cog lus nrog 10 tus neeg muag khoom siv thev naus laus zis thiab kev tsim nyog Medicaid los muab ntau dua $ 600 lab hauv cov khoom lag luam thiab cov kev pabcuam pub dawb thiab luv nqi. Cov lus cog tseg no yog los pab cov xeev ua haujlwm thiab kev koom tes hauv zej zog kom zoo thaum tseem ua kom cov txheej txheem Medicaid niaj hnub. DHCS tab tom soj ntsuam cov cib fim nrog cov neeg muag khoom siv thev naus laus zis los txiav txim siab seb cov kev pabcuam pub dawb no yuav txhawb nqa California txoj kev siv thiab kev ua kom niaj hnub li cas.
- In June 2026, CMS released an interim final rule with additional work requirements implementation details.
- Kev Tshawb Fawb Txog Kev Tsim Nyog Rau Lub Hlis
- Txij li lub Peb Hlis Ntuj hnub tim 1, 2027, qee tus neeg laus hnub nyoog 19–64 xyoo yuav tsum tau rov ua dua Medi-Cal txhua rau lub hlis es tsis yog txhua xyoo. Yog tsis ua raws sijhawm yuav ua rau poob kev pov hwm. Nyeem ntxiv txog kev kuaj xyuas kev tsim nyog rau rau lub hlis ntawm nplooj ntawv Medi-Cal Updates.
- In March 2026, CMS released guidance regarding implementation of six-month renewals in alignment with H.R. 1.
- Txo Kev Sau Npe Uas Muaj Cov Npe Zoo Sib Xws
- Txij li Lub Ib Hlis Ntuj hnub tim 1, 2027, HR 1 yuav tsum kom cov xeev hloov kho cov ntaub ntawv chaw nyob Medicaid siv cov ntaub ntawv xws li lub hauv paus ntaub ntawv hloov chaw nyob hauv tebchaws thiab cov ntawv xa rov qab. Pib xyoo 2029, tsoomfwv tebchaws yuav tsim kom muaj lub ntaub ntawv hauv tebchaws los txheeb xyuas cov tib neeg uas yuav tau sau npe rau hauv Medicaid hauv ntau dua ib lub xeev.
- Thaum Lub Kaum Ib Hlis 2025, CMS tau tshaj tawm cov ntawv ceeb toom ceeb toom rau cov xeev kom tiv thaiv kev sau npe Medicaid lossis CHIP tib lub sijhawm hauv ntau dua ib lub xeev.
- Cov Kev Txwv ntawm Kev Them Nqi Rov Qab
- Txij li Lub Ib Hlis Ntuj hnub tim 1, 2027, Medi-Cal yuav them tsawg dua cov nqi kho mob yav dhau los: cov neeg laus hnub nyoog 19–64 xyoo uas tsis muaj menyuam tau txais ib hlis ntawm kev them rov qab, thaum txhua tus tswv cuab lwm tus tau txais ob lub hlis.
- Kev Sib Koom Nqi
- Txij lub Kaum Hli Ntuj hnub tim 1, 2028, qee tus neeg laus uas muaj Medi-Cal yuav them me ntsis rau qee yam kev pabcuam, txwv tsis pub tshaj 5 feem pua ntawm cov nyiaj tau los hauv tsev neeg, tsis muaj kev them rau kev kho mob thaum muaj xwm txheej ceev, kev kuaj mob, kev cev xeeb tub, kev kho mob menyuam yaus, kev noj qab haus huv ntawm lub hlwb, lossis cov kev pabcuam hauv tsev kho mob hauv zej zog.
Lwm Cov Kev Ua Haujlwm ntawm Tsoom Fwv Tebchaws
- Kev Sib Koom Cov Ntaub Ntawv Hauv Tebchaws
- Thaum Lub Xya Hli 2025, ua qhov kev hloov pauv uas tau ua ntev los lawm, cov ntawv ceeb toom tau qhia tias CMS tau qhia cov ntaub ntawv tswv cuab Medicaid rau US Department of Homeland Security (DHS), ua rau Immigration and Customs Enforcement (ICE) nkag mus rau cov ntaub ntawv tus kheej.
