Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is in part governed by, and funded pursuant to, federal Medicaid program provisions.

Existing federal law, enacted on July 4, 2025, sets forth various changes to Medicaid eligibility with regard to community engagement reporting, redeterminations, retroactive coverage, and cost sharing, among other factors, for certain Medicaid populations. For purposes of eligibility redeterminations, existing federal law requires that certain beneficiaries between 19 and 64 years of age, inclusive, with income up to 138% of the federal poverty level, commonly known as Medicaid expansion adults, undergo a redetermination once every 6 months, instead of an annual redetermination, except as specified.

Existing law, for purposes of acquiring information necessary to conduct eligibility redeterminations, requires a county to gather information available to the county that is relevant to the beneficiarys Medi-Cal eligibility before contacting the beneficiary.

This bill would require the county, in the case of an annual or semiannual 6-month redetermination, to verify countable income and assets at renewal without requesting additional verification information or documentation if any of specified sets of conditions are met, relating to certain financial data sources.

This bill would require that these provisions be implemented subject to an appropriation made by the Legislature.

By creating new duties for counties relating to Medi-Cal eligibility determinations or redeterminations, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is in part governed by, and funded pursuant to, federal Medicaid program provisions.

Existing federal law, enacted on July 4, 2025, sets forth various changes to Medicaid eligibility with regard to community engagement reporting, redeterminations, retroactive coverage, and cost sharing, among other factors, for certain Medicaid populations. For purposes of eligibility redeterminations, existing federal law requires that certain beneficiaries between 19 and 64 years of age, inclusive, with income up to 138% of the federal poverty level, commonly known as Medicaid expansion adults, undergo a redetermination once every 6 months, instead of an annual redetermination, except as specified.

Existing state law generally requires a county to perform eligibility redeterminations for Medi-Cal beneficiaries every 12 months and to promptly redetermine eligibility whenever the county receives information about changes in a beneficiarys circumstances, as specified.

This bill would make changes to those redetermination provisions to conform to the 6-month redetermination requirement under the above-described federal law for Medicaid expansion adults. The bill would make other conforming changes to related provisions.

Existing law, for purposes of acquiring information necessary to conduct eligibility redeterminations, requires a county to gather information available to the county that is relevant to the beneficiarys Medi-Cal eligibility before contacting the beneficiary.

This bill would require the county, in the case of an annual or semiannual redetermination, to verify countable income and assets at renewal without requesting additional verification information or documentation if any of specified sets of conditions are met, relating to certain financial data sources.

By creating new duties for counties relating to Medi-Cal eligibility determinations or redeterminations, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is in part governed by, and funded pursuant to, federal Medicaid program provisions.

Existing federal law, enacted on July 4, 2025, sets forth various changes to Medicaid eligibility with regard to community engagement reporting, redeterminations, retroactive coverage, and cost sharing, among other factors, for certain Medicaid populations. For purposes of eligibility redeterminations, existing federal law requires that certain beneficiaries between 19 and 64 years of age, inclusive, with income up to 138% of the federal poverty level, commonly known as Medicaid expansion adults, undergo a redetermination once every 6 months, instead of an annual redetermination, except as specified.

Existing state law generally requires a county to perform eligibility redeterminations for Medi-Cal beneficiaries every 12 months and to promptly redetermine eligibility whenever the county receives information about changes in a beneficiarys circumstances, as specified.

This bill would make changes to those redetermination provisions to conform to the 6-month redetermination requirement under the above-described federal law for Medicaid expansion adults. The bill would make other conforming changes to related provisions.

Existing law, for purposes of acquiring information necessary to conduct eligibility redeterminations, requires a county to gather information available to the county that is relevant to the beneficiarys Medi-Cal eligibility before contacting the beneficiary.

This bill would require the county, in the case of an annual or semiannual redetermination, to verify countable income and assets at renewal without requesting additional verification information or documentation if any of specified sets of conditions are met, relating to certain financial data sources.

By creating new duties for counties relating to Medi-Cal eligibility determinations or redeterminations, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is in part governed by, and funded pursuant to, federal Medicaid program provisions.

Existing federal law, enacted on July 4, 2025, sets forth various changes to Medicaid eligibility with regard to community engagement reporting, redeterminations, retroactive coverage, and cost sharing, among other factors, for certain Medicaid populations. For purposes of eligibility redeterminations, existing federal law requires that certain beneficiaries between 19 and 64 years of age, inclusive, with income up to 138% of the federal poverty level, commonly known as Medicaid expansion adults, undergo a redetermination once every 6 months, instead of an annual redetermination, except as specified.

Existing state law generally requires a county to perform eligibility redeterminations for Medi-Cal beneficiaries every 12 months and to promptly redetermine eligibility whenever the county receives information about changes in a beneficiarys circumstances, as specified.

This bill would make changes to those redetermination provisions to conform to the 6-month redetermination requirement under the above-described federal law for Medicaid expansion adults. The bill would make other conforming changes to related provisions.

Existing law, for purposes of acquiring information necessary to conduct eligibility redeterminations, requires a county to gather information available to the county that is relevant to the beneficiarys Medi-Cal eligibility before contacting the beneficiary.

This bill would require the county, in the case of an annual or semiannual redetermination, to verify countable income and assets at renewal without requesting additional verification information or documentation if any of specified sets of conditions are met, relating to certain financial data sources.

By creating new duties for counties relating to Medi-Cal eligibility determinations or redeterminations, the bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that, if the Commission on State Mandates determines that the bill contains costs mandated by the state, reimbursement for those costs shall be made pursuant to the statutory provisions noted above.

SENATE COMMITTEE ON

Senator Sabrina Cervantes, Chair

2025 - 2026 Regular Session

AB 2201 (Boerner) - Medi-Cal: eligibility redetermination

Bill Summary:

AB 2201 would impose requirements on counties regarding the Medi-Cal eligibility redetermination process.

Fiscal Impact:

• Unknown ongoing costs, potentially low millions, due to higher Medi-Cal caseloads to the extent that additional beneficiaries would remain eligible for the program (General Fund and federal funds).
• Unknown ongoing costs, potentially hundreds of thousands, for the Department of Health Care Services (DHCS) for state administration (General Fund and federal funds).
• Unknown one-time costs, potentially hundreds of thousands, for automation updates (General Fund and federal funds).
• Unknown costs to counties for administration. Costs would be potentially reimbursable by the state, subject to a determination by the Commission on State Mandates.

Background:

The Medi-Cal program provides health care services to qualified low-income individuals. The Medi-Cal program is primarily governed by the federal Medicaid program. H.R. 1 (Public Law No 119-21) made a number of significant changes that restrict eligibility and funding for the federal Medicaid program. Among the provisions, H.R. 1 requires an eligibility redetermination process every 6 months for nondisabled adults between the ages of 19 and 65 who gained coverage through the federal Affordable Care Act (“ACA expansion adults”). Prior to the enactment of H.R. 1, the federal Medicaid program required the eligibility of all Medicaid recipients to be renewed once every 12 months or when the recipient reported a change in circumstances.

Counties determine eligibility for Medi-Cal at the local level. State law requires counties, for purposes of acquiring information necessary to conduct Medi-Cal eligibility redeterminations, to gather information available to the county that is relevant to the beneficiary’s Medi-Cal eligibility prior to contacting the beneficiary. Sources for these efforts must include information contained in the beneficiary’s file or other information, including more recent information available to the county. Information sources include Medi-Cal, CalWORKs, and CalFresh case files of the beneficiary or of any of their immediate family members, which are open, or were closed within the last 90 days, information accessed through certain databases, and, wherever feasible, other sources of relevant information reasonably available to the county, as specified.

Proposed Law:

Specific provisions of the bill would:

• Require the county, in the case of an annual or six-month redetermination, to verify countable income at renewal without requesting additional verification information or documentation if either of the following two sets of conditions are met:
  • The most recent income determination was based on a previously verified attestation of income at or below 100 percent of the federal poverty level, including ex parte, electronic, or administrative verification, during either the initial application or at the most recent renewal within the last 12 months; the county has checked financial data sources, and no information has been received; and no contradictory information is on file.
  • The most recent income determination, at either initial application or most recent renewal, was within the last 12 months; the beneficiary receives only income under Title II of the federal Social Security Act and any other sources of stable income, defined as any income that generally does not fluctuate (except for cost-of-living adjustments); and no contradictory information is on file.
• Require the county, in the case of an annual redetermination, to verify countable assets at renewal without requesting additional verification information or documentation if all of the following conditions are met:
  • The most recent asset verification was based on a previously verified attestation of assets, at either initial application or most recent renewal, within the last 12 months.
  • The county has checked financial data sources, and no information is received, or no response has been received within a reasonable timeframe, or the beneficiary has only stable assets, defined as any assets that are unlikely to increase in value, at the most recent determination.
  • No contradictory information is on file.
  • Make the implementation of the provisions subject to an appropriation made by the Legislature.

Related Legislation:

SB 164 (Committee on Budget and Fiscal Review, Chapter 27, Statutes of 2026), the health budget trailer bill, included provisions related to the Medi-Cal eligibility redetermination process.

AB 2161 (Bonta) would include provisions related to H.R. 1’s eligibility redetermination process. The bill is scheduled to be heard August 3, 2026 in this committee.

AB 2208 (Stefani) would establish cost-sharing provisions in the Medi-Cal program in response to H.R. 1 and include provisions related to the eligibility verification process.

Staff Comments:

The Budget Act of 2026 includes the following:

• • • $196.9 million General Fund in 2026-27 for county eligibility workload related to H.R. 1 implementation.
    • $33 million ($15.5 million General Fund and $17.5 million federal funds) in 2026-27, $11.3 million ($5.7 million General Fund and $5.7 million federal funds) in 2027-28, $3.3 million ($1.6 million General Fund and $1.6 million federal fund) in 2028-29 and 2029-30 for DHCS staff positions and resources to support implementation of eligibility and other changes related to H.R. 1.

