What is Medi-Cal?
Medi-Cal is the state of California’s Medicaid program. It is a public health insurance program for low-income people. Medi-Cal provides critical health care and home care services for low income people with disabilities, older people, low-income people, children, pregnant people, and immigrants. Almost 40% of Californians, 14 million people, are enrolled in Medi-Cal. Medi-Cal insures half of the kids in California. Medi-Cal pays for one in four births in California.
Why is Medi-Cal Important for People with Disabilities?
Medi-Cal pays for things like doctors’ appointments, medicine, wheelchairs, walkers, hearing aids, treatments, tests, co-pays, dental care, and surgeries. It pays for personal care attendants that help people with disabilities and older adults live in the community, eat, get dressed, and work. Since California allows an enrollee’s family members to be employed as personal care attendants, Medi-Cal employment income can help to stabilize entire households and families. Medi-Cal also pays for long-term care like nursing homes. It funds supported employment and supported housing. It provides services to kids with disabilities in school. In California, it pays for doula care, family planning services, abortion, and the cost of giving birth.
How Do I Know If I Have Medi-Cal?
There are many different healthcare access and services programs that are funded by Medi-Cal. Many of them are delivered through healthcare plans. Some examples of Medi-Cal programs that help people with disabilities and older adults are:
- Waivers that provide Home and Community-Based Services (HCBS)
- Home and Community-Based Alternatives (HCBA) Waiver
- HCBS Waiver for the Developmentally Disabled (HCBS-DD) Waiver
- Self-Determination Program (SDP)
- Assisted Living Waiver (ALW)
- Multipurpose Senior Services Program (MSSP)
- Medi-Cal Waiver Program (MCWP)
- In Home Supportive Services (IHSS)
- Program for All Inclusive Care for the Elderly (PACE)
- Working Disabled Program
- County Mental Health or Behavioral Health Services
- Medi-Cal Access Program (MCAP)
- Medi-Cal Access Infant Program
- California Children Services (CCS)
- Modified Adjusted Gross Income Eligibility for Medi-Cal
How Does Medi-Cal Funding Work?
Medicaid dollars from the federal government make up over half (61%) of California’s Medi-Cal budget. They make up one-fifth (21.5%) of the whole state budget. If Congress succeeds in cutting Medicaid, California will likely make deep budget cuts to many essential programs that help people with disabilities and make the lives of many Californians better.
What About Medicare? Are Medi-Cal and Medicare Connected?
Medicare is a separate public health insurance program that covers people over 65 and some people with disabilities. One in five people who have Medicare are also covered by Medicaid because they have low income. This is called being “dually eligible.” Nearly 30% of federal Medicaid dollars go to people on Medicare who need support to pay for their Medicare co-payments. A cut to Medi-Cal is a cut to Medicare.
How Does the Budget Process Work In California?
In California, the Governor proposes a budget in January. For the next few months, the California state legislature, made up of the Senate and the State Assembly, works on creating their version of the budget based on the Governor’s budget proposal. In May, the Governor sometimes proposes an updated budget called the “May Revise.”
After the May Revise, the legislature works to pass their proposed budget. After that, the budget is sent to the Governor for signing. The Governor has the power to reduce or eliminate any spending in the bill before signing it.
The Governor has already released the May Revise. There are huge cuts to healthcare and human services in the 2025 May Revise. The legislature has also released its proposed budget. In the next week or so, the legislature and the Governor will try to pass a budget. There may be a final vote on the state budget very soon–probably by Friday, June 13.
What Threats to Medi-Cal and Medicare are in California’s Proposed Budget?
Since Congress is working on a budget that proposes cuts to healthcare programs like Medicaid and Medicare of $1 trillion dollars, there will be a decrease in the amount of money that goes to state healthcare programs like Medi-Cal. If Congress makes these cuts or decreases, across the U.S., at least 16 million people will lose their healthcare coverage. This includes 1.3 million people on Medicare. 51,000 people will die every year because they will lose access to healthcare.
California Governor Gavin Newsom has proposed $5 billion in cuts from the state budget. Some of the deepest cuts are to the Medi-Cal program, as well as housing and public benefits. Instead of finding ways to bring in more money for the state budget to make up some of the losses created by federal budget cuts, Governor Newsom’s proposed budget would cut the state’s Medi-Cal spending by billions of dollars on the backs of immigrants, older adults, and disabled people. If passed, this proposed budget would hurt many low-income people, disabled people, and older adults in California because it:
Freezes enrollment into Medi-Cal for some immigrant Californians starting in January 2026.
