Bill
SB 1422
SB 1422 would cap full Medi-Cal for most 19+ non-citizens to pregnancy/emergency care after 2026, with a $30 monthly premium starting 2027 and reduced dental benefits.
Jurisdiction: California
Purpose
- SB 1422 aims to revise eligibility rules for Medi-Cal based on immigration status, with the objective of expanding or restructuring access to Medi-Cal benefits for individuals who do not have satisfactory immigration status, while introducing premiums and certain benefit limitations over time.
Key Provisions and Changes
1) Eligibility for full Medi-Cal benefits by age and status (amendment to Welfare and Institutions Code § 14007.8)
- The bill rewrites eligibility rules so that:
- For individuals 25 years of age or younger who lack satisfactory immigration status (or cannot establish it), they would be eligible for the full scope of Medi-Cal benefits, subject to defined service limitations (the same general coverage framework as other Medi-Cal enrollees but with status-related constraints).
- It creates a phased timeline for older adults to qualify for full Medi-Cal despite immigration status, contingent on system implementation milestones:
- 50 years and older: eligible for full Medi-Cal benefits (subject to limitations) no sooner than the system is programmed for implementation (with systems-programming notice to the Department of Finance; no earlier than May 1, 2022 in the bill text’s historical notes, but the bill formalizes this in the current proposal).
- 26 to 49 years: eligible for full Medi-Cal benefits no sooner than January 1, 2024, again contingent on implementation progress.
- These provisions are subject to the same service limitations as other Medi-Cal benefits (subdivisions (b), (c), (k), (i)) and exclude nonminor dependents and certain individuals who would otherwise be eligible under different sections.
2) Post-2026 eligibility and benefits for 19+ individuals without satisfactory immigration status
- Beginning no sooner than January 1, 2026:
- An individual 19+ without satisfactory immigration status who is otherwise eligible would be limited to:
- Medically necessary pregnancy-related services, emergency services, and care directly related to emergencies (as defined by federal law).
- If a previously full-scope Medi-Cal recipient loses full-scope Medi-Cal eligibility after Jan 1, 2026, they may reenroll to full-scope Medi-Cal within 3 months of disenrollment (with the condition of paying any outstanding premiums incurred prior to the three-month cure period).
- Nonminor dependents and individuals eligible under other immigration provisions (Section 14005.28) are exempt from these limits and would retain full-scope Medi-Cal until age 26.
3) Pregnancies and pregnant individuals
- If an individual 19+ loses full-scope Medi-Cal after 2026 but is pregnant, they would remain eligible for full Medi-Cal benefits throughout the pregnancy and for 12 months after the pregnancy ends (subject to service limitations).
4) Premiums
- Beginning no sooner than July 1, 2027:
- Most individuals described in the full-scope groups (19+) would be required to pay a monthly premium of $30 as a condition of Medi-Cal eligibility.
- Exemptions from the premium include: individuals under 19, individuals over 59, and pregnant individuals.
- If a member fails to pay the monthly premium for more than 90 days, they would be limited to medically necessary pregnancy-related and emergency services until premiums are paid (restoring full eligibility only after payment).
- Nonminor dependents and those who would be eligible for Medi-Cal under Section 14005.28 remain exempt from the premium requirement and retain full benefits through age 26.
5) Dental Services
- Beginning no sooner than July 1, 2026, individuals 19+ who are eligible for Medi-Cal under the new rules would generally lose most dental services, except for emergency dental care; exemptions apply for nonminor dependents and those eligible under 14005.28 (they retain full benefits through age 26).
6) Administrative and implementation provisions
- Department requirements:
- Monthly updates to Legislature on implementation status.
- Enrollment in Medi-Cal managed care plans is required for those eligible for full-scope Medi-Cal, though this does not limit eligibility for other children’s Medi-Cal programs.
- The department may use accelerated contracting processes and may rely on noncompetitive bids for contracts under this section, with some exemptions from standard public contracting rules.
- All-county letters and plan letters may be used for initial implementation prior to regulations.
- Semiannual status reports to the Legislature until regulations are adopted.
- Fiscal and local government implications:
- The bill would constitute a state-mandated local program because counties administer Medi-Cal eligibility determinations.
- Reimbursement requirements would be governed by existing state mandates framework if the California Commission on State Mandates determines costs are mandated by the state.
7) Compliance and federal alignment
- The bill requires compliance with federal law, including 1621(d) of Title 8 U.S.C., and coordinates with federal Medicaid participation where available.
Effective Dates and Timeline
- Core eligibility revisions reference dates starting January 1, 2026 (for new restrictions) and July 1, 2027 (premium imposition), with earlier phased eligibility changes for younger age groups linked to implementation milestones.
- Ongoing reporting and regulatory development are mandated.
Impact Overview
Note
- The bill’s text includes several phased, implementation-dependent provisions and exemptions. The exact effect will depend on federal approvals, departmental regulations, and legislative actions on mandated reimbursements and funding.
Compiled from official sources — confirm details with the bill’s official record.
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