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SENATE COMMITTEE ON HEALTH

Senator Akilah Weber Pierson, Chair

BILL NO: AB 2201

SUBJECT: Medi-Cal: eligibility redetermination

SUMMARY:

Implements the federal requirement to renew specified Medi-Cal recipients’ eligibility every six months instead of twelve and specifies additional conditions that require counties to verify a Medi-Cal recipient’s eligibility based on information the county has in the recipient’s file.

Existing federal law:

1. Establishes the Medicaid program to enable each state to furnish medical assistance on behalf of individuals whose income and resources are insufficient to meet the costs of necessary medical services. [42 USC §1396, et seq.]
2. Requires the eligibility of all Medicaid recipients to be renewed when the recipient reports a change in circumstances or once every 12 months. [42 C.F.R. §435.916 and §435.919]
3. Starting January 1, 2027, as enacted by H.R. 1 (Public Law No. 119-21), requires individuals with incomes below 138% of the federal poverty level (FPL) who are under age 65, not pregnant, and have no Medicaid-eligible dependents (known as “the Affordable Care Act (ACA) expansion adults”) have their eligibility for Medicaid additionally redetermined every six months. Exempts individuals who are Indian, Urban Indian, California Indian, or otherwise eligible for Indian Health Services. [42 USC §1396a]

Existing state law:

1. Establishes the Medi-Cal program, which is administered by the Department of Health Care Services (DHCS), and under which qualified low-income individuals receive health care services. [WIC §14000, et seq.]
2. Delegates, to the county of residence, the responsibility for Medi-Cal eligibility determinations and ongoing case management. [WIC §14015.5]
3. Requires a county to perform redeterminations of eligibility for Medi-Cal recipients every 12 months and to promptly redetermine eligibility whenever the county receives information about changes in a recipient’s circumstances that may affect eligibility for Medi-Cal benefits. [WIC §14005.37]
4. Requires a county to make a determination of continued eligibility when redetermining eligibility, if based on information available to the county, including the Medi-Cal, CalWORKs, and CalFresh case files of the recipient or their immediate family members or information accessed through electronic databases, the county is able to verify eligibility ex parte (without seeking information from the recipient). When eligibility is verified based on such information, requires the county to notify the recipient of their continued eligibility and the information it is based on. Requires the recipient to contact the county by internet, phone, mail, in person, or other commonly available electronic means where such communication is available with the county, if any information in the notice is inaccurate. Requires nothing of the recipient to maintain eligibility if the information is correct. [WIC §14005.37]

This bill:

1. Implements the new federal requirement that ACA expansion adults have their eligibility redetermined every six months instead of 12.
2. Requires counties to use three additional methods for renewing eligibility ex parte for Medi-Cal recipients at their annual or semiannual redetermination:
   1. If the most recent income determination within the past 12 months was based on a previously verified attestation of income at or below 100 percent of the FPL there is no contradictory information on file, and the county checks financial data sources, and no information is received, then countable income shall be considered verified;
   2. If the most recent income determination within the past 12 months was based on a previously verified attestation of only federal retirement, survivors, or disability insurance, or other income that does not fluctuate except for cost-of-living adjustments, there is no contradictory information on file, then countable income shall be considered verified; and,
   3. If the most recent asset verification within the past 12 months was based on a previously verified attestation of assets, and the county has checked financial data sources and no information is received or the recipient has only stable assets that are unlikely to increase in value, and no contradictory information is on file, then countable assets shall be considered verified.
3. Makes other technical changes in reference to the new six month renewal requirement.
4. Conditions implementation of this bill upon and appropriation made by the Legislature and provides for reimbursement to local agencies should the Commission of State Mandates determine that this bill contains costs mandated by the state.

FISCAL EFFECT:

According to the Assembly Appropriations Committee:

Cost pressures of an unknown amount to county health and human services agencies, which perform Medi-Cal eligibility determinations on behalf of the state. Based on an estimate provided by the County Welfare Directors Association of California for AB 2161 (Bonta), which also addresses implementation of related H.R. 1 requirements on Medi-Cal redeterminations, costs could be in the hundreds of millions of dollars annually (General Fund, federal funds).

The committee also noted that the author submitted a letter to the Assembly Budget Committee requesting language in the June 2026 trailer bill directing DHCS to reinstate strategies that streamline the renewal process and minimize coverage losses.

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, this bill will help minimize the negative impacts of the Trump Administration’s attack on Medi-Cal. This bill will help to streamline the Medi-Cal verification process, removing administrative barriers that threaten Medi-Cal health coverage. Currently, 14 million Californians rely on Medi-Cal coverage, of which 5 million are children. Work requirements for Medi-Cal participation and increased frequency of renewals from annual to every 6 months mean county offices will be stretched thin by the sheer volume of additional paperwork and ultimately put Californians at risk of losing access to Medi-Cal. California needs to protect healthcare services, especially for children. We cannot stand idly by and let the Trump Administration destroy lifeline programs for our most vulnerable population.
2. H.R. 1. H.R. 1, the federal budget reconciliation bill passed in July 2025, makes a number of changes primarily to lower taxes, increase funding for immigration control and national defense, and restrict access to and funding for SNAP and Medicaid. Medicaid payments were reduced by defunding family planning providers that provide abortions, prohibiting new or increased provider taxes to fund Medicaid and requiring a gradual reduction of existing provider taxes, capping the rate the state may set for certain services, reducing the federal share of payment for emergency services to adults with unqualified immigration status, and making changes in allowable payments under federal waiver programs. More relevant to this bill are a number of changes to the Medicaid eligibility rules, which were enacted to reduce the number of people receiving assistance through the Medicaid program.

Under current federal regulation and state law, Medi-Cal eligibility must be redetermined once every 12 months or whenever an individual reports a change in circumstances. H.R. 1 requires an additional eligibility renewal process every six months for the same group of ACA expansion adults that the work requirements apply to, starting January 1, 2027. This is intended to reduce Medicaid enrollment because eligible individuals often fail to respond to requests for information. In fact, prior to the ACA’s requirement that redeterminations be done only annually, California would use additional redeterminations, at times quarterly redeterminations when the state budget was tight, to reduce Medi-Cal enrollment.

1. Medi-Cal redeterminations and the COVID-19 unwinding flexibilities. Since the passage of SB 87 (Escutia, Chapter 1088, Statutes of 2000) over 25 years ago, the Medi-Cal program has required counties to first look to the information the county has in a recipient’s case file when processing a Medi-Cal redetermination to attempt to renew eligibility with only the minimum amount of information required from the recipient. This model was incorporated and expanded by the ACA. The ACA exempted many populations from assets tests, simplified how their income is counted, and allowed for self-attestation of many elements of eligibility such as income that is accepted unless the county has information to the contrary in the file or via electronic verification databases. The ACA also required sending recipients prepopulated renewal forms showing the information already on file, only requiring recipients to correct incorrect information or supply missing information. Nonetheless, redeterminations are still a considerable burden for county eligibility workers both for the time on the back end to find the information necessary to redetermine eligibility and the time required to obtain any missing information from the recipient. This was most evident after the COVID-19 public health emergency. After three years of keeping people on Medi-Cal without redeterminations due to the public health emergency, counties had to resume redeterminations, only information in the case files was in many cases three years out of date. At that time, according to DHCS’s September 2023, “Medi-Cal COVID-19 Public Health Emergency and Continuous Coverage Operational Unwinding Plan,” DHCS obtained approval from the federal government to utilize the three sets of conditions in this bill (among 14 others) that would allow for faster redeterminations: 1) verifying the income of those below 100% of the FPL with just a check in the case file and with electronic resources; 2) verifying the income of those with income sources deemed stable (such as social security benefits) with just a check of the case file; and, 3) expanded use of an electronic asset verification report to verify assets. According to a March 2024 issue brief by DHCS, the first two of these flexibilities had the greatest impact on counties’ ability to renew Medi-Cal ex parte, though it should be noted that Medi-Cal only had an assets test for part of the time the unwinding occurred. After the unwinding, DHCS revoked these flexibilities via All-County Letter 25-09, effective June 30, 2025.

However, in November 2024, the federal Centers for Medicare and Medicaid Services issued a guidance, “Use of Unwinding-Related Strategies to Support Long-Term Improvements to State Medicaid Eligibility and Enrollment Processes,” that authorized states to implement these flexibilities (now called “strategies”) indefinitely without requiring the need of a federal waiver. The guidance outlines where state plan amendments are needed, where updated verification plans are needed, and where the state may just implement pursuant to the guidance. According to a tracker by the Kaiser Family Foundation, as of January 2026, across the political spectrum, 15 states are utilizing the below 100% of the FPL strategy and 6 are utilizing the stable source of income strategy. The asset verification strategy is not tracked there. Another 11 states used a modified version of the below 100% FPL strategy for just for those individuals reporting no income.

1. Related legislation. SB 987 (Weber Pierson) would have created the California Health Access Fund to redirect any savings to the state resulting from decreased enrollment in the Medi-Cal program caused by the implementation of H.R. 1 to ensure that California residents losing health coverage can continue to receive health care services and that health care providers are reimbursed for these services. SB 987 was held on the Senate Appropriations suspense file.

SB 1202 (Weber Pierson) would require DHCS to track and publish data including the number of individuals who lose coverage due to eligibility barriers imposed by H.R. 1 and requires DHCS, counties, and plans to conduct outreach to Medi-Cal recipients about the H.R. 1 program changes. SB 1202 is pending in the Assembly Appropriations Committee.

AB 2161 (Bonta) would codify H.R. 1’s work requirements; requires DHCS to implement the work requirements in the least administratively burdensome way to Medi-Cal applicants and recipients as possible; and, prohibits DHCS from applying H.R. 1’s work requirements to state-only Medi-Cal populations. AB 2161 is set for hearing in this on July 1, 2026 in this Committee.