If the Governor’s budget passes, low-income immigrants with “unsatisfactory immigration status” will no longer be able to start getting Medi-Cal. It would also stop re-enrollment for people in this group who had Medi-Cal but lost it because of things like paperwork problems or income changes. This is cruel and anti-immigrant. Healthcare is a human right, no matter our immigration status.
The California legislature’s budget would also block low-income immigrants with “unsatisfactory immigration status” from starting to get Medi-Cal. It would allow some people in this group who had Medi-Cal before to re-enroll during a “grace period” of 6 months. This change does not fix the Governor’s proposal. It still prevents some immigrants from getting Medi-Cal which is unacceptable, especially because of the federal threats on immigrant communities.
Imposes $100 monthly premiums for some immigrant Californians on Medi-Cal.
The Governor’s budget would force low-income immigrants with “unsatisfactory immigration status” to pay high monthly fees that no other Medi-Cal users pay. People who qualify for Medi-Cal – for example, a person who makes about $22,000 or less a year – cannot afford $100 a month because of the high cost of housing, food, utilities, transportation, and other living expenses. The fees would lead to many immigrants losing their Medi-Cal even if they are eligible.
The California legislature’s budget proposes a $30 monthly fee, and softens the blow slightly by limiting the age range of those who must pay to people between 19 and 59 yrs old and delaying the fee until 2027. This is still unacceptable because it makes pay fees that other people on Medi-Cal do not have to pay.
Eliminates IHSS, long-term care, and dental benefits for some immigrant Californians.
IHSS benefits allow people with disabilities and older adults to receive the personal assistance care we need to live safely in our homes and communities. Long-term care health benefits allow people with disabilities and older adults to receive skilled care in nursing homes. Dental care is also a very important part of our health. Taking these benefits away from immigrant older adults and disabled people is cruel and anti-immigrant. It will make it much harder for people to live safely and with dignity as they age or acquire complex care needs.
The California legislature’s budget rejects the Governor’s attempt to get rid of long term care and IHSS benefits for immigrants. The legislature’s budget proposes delaying the loss of dental benefits until July 2027.
Reinstates the $2,000 asset limit for all older adults and people with disabilities on Medi-Cal ($3,000 limit for couples).
The proposal to reinstate the asset limit is cruel and forces people with disabilities and older adults to live in poverty in order to have access to essential healthcare. The proposed caps also penalize couples by giving them a lower cap. Right now, people who qualify for Medi-Cal on the basis of low-income do not have an asset limit. Disability rights advocates and allies worked for many years to raise the asset limit so that people who qualify for Medi-Cal on the basis of disability or age could save money for the future without fear of losing essential long-term care or healthcare. This reversal would take us back in time and undo years of advocacy.
The California legislature’s budget rejects the Governor’s asset limit proposal of $2000 but retains an asset limit of $130,000. However, both the Governor’s and Legislature’s budgets allow a “look back” at the assets that beneficiaries had in their accounts up to 30 months before this new asset limit is applied. Advocates are pushing for a “hold harmless” provision in the budget that would allow Medi-Cal beneficiaries with assets over the limit to transfer or spend down assets before a new limit takes effect and avoid getting kicked off Medi-Cal.
Reduces In Home Supportive Services (IHSS) overtime hours (from 66 to 50 per week).
The Governor’s budget proposes to reduce the number of hours that IHSS care workers can be paid for. If this passes, it would harm many people with disabilities and older adults who rely on family member caregivers or who live in rural areas. IHSS workers who serve clients in rural areas must spend hours driving to reach their clients’ homes and to go from one home to another. They will have less paid hours to spend providing care.
The California legislature’s budget rejects the Governor’s proposal to cap overtime hours for IHSS workers.
Imposes prior authorization for hospice care.
Prior authorization is a process where doctors have to get approval beforehand from insurance providers before giving some healthcare services or treatments. It is one of the biggest barriers to healthcare access in today’s healthcare delivery system. One in three Medicaid users report not getting the care their doctor recommended because of prior authorization. One in four experienced a decline in health as a result of these hurdles. Requiring people to get prior authorization for hospice care, when they are at the end of their life, is inhumane. It will lead to care delays and will cause people and their families to suffer at a time when they should be given the care that allows them to feel as comfortable as possible.
