Starting in 2027, federal work-reporting requirements and twice-yearly eligibility reviews could interrupt care and create new administrative burdens for medical practices.
San Diego physicians should prepare for patients to lose Medi-Cal because of missed paperwork, communication problems, or difficulty documenting compliance with new federal requirements.
The California Department of Health Care Services counted 908,970 San Diego County residents as certified eligible for Medi-Cal in January 2026. They represented 27.5% of the county’s population and included 299,712 residents ages 18 and younger. DHCS considers those figures preliminary.
Beginning January 1, 2027, federal law will require California to review Medi-Cal eligibility every six months for the Affordable Care Act’s new-adult population, principally nondisabled adults ages 19 through 64. The law will also require specified adults to complete qualifying work, education, training, or community-service activities unless they receive an exemption.
The California Department of Health Care Services and county eligibility systems will first attempt to verify qualifying activity or an exemption through available data. When they cannot, affected enrollees must provide evidence that they meet the requirements.
The Congressional Budget Office estimates that 70% of people nationally who lose coverage through six-month reviews will do so because of missed paperwork, communication failures, or difficulty navigating reenrollment—not because officials determine that they no longer qualify.
Even temporary coverage interruptions could complicate treatment. Patients may postpone appointments, face medication-access problems, or interrupt specialty referrals while they try to restore coverage. Practices could face more eligibility checks, denied claims, uncompensated services, and demands on administrative staff.
Other Medi-Cal changes will reduce retroactive coverage beginning in 2027. California will also impose $30 monthly premiums on certain state-funded immigrant enrollees no sooner than July 2027. Some Medi-Cal adults will face copayments beginning in October 2028.
Key takeaways for physicians
Physicians should proactively prepare their staff for more frequent eligibility verifications starting in 2027. They need to identify patients at risk of care disruptions during coverage lapses, establish clear referral pathways to county services and enrollment assistance organizations, and carefully track claim denials, unpaid services, and canceled care related to disenrollment.
The sources reviewed do not provide a definitive estimate of how many San Diego residents will lose coverage specifically because of work reporting and six-month eligibility reviews. The effects on physician workload, patient adherence, and practice finances therefore remain uncertain.