AB 2208 (Stefani) would codify H.R. 1’s Medicaid cost-sharing requirements and limits the cost sharing to one cent; require Medi-Cal systems implementing H.R. 1 changes to be user-tested; and require the state to provide three months of retroactive eligibility for Medi-Cal even after H.R. 1 limits federal payments for retroactive eligibility. AB 2208 2161 is set for hearing on July 1, 2026 in this Committee.

1. Prior legislation. AB 2956 (Boerner of 2024) would have allowed individuals to keep their Medi-Cal coverage for a full 12 months, regardless of changes in income, and directed California to seek federal approval, when necessary, to make permanent all federal Medi-Cal enrollment streamlining strategies. AB 2956 was held on the Assembly Appropriations Committee suspense file.

SB 184 (Committee on Budget and Fiscal Review, Chapter 47, Statutes of 2022) implements continuous eligibility for children under age five (no redetermination required), contingent upon an appropriation, the availability of funds, and systems readiness.

AB X1 1 (Perez, Chapter 3, Statutes of 2013) implements the Affordable Care Act, which incorporated various changes to the renewal process such as the inclusion of simplified eligibility determined based on Modified Adjusted Gross Income and the requirement for prepopulated renewal forms that sought from the recipient only the information the county was missing in order to renew Medi-Cal eligibility.

SB 87 (Escutia, Chapter 1088, Statutes of 2000) makes various changes to the Medi-Cal eligibility, renewal, and termination procedures, including requiring the ex parte process for renewals.

1. Support. A number of county organizations including the County Welfare Directors Association and other related associations write that counties have experience navigating large-scale eligibility transitions. During the Medi-Cal unwinding process in 2023, California implemented federal renewal streamlining strategies that reduced procedural terminations and doubled the automatic renewal rate. When the strategies ended on June 30, 2025, automatic renewal success was cut in half, resulting in hundreds of thousands of renewals that county workers must manually process each month. This workload is expected to grow further starting January 1, 2027, when counties must conduct renewals twice a year. This bill would reinstate proven Medi-Cal renewal streamlining strategies which would reduce county workloads, minimize wrongful terminations, and preserve staff capacity for complex cases, protecting thousands of Californians from losing their coverage. Sponsors Western Center on Law and Poverty, Health Access, Justice in Aging, Latino Coalition for a Healthy California, National Health Law Program, and The Children’s Partnership write that this bill would also deliver meaningful administrative and downstream healthcare cost savings to the state and counties. Improving the rate of automatic renewals and decreasing procedural terminations will minimize gaps in coverage, thus reducing ‘churn’. Churning causes gaps in healthcare coverage, which can lead to postponing visits to the doctor or delaying a prescription refill leading to major financial consequences for everyone involved. Beyond administrative costs associated with churning, people who get back on coverage often have higher monthly health care costs due to pent-up demand for services, contributing to less predictable expenditures for the state. Further, keeping people on Medi-Cal will generate downstream cost savings by reducing uncompensated emergency care and reducing the pressures on county indigent care programs.
2. Amendment. The committee and author have agreed to a technical amendment to incorporate these additional processes into the existing ex parte process that requires notifying the recipient of the eligibility determination and only requiring a response if the information is not correct:

14005.37(e)(3):  In the case of an annual or semiannual redetermination, if, based upon information obtained pursuant to paragraph (1) or (2), the county is able to make a determination of continued eligibility, the county shall notify the beneficiary of both of the following . . .

SUPPORT AND OPPOSITION:

Support: Health Access California (co-sponsor)

Justice in Aging (co-sponsor)

Latino Coalition for a Healthy California (co-sponsor)

National Health Law Program (co-sponsor)

The Children's Partnership (co-sponsor)

Western Center on Law & Poverty (co-sponsor)

Access Reproductive Justice
All for Kids
Alliance for Children's Rights
AltaMed Health Services
Alzheimer's Greater Los Angeles
Alzheimer's Orange County
Alzheimer's San Diego
American Federation of State, County and Municipal Employees

Asian Americans Advancing Justice Southern California
Asian Resources, Inc.
Association of Regional Center Agencies
Bay Area Legal Aid
Bleeding Disorders Council of California
Buen Vecino
California Academy of Family Physicians
California Alliance for Retired Americans
California Association of Public Hospitals & Health Systems
California Behavioral Health Association
California Collaborative for Long-term Services and Supports
California Community Foundation

California Dental Association
California Immigrant Policy Center
California Kidney Care Alliance
California LGBTQ Health and Human Services Network
California Pan - Ethnic Health Network
California Physicians Alliance

California Primary Care Association Advocates
California Rural Legal Assistance, Inc.
California School-Based Health Alliance
California State Association of Counties

California State Council of Service Employees International Union
Cardea Health
Celestria Health

Child Care Resource Center
Children Now
Choice in Aging
Coalition of California Welfare Rights Organizations
Coalition of Orange County Community Health Centers
Community Clinic Association of Los Angeles County
County Health Executives Association of California

County of Contra Costa

County of Los Angeles

County of San Diego
County Welfare Directors Association of California
Courage California
Desert Healthcare District and Foundation
Disability Rights California

East Bay Community Law Center
Families in Schools
Family Voices of California
Friends Committee on Legislation of California
Gender Affirming Professionals
GLIDE
Health4Kern
Healthy Contra Costa
Hispanas Organized for Political Equality
Indivisible CA: Statestrong
LA Best Babies Network
Legal Aid Foundation of Los Angeles
Los Angeles LGBT Center
Maternal and Child Health Access
Multi-Faith Action Coalition
Neighborhood Legal Services of Los Angeles County
Orange County United Way
Planned Parenthood Affiliates of California
Private Essential Access Community Hospitals
Rural County Representatives of California
San Francisco AIDS Foundation
San Francisco Senior and Disability Action
Santa Cruz Community Ventures
Senior Services Coalition of Alameda County
Sharp Healthcare
South Asian Network
The Los Angeles Trust for Children’s Health
Transitions Clinic Network
United Domestic Workers/AFSCME Local 3930
Urban Counties of California
Venice Family Clinic
Vision Y Compromiso

Western Center on Law & Poverty, Inc.
Youth Take Lead

Oppose: None received.

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ASSEMBLY THIRD READING

ATR Bill Id:AB 2201

Author:(Boerner and Bonta)

As Amended Ver:May 18, 2026

Majority vote

SUMMARY

Implements processes to facilitate redetermining an individual's Medi-Cal eligibility by streamlining required income and asset verification, contingent on an appropriation of funds for such purposes.

Major Provisions

COMMENTS

During the federal COVID-19 public health emergency (PHE), regular Medicaid redetermination processes were suspended as a condition of receiving a temporary increase in federal Medicaid matching funds. During that time, Medi-Cal beneficiaries were not subject to annual eligibility redetermination, and those who were enrolled stayed on the program unless they voluntarily disenrolled or moved out of state. States began redetermining eligibility as of April 1, 2023 in a process known as the "PHE Unwinding." Resuming eligibility determinations after three years of continuous enrollment was a major workload for states, and was projected to result in significant coverage losses as a result of "procedural disenrollment." Procedural disenrollment is when an individual is disenrolled without having been deemed ineligible, often due to missing or late paperwork.

To ease implementation and assist Medicaid enrollees to retain coverage during the PHE Unwinding, the federal government offered states a number of strategies (sometimes called "federal flexibilities") that allowed states to streamline aspects of the redetermination process, including verification of income, and assets. States applied for and were granted waivers to implement these strategies, which generally sunset by June 30, 2025. Based on positive feedback from states and their review of the risks and benefits of these strategies, the Centers for Medicare and Medicaid Services (CMS) codified states' abilities to use many of these strategies long-term beyond the end of the PHE Unwinding.

According to "California's Journey with Medi-Cal Redeterminations," an issue brief published by the California Health and Human Services Agency (CHHSA issue brief), California implemented 17 strategies approved by CMS through waiver authority or under existing federal Medicaid law to streamline enrollment and keep individuals in coverage as the Medi-Cal redetermination process restarted. This bill extends some of the key strategies that the state implemented on a temporary basis during the PHE Unwinding with respect to redetermination of eligibility.

Basic Medi-Cal Eligibility Redetermination Requirements and Processes. As with most components of Medicaid, the federal government has rules establishing minimum requirements for eligibility groups that must be covered and eligibility rules that must be followed, and states have a variety of options in how they design their programs, as long as they seek federal approval for program changes.

Individuals who have been found eligible and are enrolled in Medi-Cal must have their eligibility redetermined every 12 months in order to retain coverage for the next year. If, during the 12-month period, new information that affects eligibility becomes available to the county, either reported by the individual or accessed through other electronic data sources, a beneficiary or enrollee will automatically have their eligibility redetermined based on the new information. Beneficiaries must report to the county any change in their circumstances that may affect their Medi-Cal eligibility within ten calendar days of the change.

To renew beneficiaries' Medicaid coverage, states must first attempt to confirm ongoing eligibility using data available to the agency without requiring information from the individual. This requirement, also known as ex parte renewals, can reduce the administrative burden for states and simplify the process for beneficiaries. An ex parte renewal is a redetermination of eligibility that states can make based on reliable information available to the agency without requiring information from the individual.

The federal Patient Protection and Affordable Care Act (ACA) required states to implement data-sharing strategies to simplify eligibility and redetermination processes for beneficiaries. Medicaid and Children's Health Insurance Program (CHIP) agencies now rely primarily on information available through data sources (e.g., the Social Security Administration, the Departments of Homeland Security and Labor) rather than paper documentation from families for purposes of verifying eligibility.

State law establishes specific process requirements and due process safeguards for redeterminations of eligibility. Generally, a beneficiary has 30 days to respond to a request for information, if additional information is needed to establish eligibility. If the beneficiary does not provide the necessary information to the county within the 30-day period, the county may send the beneficiary a 10-day Notice of Action of terminating their eligibility. If terminated, the beneficiary still has 90 days from termination to "cure" or provide the information requested. Beneficiaries also have the right to appeal an adverse determination.

