Contra Costa County health officials are urging eligible undocumented residents without health insurance to sign up for Medi-Cal by Dec. 31.
This is because starting Jan. 1 the state, in a cost-cutting move, will no longer accept new enrollees to the full-scope plan, which includes everything from check-ups to prescriptions and surgery. There are exceptions for pregnant women and children.
Current Medi-Cal participants, including those without residency documents, can remain on the health plan, said Marla Stuart, Contra Costa County’s director of Employment and Human Services (EHSD).
“The state isn’t pausing the coverage, the state is freezing enrollment,” Stuart said.
The halt applies to adults age 19 and up. Those under age 19 and pregnant women are still eligible for coverage, even if they are undocumented. Pregnant women get coverage for one year after delivery.
Dental care under Medi-Cal is also ending for many undocumented adults on July 1, 2026, even those currently enrolled. Emergency dental care will be covered.
Emergency health care will also still be covered for all undocumented residents, Stuart said. To receive emergency coverage, people still need to enroll in Medi-Cal. This can be done in advance, but in many cases enrollment happens at the emergency room at the time of treatment.
“And that’s still important. Because we want everyone to have coverage for emergency care,” she said.
But, as for anyone on Medi-Cal, undocumented recipients need to make sure they complete the required annual renewal process to keep coverage. Plan members could lose coverage if they don’t renew and their residency status is subject to the state enrollment freeze.
Renewals are on a rolling basis, depending on when one first got coverage. Letters are sent to let recipients know it’s time to re-enroll. This is why it’s critical to let Medi-Cal know of any address changes.
Get help enrolling in Medi-Cal
For help enrolling in Medi-Cal, call the Contra Costa County Employment and Human Services office, 866-663-3225 or visit Medi-Cal’s online enrollment site, BenefitsCal.com.
With the Medi-Cal freeze deadline looming, the county hopes to quickly spread the word to as many as possible eligible uninsured undocumented immigrants. But the impacts of changes to Medi-Cal, the state name for the federal Medicaid program, are large and complex, with a pipeline of additional federal and state measures lined up to cut costs.
County’s chief health officer emphasizes value of preventative care
In the county’s push to get residents on Medi-Cal while they still can, Ori Tzvieli, the county’s head health officer and a physician, emphasized the health and cost benefits of regular health care.
People who don’t have access to routine care often end up seeking help at advanced stages of illness or disease, when treatments may be less effective, and more expensive, Tzvieli said. And treatable conditions may go undiagnosed.
“An ounce of prevention can be much better for the patient and also cheaper,” he said to Richmondside.
He gave the example of someone with hypertension or high blood pressure who doesn’t see a doctor until they have a stroke, and need nursing care or rehabilitation. “It’s much cheaper and effective to treat someone’s hypertension,” Tzvieli said.
As for concerns that potential applicants won’t enroll in Medi-Cal for fear of tipping off U.S. Immigration and Customs officials (ICE), Contra Costa’s health department follows a policy of not sharing patient information with federal agencies without a warrant or court order.
However, the county is required to share some Medi-Cal information with the state, and the state in turn is required to share information with the federal Centers for Medicare and Medicaid Services (CMS).
Late last summer a court blocked federal health agencies from sharing Medicaid data with immigration deportation officials, which was occurring at least to some degree in some jurisdictions, including California, after a legal challenge by numerous states. California was one. The federal government said last month it could still legally share some Medicaid information with ICE, a move under court review.
Contra Costa County supervisors consider impacts of Medi-Cal changes on thousands of residents
In an emotionally-charged discussion where many people spoke, the Contra Costa County Board of Supervisors on Tuesday heard a presentation from county health and employment and human services officials on potential impacts of the double whammy of the federal H.R 1, also known as the Big Beautiful Bill, and the state changes, as it takes measures to deal with budget shortfalls. This includes the end of the year undocumented Medi-Cal freeze.
The board didn’t take action or make decisions as it was an informational session. The issue is expected to be revisited in January. The message was sobering, though officials stressed the situation is marked by unknowns.
According to county projections, as many as 93,000 people in Contra Costa County could be subject to new Medi-Cal rules making them vulnerable to losing coverage. This is the high-end estimate. Officials also said that in a worst-case scenario, the county could lose as much as $307 million in federal and state health funding over the next few years from Medi-Cal cuts and changes.
“We believe everyone should be able to have access to health care without fear.”
— Ori Tzvieli, Contra Costa County’s chief health officer
Photo courtesy Contra Costa County
The county losses would result from fewer Medi-Cal enrollees, due to people not re-enrolling or not being eligible for the coverage (the federal government reimburses providers for most of this care), and from as cuts to Federally Qualified Health Centers, or the county’s safety net of those who provide last-resort health coverage. Most county health systems are federally qualified centers, including Contra Costa County’s.
In addition to the state’s undocumented adult Medi-Cal new enrollment freeze, other changes coming to Medi-Cal include requiring recipients to pay premiums ($30 for Californians starting July 1, 2027), and, under the federal Big Beautiful Bill, a requirement to work, co-pays for some services, twice-yearly renewal requirements (now yearly), and a tightening of immigrant eligibility, among others.
A few things make it challenging to predict the effects of Medi-Cal changes at this point. Many of the details of new Big Beautiful Bill regulations haven’t been released. And the outcome of pending or potential lawsuits and court actions are uncertain. It’s also unclear, what, if any, future steps the state might take to step in to help. California has a history of doing this, but the state budget isn’t locked in.
Adding to this is the impossibility of knowing who can or can’t meet Medi-Cal work or co-pay requirements, or deal with the expected increases in required paperwork.
But many healthcare policy experts say the changes could be dire, leaving significantly more people uninsured. Public health systems will face higher demands for care and less money to provide it, they say.
The changes will also impact community clinics including LifeLong Medical Care, which runs the bustling William Jenkins Health Center on Harbour Way. According to 2024 data, 70% of LifeLong’s patients systemwide are on Medi-Cal, including under an agreement with Contra Costa Health. Kaiser Permanente also sees Medi-Cal patients under the county’s health system.
Tuesday, the board was presented with ideas on ways the county can prepare for Medi-Cal losses, and keep more people covered. This included bolstering EHSD’s already rigorous Medi-Cal enrollment counseling and outreach, much of which is done in partnership with community organizations.
It was also suggested the county expanding its Basic Health Care, a program adopted last year to provide healthcare at county facilities with county dollars for low-income or disabled residents of any immigration status who aren’t eligible for Medi-Cal or Covered California, the state’s Affordable Care Plan marketplace. People who are undocumented aren’t eligible for Covered California.
Numerous speakers addressed the board, many making passionate pleas for the county to do all it can to make sure immigrants of any legal status can get healthcare, as a basic human right. People talked of the fear many immigrants live in today, with federal ICE raids and deportations, including in seeking healthcare. They called on the county to strengthen supports for vulnerable immigrants in the wave of healthcare challenges.
“We believe everyone should be able to have access to health care without fear,” health officer Tzvieli said.
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