On a weekday morning in Watsonville, sunlight filters across the lobby of La Manzana Community Resources, where families gather in the steady rhythm of a community center that has become a lifeline. Parents rock toddlers on their hips. Elders wait with renewal packets folded sharply in their hands. Conversations drift between Spanish, English, and Mixteco as advocates help residents navigate the network of public services that keep many local households afloat.
People come to La Manzana or “Manzanita” seeking stability—guidance with housing, support during crisis, a trusted place to make sense of paperwork and policies. But in recent months, a different question has been rising to the surface:
“What’s going to happen to my Medi-Cal?”
For years, Medi-Cal has been the foundation low-income families relied on to stay healthy and financially secure. It meant children had access to pediatric care, adults could manage chronic conditions, and unexpected illness wouldn’t push a household into disaster.
That foundation is about to shift.
Beginning in 2026, sweeping state and federal changes will alter who can enroll in Medi-Cal, what services are covered, and what families must do to remain insured. As news of these changes reaches kitchen tables, agricultural fields, breakrooms, and waiting rooms like this one, a broader truth is becoming clear:
When Medi-Cal changes, the entire health-care landscape of Santa Cruz County changes with it.
What’s Changing: State Policy and H.R. 1
Starting January 1, 2026, most undocumented adults ages 19 and older who only recently began to qualify will no longer be able to newly enroll in full-scope Medi-Cal. Those already enrolled can keep their coverage, but only if they renew on time each year and will be subject to a copayment in the coming years.
Beginning the same day, Medi-Cal will also reinstate an asset test for older adults, people with disabilities, and individuals who qualify through long-term care. This means Medi-Cal will once again review what members and applicants own—including bank accounts, cash, and certain property—when determining eligibility. The new limit is $130,000 for one person, with $65,000 added for each additional household member, up to ten people. Some assets remain exempt, such as the home someone lives in, one vehicle, household items, and certain retirement accounts.
While income rules are not changing, these assets will be checked at each annual renewal, creating new barriers for many low-income seniors and adults with disabilities who previously qualified without this requirement.
On July 1, 2026, adults without satisfactory immigration status will lose full dental benefits, retaining only emergency dental care—treatment for pain, infections, or extractions. Pregnant people will continue to receive full dental benefits during pregnancy and for one year after giving birth.
Then, beginning July 1, 2027, some adults ages 19–59 will be required to pay $30 per month to maintain full-scope Medi-Cal coverage. Those who cannot pay will move to emergency and pregnancy-related services only.
At the federal level, H.R. 1, also known as the One Big Beautiful Bill Act (OBBBA), introduces work requirements for many Medi-Cal (known as Medicaid at the federal level) expansion enrollees starting in 2027. Adults ages 19 to 64 will need to document 80 hours per month of work, education, training, or community service unless they qualify for specific exemptions. These verification rules increase the risk that eligible people—especially those with variable schedules or limited digital access—could lose coverage simply because paperwork wasn’t submitted correctly or on time.
Children under 19 and pregnant people remain eligible for full-scope Medi-Cal regardless of immigration status. Still, the coming changes represent one of the most significant shifts in California’s safety-net health system in years.
When One Thread Unravels, the Whole System Feels It
Santa Cruz County is home to more than 80,000 Medi-Cal enrollees, and thousands of undocumented adults could be affected by the upcoming restrictions. But the impact will be far broader than the number of people whose benefits change or disappear. They will impact wait times, increase lose of providers and increase the cost of medical insurance.
Strain on Clinics and Specialists
A large portion of local health-care reimbursement comes from Medi-Cal. When fewer adults have full coverage—or when reimbursements shrink—clinics and hospitals immediately feel the loss. Recruiting essential specialists becomes harder. A single retirement or relocation in a field like cardiology, orthopedics, or neurology can leave whole communities without local access.
The result:
- longer wait times,
- reduced service availability,
- families forced to travel farther for care,
- and increased pressure on already stretched providers.
Rising Health-Care Costs for Everyone
Reduced Medi-Cal reimbursement means health systems must find revenue elsewhere. Typically, that comes from raising rates on private insurance plans. Insurers then pass those costs to workers and employers through higher premiums, deductibles, and co-pays.
Even households that never use Medi-Cal will feel the impact in their wallets.
Emergency Rooms Under Increasing Pressure
When people lose comprehensive Medi-Cal coverage, they don’t stop getting sick—they lose access to preventive care. Chronic illnesses worsen. Untreated dental issues become infections. A manageable condition becomes an emergency.
This pushes more people into already overcrowded emergency rooms and strains ambulance services. Watsonville Community Hospital and Dominican Hospital already operate among the busiest ERs in the state. Additional pressure will affect everyone who seeks emergency care, regardless of insurance status.
Human Consequences Behind the Numbers
The abstract becomes real in moments like these:
- A father stopping his blood-pressure medication because he’s unsure whether insurance will cover it.
- A mother delaying care for a tooth infection until the pain becomes unbearable.
- A young adult missing work—and wages—because untreated illness catches up with them.
A national study found that people who gained Medi-Cal under the state’s expansion were 21% less likely to die each year than those without access. Losing coverage doesn’t just raise costs. It increases preventable suffering—and preventable loss of life.
What We Can Do Now: A Countywide Effort
The Santa Cruz County Immigration Coalition—guided by Community Bridges, the Community Action Board of Santa Cruz County (CAB), and dozens of other local partners and advocates—is mobilizing partners across the county to protect families from losing critical care. Through collaborative outreach, bilingual materials, and provider training, the coalition is working to lessen the impact of the 2026–2027 changes.
Here’s what service providers, educators, and community advocates can do right now:
- Help Families Enroll or Renew Before December 31, 2025
This is the most urgent step for undocumented adults. Enrolling or renewing before the deadline preserves full-scope Medi-Cal in 2026. Ask about Medi-Cal status at every visit, provide enrollment help, and promote the deadline widely.
- Strengthen Renewal Habits
Most Medi-Cal losses happen because renewal packets are missed or mailed to old addresses. Encourage families to check their mail, update contact information, and return forms promptly. Remind them they have 90 days to fix an accidental lapse.
- Encourage Dental Visits Before July 2026
Comprehensive dental coverage ends for many adults on July 1, 2026. Urge families to get preventive care now to avoid emergencies later.
- Prepare for the 2027 Work Requirements
Work-reporting rules will increase paperwork barriers. Train staff on what counts toward the 80-hour requirement, who is exempt, and how to help clients document compliance.
- Use Coalition Materials Everywhere
Share multilingual flyers and toolkits across clinics, schools, food distributions, and community events. Consistent, trusted messaging prevents misinformation and confusion. Click here to view and download the Coalition’s print materials: communitybridges.org/wp-content/uploads/2025/11/Medi-Cal-Outreach-SCCICPVC-1.pdf
- Share What You’re Seeing
Report emerging trends, challenges, and stories. This helps the Coalition target resources, advocate effectively, and respond to community needs in real time.
A Call to Action: We Need All of Us
The health of Santa Cruz County is a shared ecosystem. When families lose care, the strain spreads—to schools, emergency rooms, providers, and workplaces. The Medi-Cal changes coming soon affect far more than those directly impacted; they reshape the stability of the entire county.
The Santa Cruz County Immigration Coalition urges every service provider, health worker, educator, and community partner to join this effort. Talk about renewals at every appointment. Host enrollment days. Share outreach materials. Support families through the confusion.
If we act early, clearly, and compassionately, we can prevent thousands of unnecessary coverage losses—and preserve the health and resilience of our community.
Because when we protect care for the most vulnerable, we strengthen care for everyone.
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