House of Representatives (H.R). 1. H.R. 1 (Public Law 119-21), officially titled the "One Big Beautiful Bill Act," includes significant Medicaid-related changes that reduce federal investment in Medicaid, including new eligibility rules for the ACA expansion population. More stringent eligibility rules result in cost savings from individuals losing Medicaid coverage. H.R. 1 represents the largest-ever cut to the Medicaid program, with savings from Medicaid eligibility-related and financing changes projected to partially offset the loss of federal revenue associated with tax cuts that disproportionately benefit the wealthy and corporations. These changes create significant concern about Medi-Cal coverage loss and county administrative effort and costs to address increased eligibility workload. H.R. 1, with certain exceptions, requires the ACA expansion population—generally, adults ages 19 through 64 without dependent children— to engage in a minimum of work or community engagement requirements (called "community engagement requirements" in H.R. 1) beginning in 2027. H.R. 1 also requires states to redetermine eligibility for the ACA expansion population twice a year instead of once a year.

The Department of Health Care Services (DHCS) expects approximately 1.4 million people to lose Medi-Cal coverage because of implementation of work or community engagement requirements. In addition, many eligible Medi-Cal beneficiaries are projected to lose coverage because of the increased frequency of eligibility paperwork.

Federally Allowable Strategies Improve Ex Parte Rates and Reduce Procedural Disenrollments. According to DHCS, nationwide data on Medicaid unwinding of the COVID-19 emergency continuous coverage provision show that a majority of disenrollments occurred due to procedural reasons (e.g., late submission of paperwork, failure to respond to a state's request for information, lost forms), rather than legitimate losses of eligibility (i.e., changes in income or circumstances that would make individuals ineligible for Medicaid). One key metric related to state's Medi-Cal eligibility processing is how many individuals are able to be renewed through the "ex parte" process, that is, in an automated manner without an individual being contacted to provide supplemental documentation. A higher ex parte rate reflects a more efficient renewal process and helps more eligible people maintain coverage, and is shown to dramatically reduce procedural disenrollments. Starting in July 2025, when the streamlining strategies were discontinued, the ex parte rate began to declined from an average of 77% in the period from March through June of 2025, to an average of 40% in the period from July 2025 through January 2026.

Effect of This Bill. This bill implements strategies as noted below. Restarting eligibility streamlining strategies would be expected to improve the state's ex parte rate, thereby reducing county administrative workload and keep more people on Medi-Cal.

1. "100% FPL" and "Stable Income" Strategies. One of these income-related strategies allows for automatic verification of income for households whose attestation of income under 100% of the federal poverty rate (FPL) was verified within the last 12 months (at application or renewal) when no income information is returned through data sources and there is no contradictory information on file. This will allow more beneficiaries to have the annual renewal completed through ex parte and without the need to complete an annual renewal packet. The other flexibility extends automatic determination of income to individuals who receive payments under the Social Security disability insurance program or other stable sources of income, and have no other conflicting income information on file.
2. Streamlined Use of Asset Verification System (AVS). For individuals subject to an asset test whose eligibility is being determined on the basis of being age 65 or older or having blindness or a disability, federal law requires states to use an AVS to verify assets held in a financial institution. An AVS collects information directly from financial institutions to determine whether certain seniors and people with disabilities who are applying for or receiving Medicaid have assets below eligibility caps. According to CMS, as long as the state builds into its ex parte renewal process a reasonable period of time for financial institutions to respond to an AVS query, CMS has determined that the state may assume no change in the value of a previously verified asset if the state submits a request through its AVS and no information is returned or there is no response from the AVS within the reasonable timeframe the state has established. This would enable the state to complete an ex parte renewal without requesting additional documentation of asset types that can be verified with AVS.

According to the Author

This bill will help minimize the negative impacts of the Trump Administration's attack on Medi-Cal. Specifically, this bill will help to streamline the Medi-Cal verification process, removing administrative barriers that threaten Medi-Cal health coverage. New H.R. 1 paperwork requirements mean county offices will be stretched thin by the sheer volume of work, which puts Californians at risk of losing access to Medi-Cal. The author concludes that we cannot stand by and let the Trump Administration destroy lifeline programs for our most vulnerable populations.

Arguments in Support

This bill is co-sponsored by Western Center on Law and Poverty, Health Access, Justice in Aging, Latino Coalition for a Healthy California, National Health Law Program, and The Children's Partnership. It is also supported by a large number of consumer and health advocates and health care providers. Supporters point out various estimates project that between 1.4 million and 3 million Californians could lose Medi-Cal coverage and become uninsured as a result of H.R. 1-imposed rule changes, largely due to increased paperwork barriers. Supporters note that when the strategies were turned off on June 30, 2025, the rate of successful automatic renewals was cut in half, meaning county workers now have to manually process hundreds of thousands of applications that could have been processed automatically had the strategies remained in place. Supporters argue this bill will save counties administrative effort and cost, reduce procedural disenrollments, and keep more people covered.

Arguments in Opposition

None on file.

FISCAL COMMENTS

According to the Assembly Committee on Appropriations:

Cost pressures of an unknown amount to county health and human services agencies, which perform Medi-Cal eligibility determinations on behalf of the state. Based on an estimate provided by the County Welfare Directors Association of California for AB 2161 (Bonta), which also addresses implementation of related H.R. 1 requirements on Medi-Cal redeterminations, costs could be in the hundreds of millions of dollars annually (General Fund, federal funds).

The author submitted a letter to the Assembly Budget Committee requesting language in the June 2026 trailer bill directing DHCS to reinstate strategies that streamline the renewal process and minimize coverage losses.

VOTES

ASM HEALTH: 16-0-0

YES: Bonta, Chen, Addis, Aguiar-Curry, Ahrens, Caloza, Carrillo, Mark González, Johnson, Patel, Patterson, Rogers, Sanchez, Schiavo, Sharp-Collins, Stefani

ASM APPROPRIATIONS: 11-0-4

YES: Wicks, Aguiar-Curry, Calderon, Caloza, Fong, Mark González, Krell, Pacheco, Pellerin, Sharp-Collins, Solache

ABS, ABST OR NV: Hoover, Dixon, Ta, Tangipa

UPDATED

VERSION: May 18, 2026

CONSULTANT: Lisa Murawski / HEALTH / (916) 319-2097 FN: 0003014

Date of Hearing: May 6, 2026

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Buffy Wicks, Chair

ABPCA Bill Id:AB 2201

Author:(Boerner) – As Amended Ver:April 9, 2026

Urgency: No State Mandated Local Program: Yes Reimbursable: Yes

SUMMARY:

This bill conforms state law with federal House Resolution 1 (H.R. 1; Public Law 119-21) by requiring counties to make Medi-Cal eligibility redeterminations every six months, rather than annually, for beneficiaries 19 to 64 years of age, inclusive, with income up to 138% of the federal poverty level (“Medicaid expansion adults”), and requires counties to verify countable income and assets at renewal without requesting additional verification information or documentation, as specified.

Specifically, this bill:

1. Requires a county to perform eligibility redeterminations every six months for Medicaid expansion adults, except as specified, and makes conforming changes.
2. Requires a county to verify countable income at renewal without requesting additional information if either of the following is true:
   1. The most recent income determination was based on a previously verified attestation of income at or below 100% of the federal poverty level (FPL) during the initial application or at the most recent renewal within the last 12 months, the county has checked financial data sources, and not received information, and no contradictory information is on file (“100% FPL” strategy).
      
   2. The most recent income determination renewal was within the last 12 months, the beneficiary receives only Social Security income, and any other sources of stable income, defined as any income that generally does not fluctuate, and no contradictory information is on file (“stable income” strategy).
      

FISCAL EFFECT:

Costs of an unknown amount to county health and human services agencies, which perform Medi-Cal eligibility determinations on behalf of the state. Based on an estimate provided by the County Welfare Directors Association of California for AB 2161 (Bonta), which also addresses implementation of related H.R. 1 requirements on Medi-Cal redeterminations, costs could be in the hundreds of millions of dollars annually (General Fund, federal funds).

The author submitted a letter to the Assembly Budget Committee requesting language in the June 2026 trailer bill directing the Department of Health Care Services (DHCS) to reinstate strategies that streamline the renewal process and minimize coverage losses.

The Legislative Analyst’s Office recently warned of General Fund structural deficits of around $35 billion per year in the 2027-28 fiscal year and ongoing.

COMMENTS:

1. Purpose. This bill is co-sponsored by The Western Center on Law and Poverty, Health Access, Justice in Aging, Latino Coalition for a Healthy California, National Health Law Program, and The Children’s Partnership. According to the author:

[This bill] will help minimize the negative impacts of the Trump Administration’s attack on Medi-Cal. This bill will help to streamline the Medi-Cal verification process, removing administrative barriers that threaten Medi-Cal health coverage. Currently, 14 million Californians rely on Medi-Cal coverage, of which 1.3 million are children. Work requirements for Medi-Cal participation and increased frequency of renewals from annual to every 6 months mean county offices will be stretched thin by the sheer volume of additional paperwork and ultimately put Californians at risk of losing access to Medi-Cal. California needs to protect healthcare services, especially for children.

1. Background. After the end of the federal COVID-19 public health emergency (PHE), California implemented 17 strategies approved by the federal government through waiver authority or under existing federal Medicaid law to streamline enrollment and keep individuals in coverage as the Medi-Cal redetermination process restarted. This bill extends some of the strategies for streamlining eligibility redeterminations the state implemented on a temporary basis during the “PHE Unwinding.” Restarting eligibility streamlining strategies is expected to increase the number of redeterminations using reliable information available to the state without the need to contact the enrollee, thereby reducing county administrative workload and keep more people on Medi-Cal. To implement these strategies, states must document their use in the appropriate state verification policies and procedures.
2. Related Legislation. This bill is part of a package of bills related to implementing various aspects of H.R. 1 and sponsored by the coalition sponsoring this bill.
   
