Medi-Cal changes are coming. Will our SLO County neighbors be ready

Author: Dawn Ortiz-Legg
Date: 11/4/2026 4:05 PM

Approximately 61,000 of our county's 282,000 residents are enrolled in Medi-Cal. Local estimates indicate that about 21,000 residents may be subject to new work and community-engagement requirements, while approximately 6,000 may be affected by a transition from managed-care coverage to Medi-Cal fee-for-service.

Recently, I visited my 94-year-old next-door neighbor and spoke with her caregiver, Maria. Maria had recently undergone the amputation of two toes because of a diabetes-related infection.

She was receiving medical care, and when I asked whether she was enrolled in Medi-Cal, she said yes. When I asked whether she knew about the upcoming changes to the program, she said she did not.

That conversation has stayed with me.

Maria is not just a Medi-Cal statistic. She is a caregiver, a working member of our community, and someone who deserves access to the health care she needs. Yet, like many people who depend on Medi-Cal, she may not know what is changing, what those changes could mean for her, or what she needs to do to keep her coverage.

What happens when the people most affected by a policy change don't even know it's coming?

Maria's story could be the story of a neighbor, a parent, a person with a disability, a maintenance worker, or someone quietly holding a family together.

These are people we see every day. They may be our friends, our coworkers, the people who care for our loved ones, or the people who keep our community running. Many depend on Medi-Cal to access the care that allows them to live and work with dignity.

And the numbers here in San Luis Obispo County are significant. Approximately 61,000 of our county's 282,000 residents are enrolled in Medi-Cal. Local estimates indicate that about 21,000 residents may be subject to new work and community-engagement requirements, while approximately 6,000 may be affected by a transition from managed-care coverage to Medi-Cal fee-for-service.

CenCal Health and local partners estimate that as many as 15,000 San Luis Obispo County residents could be at risk of losing coverage without help navigating the revised renewal process.

These are not abstract numbers. They represent thousands of people whose access to medical care may depend on whether they understand a notice, meet a deadline, complete a form, or get help when they need it.
Beginning Jan. 1, 2027, most adults ages 19 through 64 in the Medi-Cal expansion population will need to document at least 80 hours per month of work, school, job training, or community service, or qualify for an exemption.

Medi-Cal expansion members will also face a change in the renewal process, moving from annual renewals to renewals every six months. Children, pregnant women, seniors, and people with disabilities will remain on annual renewal schedules. In addition, changes to immigration-related eligibility rules may affect some adults' eligibility shifting them to fee-for-service

For people already managing health challenges, work responsibilities, caregiving duties, or financial hardship, these additional requirements may be difficult to navigate.

And here is the concern we cannot ignore: People may lose their health coverage not because they no longer need care, but because they miss a deadline, misunderstand a notice, cannot obtain the required documentation, or don't realize the rules have changed.

The consequences can reach far beyond an individual enrollment record.

Someone who loses coverage may postpone a doctor's appointment, skip medication, delay treatment for a chronic condition, or wait until a health problem becomes an emergency.

Families can face greater stress and uncertainty. Health care providers may face additional administrative burdens and challenges helping patients maintain continuity of care. And our entire community can feel the effects when preventable health problems go untreated.

We cannot prevent every challenge these changes may bring. But we can help prevent people from falling through the cracks simply because they didn't know what to do.

That is why San Luis Obispo County, CenCal Health, and community partners are working together to reach residents before these changes take effect and make the process easier to understand and navigate. We have launched CentralCoastCoverage.org, a local Medi-Cal member navigation hub designed to connect individuals and families with information, personalized one-on-one assistance, and resources to help them understand the changes and take the necessary steps to maintain coverage.

Through coordinated outreach and targeted support, our goal is to identify people at risk, respond quickly when barriers arise, and help prevent avoidable losses of coverage.

We are also planning an informational webinar on Nov. 17 in the evening, offered in English and Spanish, to explain the upcoming requirements, answer questions, and connect residents with available resources. Registration information will be available at CentralCoastCoverage.com, and a recording will be posted on the website for those who cannot attend.

But a website and a webinar, on their own, are not enough. We need people to share information, ask questions, check in with loved ones, and help connect those who need assistance with the resources available to them.

So I ask you to think about the people in your own life. Do you know someone who receives Medi-Cal? A caregiver? A family member? A neighbor? Someone who may be so busy managing work, family or health condition that they have not heard about the changes coming in 2027?

Please take a moment to tell them.

Maria's story is a reminder that behind every enrollment number is a human being. People should not have to navigate complicated changes to their health coverage alone, especially when the consequences of missing a step can be so serious.

The time to act is before someone loses coverage, not after.

By working together, we can help our neighbors understand what's changing, find the support they need, and protect their ability to access care.

We owe that effort to the people who depend on Medi-Cal, to the health care professionals who care for them, and to the health and well-being of our entire San Luis Obispo County community.

Photo by National Cancer Institute on Unsplash