- A federal court issued an order, effective January 5, 2026, allowing CMS to share data with ICE (a) only for individuals not lawfully residing in the U.S; and (b) only information describing an individual’s citizenship and immigration status, address, phone number, date of birth, and Medicaid ID number.
- CMS yuav tsis tshaj tawm cov ntaub ntawv hais txog lwm tus neeg thiab CMS yuav tsis tshaj tawm lwm yam ntaub ntawv, xws li kev siv cov kev pabcuam kho mob.
- Txoj Cai Lij Choj Txog Kev Ua Haujlwm thiab Kev Sib Haum Xeeb ntawm Lub Luag Haujlwm ntawm Tus Kheej Xyoo 1996 (PRWORA) Kev Txwv
- In July 2025, several federal agencies, including the federal Department of Health and Human Services (HHS), extended immigration-based eligibility restrictions under PRWORA to additional health care and other programs. This policy has been paused under a court order.
- Txoj Cai Them Nqi Rau Pej Xeem
- In July 2026, DHS issued a final rule rescinding 2022 public charge regulations and expanding immigration officer discretion to consider a wider range of income-based programs (including Medi-Cal, CalFresh, and federal housing assistance) when determining whether an applicant is likely to become a “public charge,” meaning they may become primarily dependent on government-funded support. This determination can affect visa and green card approvals. The final rule took effect on September 18, 2026, and benefits received before that date will not be considered under the new framework.
- Kev Hloov Pauv ntawm Cov Tswv Cuab uas Tsis Txaus Siab Txog Kev Nkag Tebchaws mus rau Kev Them Nqi Rau Kev Pabcuam
- In 2025, federal guidance directed all states to transition Medicaid members with unsatisfactory immigration status (UIS) from managed care to Medicaid Fee-for-Service (FFS) by January 1, 2027. Members with UIS will no longer receive services through managed care plans and will instead obtain care through Medi-Cal FFS providers. States must make operational and system changes to support the transition and help maintain access to care for affected members.
Cov Kev Ua Haujlwm uas California Tab Tom Ua
Kev Npaj Siv HR 1
- Txoj Kev Npaj Siv
- DHCS tab tom soj ntsuam qhov kev tsim nyog thiab kev hloov pauv kev ua haujlwm uas xav tau raws li HR 1, suav nrog cov txheej txheem txheeb xyuas, pawg kev tsim nyog, thiab kev hloov pauv ntawm cov txheej txheem uas xav tau kom ua raws li tsoomfwv cov cai. Nyeem DHCS' HR 1 Txoj Kev Npaj Siv.
- Stakeholder Engagement
- The California Health and Human Services Agency (CalHHS) hosts regular webinars to explain federal changes and California’s response, including impacts on Medi-Cal and CalFresh.
- Good Faith Effort Exemption Request
- DHCS has requested a six-month good faith effort exemption from CMS to complete eligibility system updates, testing, and operational changes necessary to implement Medicaid work and community engagement requirements following issuance of the federal Interim Final Rule. The requested extension would help ensure the requirements are implemented accurately and minimize unnecessary coverage disruptions for eligible Medi-Cal members.
Cov Lus Teb rau Lwm Cov Kev Ua Haujlwm ntawm Tsoom Fwv Tebchaws
- Cov ntaub ntawv ntiag tug
- DHCS issued a statement explaining CMS may share data with ICE only about individuals not lawfully residing in the U.S. while the multistate lawsuit continues.
- Kev foob
- California yog tus foob tseem ceeb hauv New York et al. tawm tsam US Department of Homeland Security et al., kev foob ntau lub xeev los thaiv txoj cai tshiab ntawm tsoomfwv qib siab txog kev them nqi rau pej xeem, sib cav tias qhov kev txhais lus dav dav no ua rau cov neeg uas yuav raug suav hais tias yog "kev them nqi rau pej xeem" tsis raug cai thiab yuav tsim kev puas tsuaj loj rau cov tsev neeg tsiv teb tsaws chaw thoob plaws lub xeev.