   AB 2161 (Bonta) implements federally required changes to Medi-Cal eligibility rules related to work and community engagement requirements and redeterminations in a manner that prioritizes maintaining Medi-Cal coverage, limits implementation to what is federally required, and codifies mandatory and state-optional exemptions to the rules. AB 2161 is pending on this committee’s suspense file.
   
   AB 2208 (Stefani) maintains three months of retroactive coverage despite H.R. 1’s restriction to one or two months, depending upon the population; implements one-cent copayments to minimize barriers to accessing health care, and allows individuals to update eligibility information using mobile devices. AB 2208 is pending on this committee’s suspense file.
   
   SB 1202 (Weber Pierson), requires DHCS to establish a dashboard to track enrollment data related to the implementation of H.R. 1 and is pending in the Senate Appropriations Committee.

Analysis Prepared by: Allegra Kim / APPR. / (916) 319-2081

Date of Hearing: April 7, 2026

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 2201

Author:(Boerner) – As Introduced Ver:February 19, 2026

SUBJECT: Medi-Cal: eligibility redetermination.

SUMMARY: Implements processes to facilitate redetermining an individual’s Medi-Cal eligibility by streamlining required income and asset verification. Specifically, this bill:

1. Aligns state law with a new federal requirement to redetermine eligibility every six months instead of every 12 months for certain populations, and makes conforming changes.
2. Requires a county to verify countable income and assets at renewal without requesting additional verification information or documentation if any of the following sets of conditions are met:
   1. All of the following are true (“100% FPL” Flexibility):
      1. An individual's most recent income documentation was based on previously verified attestation of income at or below 100% of the federal poverty level (FPL) during initial application or at their most recent renewal within the last 12 months;
      2. The county has checked financial data sources and no information was received, but all other eligibility criteria has been verified; and,
      3. There is no contradictory information on file;

or,

• 1. All of the following are true (“Stable Income” Flexibility):
     1. The most recent income determination, at either initial application or most recent renewal, was within the last 12 months;
     2. The beneficiary receives Social Security benefits or other sources of stable income at the most recent determination; and,
     3. There is no contradictory information on file;

or,

• 1. All of the following are true (Streamlining of Asset Verification):
     1. The most recent asset verification was based on a previously verified attestation of assets, at either initial application or most recent renewal, within the last 12 months;
     2. The county has checked financial data sources and no information is received or no response has been received within a reasonable timeframe, but all other eligibility criteria are verified; and,
     3. No contradictory information is on file.

EXISTING FEDERAL LAW:

1. Requires states, on or after January 1, 2027, to redetermine once every 6 months for most adults ages 19-64 without dependent children. States the six-month verifications do not apply to other populations, as specified. [42 U.S.C. § 1396a(e)(14)(L)]

EXISTING STATE LAW:

1. Establishes the Medi-Cal Program, administered by the Department of Health Care Services (DHCS), to provide comprehensive health benefits to low-income individuals who meet specified eligibility criteria. [Welfare and Institutions Code (WIC) § 14000, et seq.]
2. Makes Medi-Cal eligibility and enrollment functions a county function and responsibility, subject to the direction, authority, and regulations of DHCS. [WIC § 14001.11]
3. Establishes processes for the determination and redetermination of an individual’s eligibility for Medi-Cal, as specified in 4) through 14), below. [WIC § 14005, et seq.]
4. Requires a county to perform redeterminations of eligibility for beneficiaries every 12 months and promptly redetermine eligibility whenever the county receives information about changes in a beneficiary’s circumstance that may affect eligibility. [WIC § 14005.37]
5. Requires a loss of contact, as evidenced by the return of mail marked in such a way as to indicate it could not be delivered or that there was no forwarding address, to prompt a redetermination of eligibility. [Ibid.]
6. Requires eligibility to continue during the redetermination process and prohibits eligibility from being terminated until the county makes a specific determination based on facts clearly demonstrating the beneficiary is no longer eligible, and due process rights have been met. [Ibid.]
7. Requires, for purposes of acquiring information necessary to conduct eligibility redeterminations, a county to gather information available to the county that is relevant to the beneficiary’s eligibility, prior to contacting the beneficiary. Specifies state and federal data sources for this information. [Ibid.]
8. Requires, if a county is able to make an eligibility determination based on accessible data, the county to notify the beneficiary of the determination and the information on which it is based, and requires the county to notify the beneficiary that they must inform the county if any of the information is inaccurate, but that the beneficiary is not required to sign and return the notice if all information is accurate. [Ibid.]
9. Requires a beneficiary to sign a renewal form if the beneficiary chooses to return the form in person or via mail. [Ibid.]
10. Requires, in the case of a redetermination due to a change in circumstances, if a county cannot obtain sufficient information to redetermine eligibility, a county to send the beneficiary a form that states the information needed to redetermine eligibility, and limits the additional data a county can request from the beneficiary. [Ibid.]
11. Requires a county to terminate eligibility if the purpose for a redetermination is loss of contact with the beneficiary, and the renewal form is also returned as undeliverable. [Ibid.]
12. Requires, during the 30-day period after the date of mailing a form to the beneficiary requesting additional information for redetermination of eligibility, the county to attempt to contact the beneficiary to request necessary information. Requires, if the beneficiary does not supply the necessary information to the county within the 30-day limit, a 10-day notice of termination of eligibility to be sent. [Ibid.]
13. Specifies procedures whereby an individual can request to receive retroactive eligibility for the three months preceding an eligibility determination. [Ibid.]
14. Requires a beneficiary to report any change in circumstance that may affect their eligibility within 10 calendar days following the date the change occurred. [Ibid.]

FISCAL EFFECT: Unknown. This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, this bill will help minimize the negative impacts of the Trump Administration’s attack on Medi-Cal. Specifically, the author explains, this bill will help to streamline the Medi-Cal verification process, removing administrative barriers that threaten Medi-Cal health coverage. The author argues that work requirements for Medi-Cal participation and increased frequency of renewals from annual to every six months mean county offices will be stretched thin by the sheer volume of additional paperwork, which ultimately puts Californians at risk of losing access to Medi-Cal. The author concludes that we cannot stand idly by and let the Trump Administration destroy lifeline programs for our most vulnerable populations.
2. BACKGROUND. During the federal COVID-19 public health emergency (PHE), regular Medicaid redetermination processes were suspended as a condition of receiving a temporary increase in federal Medicaid matching funds. During that time, Medi-Cal beneficiaries were not subject to annual eligibility redetermination, and those who were enrolled stayed on the program unless they voluntarily disenrolled or moved out of state. States began redetermining eligibility as of April 1, 2023 in a process known as the “PHE Unwinding.” Resuming eligibility determinations after three years of continuous enrollment was a major workload for states, and was projected to result in significant coverage losses as a result of “procedural disenrollment.” Procedural disenrollment is when an individual is disenrolled without having been deemed ineligible, often due to missing or late paperwork. To ease implementation and assist Medicaid enrollees to retain coverage during the PHE Unwinding, the federal government offered states a number of strategies (sometimes called “federal flexibilities”) that allowed states to streamline aspects of the redetermination process, including verification of income, and assets. States applied for and were granted waivers to implement these strategies, which generally sunset by June 30, 2025. Based on positive feedback from states and their review of the risks and benefits of these strategies, the Centers for Medicare and Medicaid Services (CMS) codified states’ abilities to use many of these strategies long-term beyond the end of the PHE Unwinding. These are documented in the Centers for Medicaid and CHIP Services (CMCS) Informational Bulletin, “Use of Unwinding-Related Strategies to Support Long-Term Improvements to State Medicaid Eligibility and Enrollment Processes.” This bulletin explains which strategies may be implemented permanently at state option and the process needed to effectuate the change (i.e., an amendment to the Medicaid State Plan or documentation in the state’s “Eligibility Verification Plan”).

According to “California’s Journey with Medi-Cal Redeterminations,” an issue brief published by the California Health and Human Services Agency (CHHSA issue brief), California implemented 17 strategies approved by CMS through waiver authority or under existing federal Medicaid law to streamline enrollment and keep individuals in coverage as the Medi-Cal redetermination process restarted. This bill extends some of the strategies that the state implemented on a temporary basis during the PHE Unwinding with respect to redetermination of eligibility.

• 1. Basic Medi-Cal Eligibility Redetermination Requirements and Processes. As with most components of Medicaid, the federal government has rules establishing minimum requirements for eligibility groups that must be covered and eligibility rules that must be followed, and states have a variety of options in how they design their programs, as long as they seek federal approval for program changes.

Individuals who have been found eligible and are enrolled in Medi-Cal must have their eligibility redetermined every 12 months in order to retain coverage for the next year. If, during the 12-month period, new information that affects eligibility becomes available to the county, either reported by the individual or accessed through other electronic data sources, a beneficiary or enrollee will automatically have their eligibility redetermined based on the new information. Beneficiaries must report to the county any change in their circumstances that may affect their Medi-Cal eligibility within ten calendar days of the change.

To renew beneficiaries’ Medicaid coverage, states must first attempt to confirm ongoing eligibility using data available to the agency without requiring information from the individual. This requirement, also known as ex parte renewals, can reduce the administrative burden for states and simplify the process for beneficiaries. An ex parte renewal is a redetermination of eligibility that states can make based on reliable information available to the agency without requiring information from the individual.

The federal Patient Protection and Affordable Care Act (ACA) required states to implement data-sharing strategies to simplify eligibility and redetermination processes for beneficiaries. Medicaid and Children's Health Insurance Program (CHIP) agencies now rely primarily on information available through data sources (e.g., the Social Security Administration, the Departments of Homeland Security and Labor) rather than paper documentation from families for purposes of verifying eligibility.

State law establishes specific process requirements and due process safeguards for redeterminations of eligibility. Generally, a beneficiary has 30 days to respond to a request for information, if additional information is needed to establish eligibility. If the beneficiary does not provide the necessary information to the county within the 30-day period, the county may send the beneficiary a 10-day Notice of Action of terminating their eligibility. If terminated, the beneficiary still has 90 days from termination to “cure” or provide the information requested. Beneficiaries also have the right to appeal an adverse determination.