The legislature’s response does not address this issue.
Abandons funding to address housing insecurity and homelessness.
People with disabilities are more likely than non-disabled people to be low-income and to experience housing insecurity, particularly people who also need physically accessible housing. California is a very expensive place to live, and many people cannot afford to pay for the basics. Many people who can’t pay the high costs of living in California have lost their housing. Despite the growing number of unhoused people in California and rising housing costs, the Governor’s proposal does not include any new funding to address homelessness or housing affordability.
The California legislature’s budget proposes more investments in affordable housing and homelessness prevention programs.
What are the alternatives to these devastating budget cuts?
California is now the fourth largest economy in the world and the top .1% of Californians make 250 times what middle income Californians make. We can find new ways to address budget shortfalls without balancing the budget on the backs of our immigrant, older adult and disability communities.
- Draw upon its reserves or “rainy day fund” which is currently $15.7 billion.
- Reduce spending on programs that do not support basic human needs like the prison budget, policing budget, and the expanded film industry tax credit. For example, the Governor’s budget makes harmful cuts to our healthcare but commits to new spending of over $400 million annually to expand tax credits for film studios.
- Make large corporations and the wealthiest people pay their fair share by closing tax loopholes. The dollars they hold back for themselves are dollars that this budget takes back from Medi-Cal, affordable accessible housing, or public transportation.
This money could be better spent on healthcare and basic needs support services to keep us alive and keep our communities together.
What Can I Do to Help?
Right now, these are just proposals. We need your help to tell California leaders to stop the cuts to our healthcare.
Call and Email Key California Leaders Who Can Impact the Budget
You can call or email California elected leaders who have the power to impact the state budget and tell them “No Cuts to Medi-Cal!” or support the changes that state lawmakers have proposed. You can use the call script and sample letter below if you want. The following state leaders have the power to affect the state budget process. You can click the name of each leader below to see more information about how to contact them.
Assembly Speaker Robert Rivas
Sacramento office phone number: (916) 319-2029
District office phone number: (831) 759-8676
Senator Mike McGuire, Senate Pro Tem
Sacramento office phone number: (916) 651-4002
District office phone number: (415) 479-6612
Assemblymember Jesse Gabriel, Assembly Budget Chair
Sacramento office phone number: (916) 319-2046
District office phone number: (818) 380-2460
Email: AsmBudget@asm.ca.gov
Senator Scott Weiner, Senate Budget Chair
Sacramento office phone number: (916) 651-4011
District office phone number: (415) 557-1300
Email: SBUDCommittee@sen.ca.gov
Governor Gavin Newsom
Sacramento office phone number: 916-445-2841
Use this email form on the Governor’s website.
Call Your State Assemblymember and Senator
It is also important to call and send letters or emails to your own state representatives. You can learn who your representatives are and find their contact information using this tool. You can also review some talking points in English and Spanish to help you tell your story.
Samples
Sample Call Script
My name is [your name] and I am a (older adult, immigrant, parent, person with a disability).
I am very concerned about the harsh cuts being considered in the state budget. It is unacceptable for California to cut Medi-Cal for immigrants in any way, to reinstate an outrageous $2,000 asset limit for Medi-Cal, and to abandon efforts to address housing insecurity. California is the 4th largest economy in the world and there are many ways to add revenues to the budget instead of making these horrible cuts. Please fight for our communities and stop these cuts. Thank you.
NOTE: Voicemails tend to fill up on weekends, so weekday calls are best practice.
Sample Letter
My name is [your name] and I am a (older adult, immigrant, parent, person with a disability).
[Say more about your disability and why you care about Medi-Cal.]
I am very concerned about the harsh cuts being considered in the state budget. It is unacceptable for California to cut Medi-Cal for undocumented immigrants in any way, especially in light of the federal attacks on immigrant populations. Forcing immigrant Medi-Cal recipients to pay fees that other recipients don’t pay as well as ending IHSS, long term care, and dental benefits for immigrants is unfair and anti-immigrant. Reinstating asset limits for Medi-Cal is cruel. Disability rights groups and allies advocated for years to change this terrible policy which forced people to live in poverty to get the care they need. Capping the number of overtime hours that IHSS workers can work will harm people with disabilities and older adults who live in rural areas.
California is the 4th largest economy in the world and there are many ways to add revenues to the budget instead of making these horrible cuts.
Please fight for our communities and stop these healthcare cuts.
Thank you.
[Your name]