- Yav dhau los California tau xa cov lus tawm tswv yim tawm tsam txoj cai tswjfwm tebchaws thiab tau tsa kev txhawj xeeb tias txoj cai kawg yuav tsim kev tsis meej pem, txo kev nkag mus rau cov kev pabcuam tseem ceeb, thiab ua rau cov tsev neeg sib xyaws tsis sib npaug. CalHHS kuj tau tshaj tawm ib daim ntawv tshaj tawm rau pej xeem thaum Lub Xya Hli 2026 rov lees paub qhov kev tawm tsam ntawm California thiab ceeb toom tias txoj cai no yuav ua rau cov tsev neeg tsim nyog tsis txhob nrhiav kev pabcuam tseem ceeb thiab ua rau muaj kev ntshai ntxiv rau hauv cov zej zog tsiv teb tsaws chaw.
- California continues to provide trusted information and legal service referrals to help families navigate federal public charge policies. A list of qualified nonprofit organizations is available on the California Department of Social Services website, and additional guidance is available on the CalHHS public charge webpage.
- California yog tus foob ua tus thawj coj hauv State of California et al. v. US Department of Homeland Security et al., qhov kev foob ntau lub xeev tawm tsam CMS-DHS daim ntawv cog lus sib koom cov ntaub ntawv, thiab tus foob hauv State of New York et al. v. US Department of Justice et al. tawm tsam cov kev txwv PRWORA uas nthuav dav.
- California is a lead plaintiff in Commonwealth of Massachusetts et al. v. Mehmet Oz, M.D. et al., a multi-state lawsuit filed in June 2026 challenging portions of the federal Interim Final Rule implementing Medicaid work and community engagement requirements. On October 29, 2026, a federal court invalidated the rule’s requirement that medically frail individuals demonstrate their condition significantly impairs their ability to comply with work requirements, while leaving the broader work requirement framework in place.
- California yog tus foob tseem ceeb hauv New York et al. tawm tsam US Department of Homeland Security et al., kev foob ntau lub xeev los thaiv txoj cai tshiab ntawm tsoomfwv qib siab txog kev them nqi rau pej xeem, sib cav tias qhov kev txhais lus dav dav no ua rau cov neeg uas yuav raug suav hais tias yog "kev them nqi rau pej xeem" tsis raug cai thiab yuav tsim kev puas tsuaj loj rau cov tsev neeg tsiv teb tsaws chaw thoob plaws lub xeev.
- Kev Npaj Hloov Pauv thiab Kev Siv UIS/FFS
- DHCS tau tso tawm Phau Ntawv Qhia Txog Txoj Cai rau kev hloov cov tswv cuab Medi-Cal uas muaj UIS los ntawm kev tswj hwm kev saib xyuas mus rau Medi-Cal FFS. Phau ntawv qhia no piav qhia txog cov ntawv ceeb toom rau cov tswv cuab, kev cia siab txog kev saib xyuas txuas ntxiv mus, cov kev xav tau rau kev sau npe rau cov kws kho mob, thiab cov haujlwm sib qhia cov ntaub ntawv uas yuav tsum tau ua. DHCS tab tom sib koom tes nrog cov phiaj xwm kev saib xyuas uas tau tswj hwm, cov nroog, thiab cov chaw muab kev pab kom txo tau kev cuam tshuam, tswj kev nkag mus rau cov kev pabcuam kho mob uas tsim nyog, thiab xyuas kom meej tias muaj kev sib txuas lus meej.
Cov peev txheej
- Kev Hloov Pauv ntawm Medi-Cal: Yam Uas Cov Tswv Cuab Yuav Tsum Paub
- Medi-Cal FAQs Kev Tsim Nyog Kev Nkag Tebchaws
- Cov Ntaub Ntawv Txog Kev Them Nqi Rau Pej Xeem
- Txoj Cai Nkag Tebchaws thiab Kev Hloov Pauv rau Daim Ntawv Qhia Txog Kev Tsim Nyog Medi-Cal
- Kev Ncaj Ncees ntawm Qhov Kev Pab Cuam: Yuav Ua Li Cas DHCS Tiv Thaiv Medi-Cal
Page last updated October 29, 2026