• 1. H.R. 1. H.R. 1 (Public Law 119-21), officially titled the “One Big Beautiful Bill Act,” includes significant Medicaid-related changes that reduce federal investment in Medicaid, including new eligibility rules for the ACA expansion population. More stringent eligibility rules result in cost savings from individuals losing Medicaid coverage. H.R. 1 represents the largest-ever cut to the Medicaid program, with savings from Medicaid eligibility-related and financing changes projected to partially offset the loss of federal revenue associated with tax cuts that disproportionately benefit the wealthy and corporations. These changes create significant concern about Medi-Cal coverage loss and county administrative effort and costs to address increased eligibility workload.
     1. Work or Community Engagement Requirements. Section 71119 of federal H.R. 1 with certain exceptions, requires the ACA expansion population—generally, adults ages 19 through 64 without dependent children— to engage in a minimum of work or community engagement requirements (called “community engagement requirements” in H.R. 1) beginning in 2027. This means an individual needs to document at least 80 hours per month of work, community service, or job training to keep Medi-Cal coverage. The law outlines mandatory and short-term hardship exemptions, which must be verified every 6 months.
     2. Six-Month Eligibility Checks. Section 71107 of federal H.R. 1 requires states to redetermine eligibility for the ACA expansion population twice a year instead of once a year.
     3. Impact. DHCS expects approximately 1.4 million people to lose Medi-Cal coverage because of implementation of work or community engagement requirements. In addition, many eligible Medi-Cal beneficiaries are projected to lose coverage because of the increased frequency of eligibility paperwork.

New work or community engagement rules also imposes significant administrative work on counties to verify compliance and on beneficiaries and applications to prove they comply. The California Welfare Directors Association (CWDA), representing county health and human services agencies that conduct eligibility determination on behalf of the state, estimates 3.5 additional hours would be needed per client, per year for robust exemption and compliance review for individuals who cannot be verified via automated data matches, as well as approximately 50 additional minutes of follow-up for clients initially deemed noncompliant and to resolve documentation issues. CWDA estimates an additional 1.2 hours per client, per year to support the shift from annual to six-month redeterminations.

• 1. Federally Allowable Strategies Improve Ex Parte Rates and Reduce Procedural Disenrollments. According to DHCS, nationwide data on Medicaid unwinding of the COVID-19 emergency continuous coverage provision show that a majority of disenrollments occurred due to procedural reasons (e.g., late submission of paperwork, failure to respond to a state’s request for information, lost forms), rather than legitimate losses of eligibility (i.e., changes in income or circumstances that would make individuals ineligible for Medicaid). One key metric related to state’s Medi-Cal eligibility processing is how many individuals are able to be renewed through the “ex parte” process, that is, in an automated manner without an individual being contacted to provide supplemental documentation. A higher ex parte rate reflects a more efficient renewal process and helps more eligible people maintain coverage, and is shown to dramatically reduce procedural disenrollments.

The ex parte rate when redeterminations began in 2023 was low: an average of 34% from the period from June 2023 to November 2023. This rate increased to 66% by December 2023, and it stayed high throughout the period in which strategies were operational. Starting in July 2025, when the strategies were discontinued, the ex parte rate began to decline dramatically. Specifically, the rate declined from an average of 77% in the period from March through June of 2025, to an average of 40% in the period from July 2025 through January 2026.

• 1. Effect of This Bill. This bill implements strategies as noted below. Restarting eligibility streamlining strategies would be expected to improve the state’s ex parte rate, thereby reducing county administrative workload and keep more people on Medi-Cal. To implement these strategies, states must document their use in the appropriate state verification policies and procedures. CMS states in the 2024 guidance that approval of state verification plans is not required, but states must submit their plans to CMS upon request and CMS may require specific policies be included in verification plans in the future.
     1. “100% FPL” and “Stable Income” Strategies. One of these income-related strategies allows for automatic verification of income for households whose attestation of income under 100% FPL was verified within the last 12 months (at application or renewal) when no income information is returned through data sources and there is no contradictory information on file. This will allow more beneficiaries to have the annual renewal completed through ex parte and without the need to complete an annual renewal packet. The other flexibility extends automatic determination of income to individuals who receive payments under the Social Security disability insurance program or other stable sources of income, and have no other conflicting income information on file. According to the aforementioned CHHSA brief, during the PHE Unwinding, these changes have had the largest impact on improving the ex parte renewal rate.
     2. Streamlined Use of Asset Verification System (AVS). For individuals subject to an asset test whose eligibility is being determined on the basis of being age 65 or older or having blindness or a disability, federal law requires states to use an AVS to verify assets held in a financial institution. An AVS collects information directly from financial institutions to determine whether certain seniors and people with disabilities who are applying for or receiving Medicaid have assets below eligibility caps. According to CMS, as long as the state builds into its ex parte renewal process a reasonable period of time for financial institutions to respond to an AVS query, CMS has determined that the state may assume no change in the value of a previously verified asset if the state submits a request through its AVS and no information is returned or there is no response from the AVS within the reasonable timeframe the state has established. This would enable the state to complete an ex parte renewal without requesting additional documentation of asset types that can be verified with AVS. Information returned by AVS that might impact eligibility after an individual's eligibility has been renewed must be treated as a change in circumstances, which triggers a reverification of assets.

1. SUPPORT. This bill is co-sponsored by The Western Center on Law and Poverty, Health Access, Justice in Aging, Latino Coalition for a Healthy California, National Health Law Program, and The Children’s Partnership. It is also supported by a large number of consumer and health advocates and health care providers. Supporters note that with the looming implementation of H.R. 1 work reporting requirements for Medi-Cal participation, increased frequency of renewals from annual to every 6 months, and reinstatement of Medi-Cal asset limits, county eligibility offices will be stretched thin by the sheer volume and complexity of cases. Supporters point out various estimates project that between 1.4 million and 3 million Californians could lose Medi-Cal coverage and become uninsured as a result of H.R. 1-imposed rule changes, largely due to increased paperwork barriers. Supporters note that when the strategies were turned off on June 30, 2025, the rate of successful automatic renewals was cut in half, meaning county workers now have to manually process hundreds of thousands of applications that could have been processed automatically had the strategies remained in place. Supporters argue this bill will save counties administrative effort and cost, reduce procedural disenrollments, and keep more people covered.
2. RELATED LEGISLATION. A package of bills, sponsored by the coalition co-sponsoring this bill, are all related to implementing various aspects of H.R. 1:
   1. AB 2161 (Bonta), also being heard on April 7, 2026, by the Assembly Health Committee, would implement federally required changes to Medi-Cal eligibility rules in a manner that prioritizes maintaining Medi-Cal coverage; would limit implementation to what is federally required and codifies mandatory and state-optional exemptions to the rules; would prohibit DHCS from applying these more stringent eligibility processes to Medi-Cal members for which these processes are not federally required.; would require data sources to be leveraged to automate eligibility determinations; and would specify notices and noncompliance procedures.
   2. AB 2208 (Stefani), also being heard on April 7, 2026, by the Assembly Health Committee, would maintain three months of retroactive coverage despite H.R. 1’s restriction to one or two months, depending upon the population; would implement one-cent copayments to minimize barriers to accessing health care, and would allow individuals to update eligibility information using mobile devices.
   3. SB 1202 (Weber Pierson), pending in the Senate Health Committee, would require the state to collect data to document the impact of H.R. 1 and would require robust outreach to assist Medi-Cal members to preserve coverage.
3. PREVIOUS LEGISLATION.
   1. AB 2956 (Boerner) sought to allow people to keep their Medi-Cal coverage for a full 12 months, regardless of changes in income, and directed California to seek federal approval, when necessary, to make permanent all federal Medi-Cal enrollment streamlining strategies. AB 2956 was held on suspense in the Assembly Appropriations Committee.
   2. SB 1289 (Roth) requires, commencing on January 1, 2026, and each month thereafter, a county with a call center for Medi-Cal applicants or beneficiaries applying for, renewing, or requesting help in obtaining or maintaining Medi-Cal coverage to collect and submit to DHCS call-center data metrics, including, but not limited to, total call volume, average call wait times by language, and the average call abandonment rate.
   3. SB 184 (Committee on Budget and Fiscal Review), Chapter 47, Statutes of 2022, implemented continuous eligibility for children younger than age five, but made the bill contingent on appropriation, the availability of funds, and systems readiness.
4. AMENDMENTS. This bill would benefit from technical amendments to clarify that meeting conditions related to assets would satisfy the asset verification, and, similarly, that meeting either condition related to income would satisfy the income verification. Essentially, amendments will split those two issues apart and address them separately, consistent with the author’s intent, without making substantive changes.

REGISTERED SUPPORT / OPPOSITION:

Support

Western Center on Law & Poverty (co-sponsor)

Health Access California (co-sponsor)
Justice in Aging (co-sponsor)

Latino Coalition for a Healthy California (co-sponsor)
National Health Law Program (co-sponsor)

The Children’s Partnership (co-sponsor)

Access Reproductive Justice
Alliance for Children's Rights
American Federation of State, County and Municipal Employees, AFL-CIO
Association of Regional Center Agencies
Bay Area Legal Aid
California Academy of Family Physicians
California Alliance for Retired Americans
California Immigrant Policy Center
California LGBTQ Health and Human Services Network
California Pan - Ethnic Health Network
Cardea Health
Children Now
Choice in Aging
Coalition of California Welfare Rights Organizations
Coalition of Orange County Community Health Centers
Community Clinic Association of Los Angeles County (CCALAC)
Community Legal Aid SoCal
Community Legal Services in East Palo Alto
Courage California
CPCA Advocates, Subsidiary of the California Primary Care Association
Disability Rights California
East Bay Community Law Center
Family Voices of California
Gender Affirming Professionals
Grace Institute - End Child Poverty in CA
Indivisible CA: StateStrong
Jewish Family Service of Los Angeles
LA Best Babies Network
Maternal and Child Health Access
Multi-faith Action Coalition
Planned Parenthood Affiliates of California
San Francisco Aids Foundation
San Francisco Senior and Disability Action
Serving Seniors
Sharp Healthcare
South Asian Network
United Domestic Workers/AFSCME Local 3930
Vision Y Compromiso

Opposition

None on file

Analysis Prepared by: Lisa Murawski / HEALTH / (916) 319-2097

Date of Hearing: April 7, 2026

ASSEMBLY COMMITTEE ON HEALTH

Mia Bonta, Chair

ABPCA Bill Id:AB 2201

Author:(Boerner) – As Introduced Ver:February 19, 2026

SUBJECT: Medi-Cal: eligibility redetermination.

