California's Medi-Cal: Immigrant families worry over new 80-hour work rule

Millions of immigrant families in California are facing a new hurdle to maintain their Medi-Cal health coverage, a state program that provides care to millions. Federal changes now require certain beneficiaries to prove they are working, studying, training, or performing community service for at least 80 hours per month.

The primary concern for many is the risk of losing essential medical care due to difficulties in completing the required paperwork or meeting the administrative demands. The California Department of Health Care Services (DHCS) will oversee this process, impacting a significant portion of Medi-Cal users.

Official DHCS documents state that individuals must engage in qualifying activities for 80 hours monthly. These activities include employment, community service, education, or participation in work programs. Alternatively, meeting an income threshold of at least $580 per month, equivalent to 80 hours at the federal minimum wage, will also satisfy the requirement.

This measure targets the "new adult group," comprising beneficiaries aged 19 to 64 without children under 13 who gained Medi-Cal eligibility through the Affordable Care Act expansion. Approximately 4.6 million beneficiaries fall into this category, with nearly three million lacking a registered exemption as of 2025. The compliance review period is also shortening from annual to semi-annual.

According to reports, between six and seven million Medi-Cal beneficiaries in California have immigrant backgrounds or belong to such families. An additional 1.5 million undocumented individuals with state-covered benefits face separate Medi-Cal changes, potentially needing further guidance. Language barriers and the prevalence of informal work without pay stubs pose significant challenges for many in proving their compliance, raising fears of coverage loss.