California is bracing for a major shift in its health safety net. A new federal rule could force up to 1 million Medi-Cal enrollees to lose their insurance—possibly even more—due to upcoming work requirements tied to Medicaid eligibility.
The rule, passed by a Republican-led Congress and backed by President Donald Trump, imposes the first-ever national work mandate in Medicaid’s 60-year history. Here, we’ll explain what’s behind the change, who it affects, and how it could reshape access to care for millions across the state.
Why nearly 1 million Californians might lose their health coverage
The change is part of a federal budget bill that ties Medicaid coverage to work. Adults on Medi-Cal—the California version of Medicaid—will soon be required to prove every six months that they’re working, going to school, or volunteering at least 80 hours a month.
There are some exceptions, including for people who are pregnant, caring for young children, or undergoing addiction treatment. But for many low-income Californians, staying covered could become far more complicated.
“It’s going to be much harder to stay insured”, said Martha Santana-Chin, head of L.A. Care Health Plan, which serves 2.3 million people in Los Angeles County. She estimates that 20% to 40% of their members—up to 1 million people—could lose their coverage.
Governor Gavin Newsom has been outspoken about the risks, calling the process a “labyrinth of manual verification”. He warned that some Californians could face a 36-page packet of paperwork every six months just to keep their health insurance.
While the full rollout plan hasn’t been finalized, about 5.1 million Californians will fall under the new requirement. Many are low-wage workers or part of households earning under $43,000 a year. Critics say they could lose insurance simply due to paperwork burdens, not because they don’t qualify.
What it could mean next for Californians
The requirement is expected to go into effect after the 2026 midterm elections, but health plans and counties are already preparing. Past efforts in Arkansas and New Hampshire showed that thousands lost coverage in just a few months, often because they missed deadlines or misunderstood the rules.
Joan Alker, a Medicaid expert at Georgetown University, noted that many people lose coverage not because they don’t meet the requirement, but because proving it is hard: their income fluctuates, or they’re paid in cash, or their jobs don’t keep good records.
Inland Empire Health Plan, which covers 1.5 million Medi-Cal members in Riverside and San Bernardino counties, estimates 150,000 people in their region could be affected. But no one knows exactly how the system will work yet, whether there will be forms online or they’ll have to be mailed in. “We don’t really know the process yet, because all of this is so new”, said CEO Jarrod McNaughton.
Many advocates worry that the loss will be steepest in communities already struggling with access to care. Supporters of the mandate say it will push more people into the workforce and preserve Medicaid for those who need it most.
For now, local health plans are focusing on outreach. Some are trying to connect members with volunteer roles and prepare for the verification process. But unless the system is made easier, millions could soon have to prove they’re working or lose their health insurance.