SUMMARY: Implements processes to facilitate redetermining an individual’s Medi-Cal eligibility by streamlining required income and asset verification. Specifically, this bill:

1. Aligns state law with a new federal requirement to redetermine eligibility every six months instead of every 12 months for certain populations, and makes conforming changes.
2. Requires a county to verify countable income and assets at renewal without requesting additional verification information or documentation if any of the following sets of conditions are met:
   1. All of the following are true (“100% FPL” Flexibility):
      1. An individual's most recent income documentation was based on previously verified attestation of income at or below 100% of the federal poverty level (FPL) during initial application or at their most recent renewal within the last 12 months;
      2. The county has checked financial data sources and no information was received, but all other eligibility criteria has been verified; and,
      3. There is no contradictory information on file;

or,

• 1. All of the following are true (“Stable Income” Flexibility):
     1. The most recent income determination, at either initial application or most recent renewal, was within the last 12 months;
     2. The beneficiary receives Social Security benefits or other sources of stable income at the most recent determination; and,
     3. There is no contradictory information on file;

or,

• 1. All of the following are true (Streamlining of Asset Verification):
     1. The most recent asset verification was based on a previously verified attestation of assets, at either initial application or most recent renewal, within the last 12 months;
     2. The county has checked financial data sources and no information is received or no response has been received within a reasonable timeframe, but all other eligibility criteria are verified; and,
     3. No contradictory information is on file.

EXISTING FEDERAL LAW:

1. Requires states, on or after January 1, 2027, to redetermine once every 6 months for most adults ages 19-64 without dependent children. States the six-month verifications do not apply to other populations, as specified. [42 U.S.C. § 1396a(e)(14)(L)]

EXISTING STATE LAW:

1. Establishes the Medi-Cal Program, administered by the Department of Health Care Services (DHCS), to provide comprehensive health benefits to low-income individuals who meet specified eligibility criteria. [Welfare and Institutions Code (WIC) § 14000, et seq.]
2. Makes Medi-Cal eligibility and enrollment functions a county function and responsibility, subject to the direction, authority, and regulations of DHCS. [WIC § 14001.11]
3. Establishes processes for the determination and redetermination of an individual’s eligibility for Medi-Cal, as specified in 4) through 14), below. [WIC § 14005, et seq.]
4. Requires a county to perform redeterminations of eligibility for beneficiaries every 12 months and promptly redetermine eligibility whenever the county receives information about changes in a beneficiary’s circumstance that may affect eligibility. [WIC § 14005.37]
5. Requires a loss of contact, as evidenced by the return of mail marked in such a way as to indicate it could not be delivered or that there was no forwarding address, to prompt a redetermination of eligibility. [Ibid.]
6. Requires eligibility to continue during the redetermination process and prohibits eligibility from being terminated until the county makes a specific determination based on facts clearly demonstrating the beneficiary is no longer eligible, and due process rights have been met. [Ibid.]
7. Requires, for purposes of acquiring information necessary to conduct eligibility redeterminations, a county to gather information available to the county that is relevant to the beneficiary’s eligibility, prior to contacting the beneficiary. Specifies state and federal data sources for this information. [Ibid.]
8. Requires, if a county is able to make an eligibility determination based on accessible data, the county to notify the beneficiary of the determination and the information on which it is based, and requires the county to notify the beneficiary that they must inform the county if any of the information is inaccurate, but that the beneficiary is not required to sign and return the notice if all information is accurate. [Ibid.]
9. Requires a beneficiary to sign a renewal form if the beneficiary chooses to return the form in person or via mail. [Ibid.]
10. Requires, in the case of a redetermination due to a change in circumstances, if a county cannot obtain sufficient information to redetermine eligibility, a county to send the beneficiary a form that states the information needed to redetermine eligibility, and limits the additional data a county can request from the beneficiary. [Ibid.]
11. Requires a county to terminate eligibility if the purpose for a redetermination is loss of contact with the beneficiary, and the renewal form is also returned as undeliverable. [Ibid.]
12. Requires, during the 30-day period after the date of mailing a form to the beneficiary requesting additional information for redetermination of eligibility, the county to attempt to contact the beneficiary to request necessary information. Requires, if the beneficiary does not supply the necessary information to the county within the 30-day limit, a 10-day notice of termination of eligibility to be sent. [Ibid.]
13. Specifies procedures whereby an individual can request to receive retroactive eligibility for the three months preceding an eligibility determination. [Ibid.]
14. Requires a beneficiary to report any change in circumstance that may affect their eligibility within 10 calendar days following the date the change occurred. [Ibid.]

FISCAL EFFECT: Unknown. This bill has not been analyzed by a fiscal committee.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, this bill will help minimize the negative impacts of the Trump Administration’s attack on Medi-Cal. Specifically, the author explains, this bill will help to streamline the Medi-Cal verification process, removing administrative barriers that threaten Medi-Cal health coverage. The author argues that work requirements for Medi-Cal participation and increased frequency of renewals from annual to every six months mean county offices will be stretched thin by the sheer volume of additional paperwork, which ultimately puts Californians at risk of losing access to Medi-Cal. The author concludes that we cannot stand idly by and let the Trump Administration destroy lifeline programs for our most vulnerable populations.
2. BACKGROUND. During the federal COVID-19 public health emergency (PHE), regular Medicaid redetermination processes were suspended as a condition of receiving a temporary increase in federal Medicaid matching funds. During that time, Medi-Cal beneficiaries were not subject to annual eligibility redetermination, and those who were enrolled stayed on the program unless they voluntarily disenrolled or moved out of state. States began redetermining eligibility as of April 1, 2023 in a process known as the “PHE Unwinding.” Resuming eligibility determinations after three years of continuous enrollment was a major workload for states, and was projected to result in significant coverage losses as a result of “procedural disenrollment.” Procedural disenrollment is when an individual is disenrolled without having been deemed ineligible, often due to missing or late paperwork. To ease implementation and assist Medicaid enrollees to retain coverage during the PHE Unwinding, the federal government offered states a number of strategies (sometimes called “federal flexibilities”) that allowed states to streamline aspects of the redetermination process, including verification of income, and assets. States applied for and were granted waivers to implement these strategies, which generally sunset by June 30, 2025. Based on positive feedback from states and their review of the risks and benefits of these strategies, the Centers for Medicare and Medicaid Services (CMS) codified states’ abilities to use many of these strategies long-term beyond the end of the PHE Unwinding. These are documented in the Centers for Medicaid and CHIP Services (CMCS) Informational Bulletin, “Use of Unwinding-Related Strategies to Support Long-Term Improvements to State Medicaid Eligibility and Enrollment Processes.” This bulletin explains which strategies may be implemented permanently at state option and the process needed to effectuate the change (i.e., an amendment to the Medicaid State Plan or documentation in the state’s “Eligibility Verification Plan”).

According to “California’s Journey with Medi-Cal Redeterminations,” an issue brief published by the California Health and Human Services Agency (CHHSA issue brief), California implemented 17 strategies approved by CMS through waiver authority or under existing federal Medicaid law to streamline enrollment and keep individuals in coverage as the Medi-Cal redetermination process restarted. This bill extends some of the strategies that the state implemented on a temporary basis during the PHE Unwinding with respect to redetermination of eligibility.

• 1. Basic Medi-Cal Eligibility Redetermination Requirements and Processes. As with most components of Medicaid, the federal government has rules establishing minimum requirements for eligibility groups that must be covered and eligibility rules that must be followed, and states have a variety of options in how they design their programs, as long as they seek federal approval for program changes.

Individuals who have been found eligible and are enrolled in Medi-Cal must have their eligibility redetermined every 12 months in order to retain coverage for the next year. If, during the 12-month period, new information that affects eligibility becomes available to the county, either reported by the individual or accessed through other electronic data sources, a beneficiary or enrollee will automatically have their eligibility redetermined based on the new information. Beneficiaries must report to the county any change in their circumstances that may affect their Medi-Cal eligibility within ten calendar days of the change.

To renew beneficiaries’ Medicaid coverage, states must first attempt to confirm ongoing eligibility using data available to the agency without requiring information from the individual. This requirement, also known as ex parte renewals, can reduce the administrative burden for states and simplify the process for beneficiaries. An ex parte renewal is a redetermination of eligibility that states can make based on reliable information available to the agency without requiring information from the individual.

The federal Patient Protection and Affordable Care Act (ACA) required states to implement data-sharing strategies to simplify eligibility and redetermination processes for beneficiaries. Medicaid and Children's Health Insurance Program (CHIP) agencies now rely primarily on information available through data sources (e.g., the Social Security Administration, the Departments of Homeland Security and Labor) rather than paper documentation from families for purposes of verifying eligibility.

State law establishes specific process requirements and due process safeguards for redeterminations of eligibility. Generally, a beneficiary has 30 days to respond to a request for information, if additional information is needed to establish eligibility. If the beneficiary does not provide the necessary information to the county within the 30-day period, the county may send the beneficiary a 10-day Notice of Action of terminating their eligibility. If terminated, the beneficiary still has 90 days from termination to “cure” or provide the information requested. Beneficiaries also have the right to appeal an adverse determination.

