ORANGE, California. Carmen Basu, dressed in a red jacket and wool scarf, stood outside her local health plan's headquarters one morning after shopping for free groceries. She brought her husband, teenage son and 79-year-old mother-in-law to help.
They grabbed canned goods, fruits and vegetables, and a grocery store gift card. And then Basu noticed a row of tables in the parking lot manned by county social service workers helping people apply for food assistance and health insurance. She was told that her mother-in-law, also a Medicaid recipient, may be eligible for food assistance.
“I would have to save less money,” said Basu, who has been the sole breadwinner for an Anaheim family since her husband suffered a stroke. “Maybe I can use this extra money to cover other expenses.”
Basu was among more than 3,000 people who attended CalOptima's November event in one of California's wealthiest counties. It marked the start of the health insurer Medicaid's $20 million campaign to help low-income residents get and keep health insurance and nutrition benefits as federal restrictions under President Donald Trump's One Big Beautiful Bill take effect.
The law reduces more than $900 billion in federal funding for the Medicaid program, known in California as Medi-Cal. It also cuts about $187 billion from the Supplemental Nutrition Assistance Program, or SNAP, known as CalFresh in California. This is about 20% of the program's budget for the next 10 years. As a result, up to 3.4 million Medi-Cal recipients and nearly 400,000 CalFresh beneficiaries could lose benefits. (Most CalFresh recipients also get Medi-Cal.)
Republican officials say the changes, some of which have already taken effect, will prevent waste, fraud and abuse through expanded eligibility checks and work requirements. Still, Medicaid health plans across the country are expanding coverage to low-income households in an effort to avoid losing members, many of whom are already struggling with high grocery and health care costs.
In Los Angeles County, health plan LA Care launched public information sessions this month to inform the public about upcoming changes to Medi-Cal. Hawaii AlohaCare mobilizes covid era coalition to help mitigate the impact of Medicaid coverage losses. And Community Behavioral Health, a Medicaid behavioral health managed care plan in Philadelphia, plans to hold a series of summits starting next year to talk about the changes.
“We know these changes will impact many of our members,” said Michael Hann, CEO of CalOptima, one of about two dozen Medi-Cal managed care plans that pay monthly based on enrollment. “We have a big responsibility to make sure they understand and can navigate these changes as they are implemented.”
CalOptima, a public organization whose board is appointed by county supervisors, has allocated up to $2 million through the end of 2028 to pay county workers eligible for events such as food distribution to provide on-site assistance. It's funding that Anh Tran, head of the Orange County Human Services Agency, said could help pay for critical work that the county might not otherwise be able to afford.
Orange County has approximately 1,500 eligibility workers who reenroll and verify approximately 850,000 Medi-Cal members and more than 300,000 CalFresh recipients.
“We're talking about families that desperately need help, especially at a time when food prices and inflation are high, and they can barely afford it,” Tran said.
In addition to funding county workers, CalOptima intends to provide grants to community organizations to conduct Medi-Cal outreach and conduct a public information campaign in multiple languages to ensure members are aware of the new requirements, Hann said.
U.S. Rep. Young Kim, a Republican who represents part of Orange County, did not respond to a request for comment but said Trump's signature budget bill, which she voted for, “takes important steps to ensure federal dollars are used most effectively and strengthen Medicaid and SNAP for our most vulnerable citizens who truly need them.” She and other Republicans said it would provide tax breaks for working Americans.
After speaking with an eligibility worker for nearly an hour, Basu learned that she earned too much for her mother-in-law, who lives with the family, to qualify for CalFresh benefits. Now, Basu said she's concerned about changes to Medi-Cal eligibility for immigrants that she fears could impact her mother-in-law, who became a legal resident about a year and a half ago.
“Before this, we paid cash for cardiology, labs and everything else. It was very expensive,” Basu said. “I think in a few months I'll have to pay out of pocket again. It's a lot of pressure on me. It's a burden.”
In most countries, people who have had a green card for less than five years are usually I don't meet the requirements for federally funded Medicaid. However, California has provided publicly funded Medi-Cal insurance for them and low-income immigrants without legal status.
But even these benefits are being canceled due to pressure on the state budget. In July, the state will eliminate full dental benefits for some members who have had a green card for less than five years, as well as for some other immigrants. In a year, this group will begin to be charged monthly premiums.
And starting in January, California will freeze admissions of people 19 and older without legal status, as well as some legal immigrants. The asset limit will also be restored for all older participants.
Meanwhile, the state is developing guidance for counties on how to implement federal changes to Medicaid eligibility, said Tony Cava, a spokesman for the California Department of Public Health. Federal biannual employment rules and eligibility tests are scheduled to take effect by early 2027 and apply to enrollees covered by the Affordable Care Act.
The California Department of Human Services, which administers the CalFresh program, has already changed how utility costs are calculated and capped benefits for very large families. It is still developing guidance on federal work requirements and changes that would disqualify some noncitizens, the agency's chief deputy director, David Swanson Hollinger, said at a recent hearing.
The Department of Health has developed “What Medi-Cal members need to know” web page about state and federal Medicaid changes. It also uses the Medi-Cal network “lighting ambassadors“to provide information and updates to communities across the state in multiple languages. And it partners with counties and Medi-Cal managed care plans to support community-based enrollment assistance, including at local events,” Cava said.
Aquilino and Fidelia Salazar, a husband and wife who are getting help with their CalFresh application, said they don't expect to be affected by work requirements and changes to Medi-Cal eligibility. That's because they are both permanent U.S. residents, have chronic health conditions and are unable to work, they said. People who are considered physically or mentally unable to work may be exempt from work requirements. But the couple is concerned that other immigrants in their community may lose care.
“It’s unfair because a lot of people really need it,” Fidelia Salazar said in Spanish. “People earn so little, and medications and going to the doctor are extremely expensive.”
