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Medi-Cal Benefits

DHCS is committed to ensuring Medi-Cal members have reliable access to high-quality, medically necessary care. These benefits remain protected under state law, even as federal policies change.

Notable Federal Actions

Vaccines

  • Restructuring of the Advisory Committee on Immunization Practices
    • In summer 2025, the federal Department of Health and Human Services (HHS) restructured the Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices (ACIP), prompting concerns about politicization of vaccine policy. ACIP reviews recommendations for vaccines such as hepatitis B, COVID-19, and measles several times a year.
    • In April 2026, HHS published an updated ACIP charter that added new directives related to vaccine safety research and expanded qualifications for ACIP members beyond the traditional requirements of expertise in immunization practices.
  • Changing Federal Vaccine Schedule
    • In January 2026, the federal government adopted a new vaccine schedule that removes several routine childhood vaccines, delays initial doses for hepatitis B and measles, mumps, and rubella (MMR) vaccines, excludes COVID-19 vaccines from standard recommendations, and reduces booster requirements for the tetanus, diphtheria, and pertussis (Tdap) vaccine and other immunizations. 
    • In May 2026, President Trump issued an executive order (EO) directing the CDC to take a second attempt at aligning the Child and Adolescent Immunization schedule with the schedule that the federal government released in January 2026.

Gender Affirming Care

  • Executive Orders
    • President Trump has issued several EOs impacting transgender people and aiming to restrict access to gender affirming care, including:
    • EO 14168: “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government” (January 20, 2025)
    • EO 14187: “Protecting Children from Chemical and Surgical Mutilation” (January 28, 2025)
  • Federal Guidance 
    • In response to these orders, federal HHS took multiple actions impacting states and state Medicaid programs:
    • Issued guidance in February 2025 expanding on the definitions for the terms sex, female, male, woman, girl, man, boy, mother, and father set forth in EO 14168. 
    • Released a State Medicaid Director Letter in April 2025 on gender affirming medications and surgeries for adolescents; rescinded prior guidance on including sexual orientation and gender identity questions in Medicaid and Children’s Health Insurance Program (CHIP) applications. 
    • Published a Centers for Medicare & Medicaid Services Informational Bulletin in June 2025 revoking existing guidance from HHS’ Office of Civil Rights on gender affirming care and patient privacy.
    • Released a report, “Treatment for Pediatric Gender Dysphoria: Review of Evidence and Best Practices,” in November 2025, purporting to discredit the evidence-based guidance of major medical associations on gender affirming care treatments for youth.
    • Issued a declaration from federal HHS Secretary Robert F. Kennedy Jr. declaring that gender affirming care is “neither safe nor effective” as a treatment for gender dysphoria in youth and asserting authority to exclude providers from federal health programs if they provide such services.
    • HHS announced that it has referred several children’s hospitals to the federal Office of Inspector General for investigation due to “failure to meet recognized standards of health care.” This includes hospitals in California such as Children’s Hospital of Orange County, UCSF Health, and Benioff Children’s Hospitals.
  • Proposed rules to:

Actions California Is Taking

Vaccines

  • West Coast Health Alliance
  • State Legislation
    • Assembly Bill (AB) 144, signed into law in September 2025, requires state-regulated health plans — including Medi-Cal managed care plans (MCPs) — to continue covering vaccines recommended by the California Department of Public Health (CDPH), CDC/ACIP, AAP, American College of Obstetricians and Gynecologists (ACOG), and American Academy of Family Physicians (AAFP). This includes vaccines provided through the Vaccines for Children (VFC) Program.
    • Importantly, AB 144 allows Medi-Cal to cover childhood vaccines outside of the VFC Program if recommended by any of the above organizations, even if not recommended by ACIP.
    • DHCS issued a stakeholder letter and updated the Provider Manual to reaffirm coverage for routine vaccines, including COVID-19, for all Medi-Cal members age six months and older.
  • Joint Statement on Vaccine Access
    • In January 2026, California reaffirmed its commitment to science-based vaccine policies through a joint statement from California Health and Human Services Agency (CalHHS) leaders, including DHCS Director Michelle Baass, California Department of Public Health Director Dr. Erica Pan, and Department of Managed Health Care Director Mary Watanabe.
    • Governor Newsom condemned federal vaccine schedule changes as “reckless,” announcing the Public Health Network Innovation Exchange to strengthen public health leadership and maintain trust in evidence-based guidance.
  • Litigation
    • California is one of 25 states in Colorado v. U.S. Department of Health and Human Services challenging the termination of $11 billion in federal public health grants to states for, among other things, promoting vaccine access. In May 2025, the court issued a preliminary injunction prohibiting the government from enforcing the announced termination of COVID-19 public health grants to California and the other state plaintiffs.
    • California is one of four states challenging a CDC decision to cut over $600 million in federal public health infrastructure funding, including grants that support core public health functions such as workforce development, data modernization, and local health department operations. 
    • California and Arizona are co-leading a 15-state lawsuit challenging the CDC’s January 2026 overhaul of its vaccine recommendations for children and adolescents. The litigation also challenges HHS Secretary Kennedy’s firing of all 17 ACIP voting members and replacing them with a majority of anti-vaccine appointees. A separate American Academy of Pediatrics case challenges the same schedule and ACIP changes, with the federal changes paused while litigation proceeds.

Gender Affirming Care

  • Coverage Assurance and Plan Guidance
    • DHCS issued a provider notice in May 2025 reaffirming that all medically necessary gender affirming care remains covered under Medi-Cal and that Medi-Cal’s policies have not changed.
    • DHCS issued guidance to MCPs on gender affirming care, including cultural competency training and access requirements.
    • DHCS and the Department of Managed Health Care are working with MCPs to ensure members can access medically necessary gender affirming services, including monitoring compliance with California’s protections and assisting members who experience barriers to care. Read the statement from CalHHS.
  • 988 Crisis Support
  • Litigation
    • California and 16 states filed suit challenging EO 14187 and subsequent directives from the Attorney General that suggest health care providers cannot legally provide gender affirming care. Litigation is ongoing, with a federal judge rejecting the Department of Justice’s motion to dismiss the case in June 2026.
    • California and 17 other states filed a lawsuit challenging the declaration by federal HHS Secretary Kennedy targeting providers of gender affirming care. In April 2026, a federal court found the declaration and the targeting of gender affirming care providers to be unlawful.

Resources

Page last updated July 1, 2026