• 1. H.R. 1. H.R. 1 (Public Law 119-21), officially titled the “One Big Beautiful Bill Act,” includes significant Medicaid-related changes that reduce federal investment in Medicaid, including new eligibility rules for the ACA expansion population. More stringent eligibility rules result in cost savings from individuals losing Medicaid coverage. H.R. 1 represents the largest-ever cut to the Medicaid program, with savings from Medicaid eligibility-related and financing changes projected to partially offset the loss of federal revenue associated with tax cuts that disproportionately benefit the wealthy and corporations. These changes create significant concern about Medi-Cal coverage loss and county administrative effort and costs to address increased eligibility workload.
     1. Work or Community Engagement Requirements. Section 71119 of federal H.R. 1 with certain exceptions, requires the ACA expansion population—generally, adults ages 19 through 64 without dependent children— to engage in a minimum of work or community engagement requirements (called “community engagement requirements” in H.R. 1) beginning in 2027. This means an individual needs to document at least 80 hours per month of work, community service, or job training to keep Medi-Cal coverage. The law outlines mandatory and short-term hardship exemptions, which must be verified every 6 months.
     2. Six-Month Eligibility Checks. Section 71107 of federal H.R. 1 requires states to redetermine eligibility for the ACA expansion population twice a year instead of once a year.
     3. Impact. DHCS expects approximately 1.4 million people to lose Medi-Cal coverage because of implementation of work or community engagement requirements. In addition, many eligible Medi-Cal beneficiaries are projected to lose coverage because of the increased frequency of eligibility paperwork.

New work or community engagement rules also imposes significant administrative work on counties to verify compliance and on beneficiaries and applications to prove they comply. The California Welfare Directors Association (CWDA), representing county health and human services agencies that conduct eligibility determination on behalf of the state, estimates 3.5 additional hours would be needed per client, per year for robust exemption and compliance review for individuals who cannot be verified via automated data matches, as well as approximately 50 additional minutes of follow-up for clients initially deemed noncompliant and to resolve documentation issues. CWDA estimates an additional 1.2 hours per client, per year to support the shift from annual to six-month redeterminations.

• 1. Federally Allowable Strategies Improve Ex Parte Rates and Reduce Procedural Disenrollments. According to DHCS, nationwide data on Medicaid unwinding of the COVID-19 emergency continuous coverage provision show that a majority of disenrollments occurred due to procedural reasons (e.g., late submission of paperwork, failure to respond to a state’s request for information, lost forms), rather than legitimate losses of eligibility (i.e., changes in income or circumstances that would make individuals ineligible for Medicaid). One key metric related to state’s Medi-Cal eligibility processing is how many individuals are able to be renewed through the “ex parte” process, that is, in an automated manner without an individual being contacted to provide supplemental documentation. A higher ex parte rate reflects a more efficient renewal process and helps more eligible people maintain coverage, and is shown to dramatically reduce procedural disenrollments.

The ex parte rate when redeterminations began in 2023 was low: an average of 34% from the period from June 2023 to November 2023. This rate increased to 66% by December 2023, and it stayed high throughout the period in which strategies were operational. Starting in July 2025, when the strategies were discontinued, the ex parte rate began to decline dramatically. Specifically, the rate declined from an average of 77% in the period from March through June of 2025, to an average of 40% in the period from July 2025 through January 2026.

• 1. Effect of This Bill. This bill implements strategies as noted below. Restarting eligibility streamlining strategies would be expected to improve the state’s ex parte rate, thereby reducing county administrative workload and keep more people on Medi-Cal. To implement these strategies, states must document their use in the appropriate state verification policies and procedures. CMS states in the 2024 guidance that approval of state verification plans is not required, but states must submit their plans to CMS upon request and CMS may require specific policies be included in verification plans in the future.
     1. “100% FPL” and “Stable Income” Strategies. One of these income-related strategies allows for automatic verification of income for households whose attestation of income under 100% FPL was verified within the last 12 months (at application or renewal) when no income information is returned through data sources and there is no contradictory information on file. This will allow more beneficiaries to have the annual renewal completed through ex parte and without the need to complete an annual renewal packet. The other flexibility extends automatic determination of income to individuals who receive payments under the Social Security disability insurance program or other stable sources of income, and have no other conflicting income information on file. According to the aforementioned CHHSA brief, during the PHE Unwinding, these changes have had the largest impact on improving the ex parte renewal rate.
     2. Streamlined Use of Asset Verification System (AVS). For individuals subject to an asset test whose eligibility is being determined on the basis of being age 65 or older or having blindness or a disability, federal law requires states to use an AVS to verify assets held in a financial institution. An AVS collects information directly from financial institutions to determine whether certain seniors and people with disabilities who are applying for or receiving Medicaid have assets below eligibility caps. According to CMS, as long as the state builds into its ex parte renewal process a reasonable period of time for financial institutions to respond to an AVS query, CMS has determined that the state may assume no change in the value of a previously verified asset if the state submits a request through its AVS and no information is returned or there is no response from the AVS within the reasonable timeframe the state has established. This would enable the state to complete an ex parte renewal without requesting additional documentation of asset types that can be verified with AVS. Information returned by AVS that might impact eligibility after an individual's eligibility has been renewed must be treated as a change in circumstances, which triggers a reverification of assets.

1. SUPPORT. This bill is supported by a large number of consumer and health advocates and health care providers. Supporters note that with the looming implementation of H.R. 1 work reporting requirements for Medi-Cal participation, increased frequency of renewals from annual to every 6 months, and reinstatement of Medi-Cal asset limits, county eligibility offices will be stretched thin by the sheer volume and complexity of cases. Supporters point out various estimates project that between 1.4 million and 3 million Californians could lose Medi-Cal coverage and become uninsured as a result of H.R. 1-imposed rule changes, largely due to increased paperwork barriers. Supporters note that when the strategies were turned off on June 30, 2025, the rate of successful automatic renewals was cut in half, meaning county workers now have to manually process hundreds of thousands of applications that could have been processed automatically had the strategies remained in place. Supporters argue this bill will save counties administrative effort and cost, reduce procedural disenrollments, and keep more people covered.
2. RELATED LEGISLATION. A package of bills, sponsored by the coalition co-sponsoring this bill, are all related to implementing various aspects of H.R. 1:
   1. AB 2161 (Bonta), also being heard on April 7, 2026, by the Assembly Health Committee, would implement federally required changes to Medi-Cal eligibility rules in a manner that prioritizes maintaining Medi-Cal coverage; would limit implementation to what is federally required and codifies mandatory and state-optional exemptions to the rules; would prohibit DHCS from applying these more stringent eligibility processes to Medi-Cal members for which these processes are not federally required.; would require data sources to be leveraged to automate eligibility determinations; and would specify notices and noncompliance procedures.
   2. AB 2208 (Stefani), also being heard on April 7, 2026, by the Assembly Health Committee, would maintain three months of retroactive coverage despite H.R. 1’s restriction to one or two months, depending upon the population; would implement one-cent copayments to minimize barriers to accessing health care, and would allow individuals to update eligibility information using mobile devices.
   3. SB 1202 (Weber Pierson), pending in the Senate Health Committee, would require the state to collect data to document the impact of H.R. 1 and would require robust outreach to assist Medi-Cal members to preserve coverage.
3. PREVIOUS LEGISLATION.
   1. AB 2956 (Boerner) sought to allow people to keep their Medi-Cal coverage for a full 12 months, regardless of changes in income, and directed California to seek federal approval, when necessary, to make permanent all federal Medi-Cal enrollment streamlining strategies. AB 2956 was held on suspense in the Assembly Appropriations Committee.
   2. SB 1289 (Roth) requires, commencing on January 1, 2026, and each month thereafter, a county with a call center for Medi-Cal applicants or beneficiaries applying for, renewing, or requesting help in obtaining or maintaining Medi-Cal coverage to collect and submit to DHCS call-center data metrics, including, but not limited to, total call volume, average call wait times by language, and the average call abandonment rate.
   3. SB 184 (Committee on Budget and Fiscal Review), Chapter 47, Statutes of 2022, implemented continuous eligibility for children younger than age five, but made the bill contingent on appropriation, the availability of funds, and systems readiness.
4. AMENDMENTS. This bill would benefit from technical amendments to clarify that meeting conditions related to assets would satisfy the asset verification, and, similarly, that meeting either condition related to income would satisfy the income verification. Essentially, amendments will split those two issues apart and address them separately, consistent with the author’s intent, without making substantive changes.

REGISTERED SUPPORT / OPPOSITION:

Support

Western Center on Law & Poverty (co-sponsor)

Health Access California (co-sponsor)
Justice in Aging (co-sponsor)
National Health Law Program (co-sponsor)

Access Reproductive Justice
Alliance for Children's Rights
American Federation of State, County and Municipal Employees, AFL-CIO
Association of Regional Center Agencies
Bay Area Legal Aid
California Academy of Family Physicians
California Alliance for Retired Americans
California Immigrant Policy Center
California LGBTQ Health and Human Services Network
California Pan - Ethnic Health Network
Cardea Health
Children Now
Choice in Aging
Coalition of California Welfare Rights Organizations
Coalition of Orange County Community Health Centers
Community Clinic Association of Los Angeles County (CCALAC)
Community Legal Aid SoCal
Community Legal Services in East Palo Alto
Courage California
CPCA Advocates, Subsidiary of the California Primary Care Association
Disability Rights California
East Bay Community Law Center
Family Voices of California
Gender Affirming Professionals
Grace Institute - End Child Poverty in CA
Indivisible CA: StateStrong
Jewish Family Service of Los Angeles
LA Best Babies Network
Latino Coalition for a Healthy California
Maternal and Child Health Access
Multi-faith Action Coalition
Planned Parenthood Affiliates of California
San Francisco Aids Foundation
San Francisco Senior and Disability Action
Serving Seniors
Sharp Healthcare
South Asian Network
United Domestic Workers/AFSCME Local 3930
Vision Y Compromiso

Opposition

None on file

Analysis Prepared by: Lisa Murawski / HEALTH / (916) 319-2097