Alameda County staff outline how HR 1 and the state budget will narrow Medi‑Cal coverage and add work requirements

Alameda County staff on Monday briefed the Board of Supervisors’ joint Social Services and Health committee on how the state budget and federal changes under HR 1 will affect Medi‑Cal coverage, especially for noncitizen residents and people in the MAGI adult expansion.

The presentation outlined three near‑term changes: an enrollment freeze for adults 19 and older with unsatisfactory immigration status effective Jan. 1, 2026; a July 1, 2026 cut to full‑scope dental benefits for certain adults with unsatisfactory immigration status; and an Oct. 1, 2026 federal redefinition of “qualified noncitizen” (QNC) that would narrow that category to lawful permanent residents, certain Cuban/Haitian entrants and migrants from Compact of Free Association nations.

Why it matters: County staff said those technical changes could translate into thousands of county residents losing full‑scope Medi‑Cal or dental coverage unless outreach and state programming work mitigate the impact. Presenters urged that coordinated outreach, updated county casework systems and state programming changes be tracked closely to prevent avoidable coverage losses.

What the county reported: Juan Bentania, the county presenter on noncitizen eligibility, said late‑February county data show about 49,910 people enrolled in full‑scope Medi‑Cal after prior expansions, a decline of roughly 1,290 from December figures. "The largest reason that we saw for the decrease would be individuals who did not complete their Medi‑Cal renewal," he said, citing a sample in which renewal noncompliance accounted for roughly 70% of discontinuations. Bentania also described inter‑county transfers, MAGI (income) failures and deaths as other causes of change.

On dental: Staff said routine full‑scope dental benefits for people 19 and older with unsatisfactory immigration status will be removed July 1, 2026; the county noted emergency dental coverage will remain and that pregnant people are exempt through pregnancy and 12 months postpartum.

On QNC redefinition: County staff said the federal change would limit QNC status to narrower immigration categories and, absent state budget funding to preserve full scope coverage, persons removed from the QNC category could be shifted to restricted scope Medi‑Cal after Oct. 1. The county estimated about 8,960 people locally would no longer be QNCs under the new definition, down about 1,640 from January estimates.

Work and community engagement: Emilia Sanders and Tammy Lou reviewed the HR 1 work/community engagement rules for the MAGI new adult group and county estimates of affected people. Sanders summarized exemptions and compliance mechanics; Lou said county records show about 158,900 Alameda County residents could be subject to work and community engagement requirements as of Feb. 19, 2026. Of those, staff estimate 15,100 may meet an exemption (a number that could be higher with more screening), 55,900 may meet requirements and roughly 87,900 currently have no documented qualifying activity on county records. Lou also cited a Department of Health Care Services projection of a 3.55% initial statewide caseload reduction (about 14,600 county‑level equivalent) and a 12.24% reduction at full implementation (about 50,300 county‑level equivalent).

County response and outreach: Presenters described outreach plans that include Health Navigators and CBO partners, targeted robocalls or texts to people who failed to renew, and coordination with CalSAW and Covered California to update consumer portals. Staff warned that some implementation depends on state programming (CalSAW) and federal guidance; the county may see temporary continuations of full‑scope coverage if CalSAW needs extra time to change programming.

Board questions and capacity: Supervisors pressed staff on specifics: who is eligible for exemptions, the length of any grace period and county capacity to help people meet requirements. Staff confirmed a three‑month grace period for individuals who were enrolled in full‑scope Medi‑Cal before Jan. 1, 2026, and noted eligibility workers carry high caseloads (roughly 2,000+ per worker) with about 140 vacant full‑time equivalents across eligibility teams.

What’s next: Staff said they will continue to update the committee as federal and state guidance arrives and as CalSAW programming is finalized. The county intends to convene a local work group to plan staffing, training and outreach to affected beneficiaries.

Source: Presentations and Q&A at the Alameda County Board joint Social Services and Health committee meeting, March 9, 2026.