April 7, 2026
Authored by the Health team
Cover image via iStock by geber86
April is Medicaid Awareness Month, and this year it arrives in the middle of a crisis. Since the ‘One Big Beautiful Bill Act’ (H.R.1) was signed into law last July, California families have been losing access to Medi-Cal and the critical care it provides to help kids grow, learn, and thrive. Here’s where things stand and what California must do to protect Medi-Cal.
What happened in Congress and what does it mean for California families?
Last July, President Trump signed H.R.1 into law, cutting nearly $1 trillion from Medicaid programs across the country (called Medi-Cal in California). The consequences have been swift and damaging. Since then, ongoing disagreements over health care spending have led to a government shutdown, sensationalistic and politically-motivated allegations of Medicaid fraud targeting California and other states, and the Trump administration releasing a vague “Great Healthcare Plan” that does not strengthen the health care safety net and is unlikely to be taken up by Republican leaders in Congress who have repeatedly tried and failed to replace the now 16-year-old Affordable Care Act.
Meanwhile, California families are already paying the price.
How have the Medicaid/Medi-Cal cuts impacted California families since H.R.1 was signed last July?
Supporters of H.R.1 claimed that kids wouldn’t be hurt by its cuts, but that’s simply not true.
As families worry about health care costs, the massive funding cuts in H.R.1 are forcing impossible decisions for the state’s budget. In fact, the H.R.1 cuts are estimated to cost California “tens of billions” of dollars in federal Medicaid matching funds every year. Over 5.4 million children in California rely on Medi-Cal for Kids & Teens for check-ups, vaccinations, health screenings, and physical, mental, and dental health care. These federal policy changes and funding reductions inevitably reduce access to that care, especially in rural and underserved communities where providers are already hard to find.
Furthermore, although most of the cuts from H.R.1 are targeted at adults, children don’t experience health care in isolation from their parents. When parents don’t have access to health care, either because they are no longer eligible or can no longer afford it, their kids are more likely to go without care, too. New requirements to show proof of the number of hours worked or in school will push many young adults off Medi-Cal due to the increased administrative burden to submit paperwork. Losing coverage then makes it harder to stay healthy enough to work or stay in school — the very things the law demands of them.
How have the Medicaid/Medi-Cal cuts impacted immigrant families?
The harm to immigrant communities has been both immediate and profound.
H.R.1 rolled back federal Medicaid coverage for many lawfully present immigrants, including refugees and people fleeing domestic violence. About 200,000 refugees, asylees, humanitarian parolees, trafficking survivors, and other immigrants previously eligible under humanitarian protections will be affected. But the damage extends well beyond those who lose eligibility on paper. Across California, families who still qualify for Medi-Cal are afraid to enroll, re-enroll, or seek the care they need, scared that any contact with a government system could put them or their loved ones at risk. Medi-Cal caseloads of children and families have already started declining as Californians fear for their safety and privacy. That means kids are missing check-ups they can’t afford to skip and not getting vaccines that should be routine, all of which can cause preventable conditions to become serious ones.
What are H.R.1’s harshest impacts that are still yet to come?
There are still many upcoming ways the law will negatively affect California kids and families. Starting in January 2027, Medi-Cal eligibility checks will occur twice a year instead of once, which could cause 400,000 adults to lose coverage simply due to the paperwork burden of staying enrolled. Similarly, when H.R.1 work reporting requirements kick in next year, about 1.4 million adults could lose Medi-Cal due to this administrative load. Ultimately, it’s projected that nearly 3 million fewer Californians will be enrolled in Medi-Cal by 2028 because of the combined federal and state policy changes to Medicaid. Those coverage losses are expected to be the greatest in Los Angeles (1.1 million people), Orange (249,000) and San Diego (210,000) Counties.
What can California’s leaders do to help get families more access to Medi-Cal?
California’s lawmakers are really the last line of defense in protecting Medi-Cal and their choices on how they implement the federal changes could mean the difference for up to 1.3 million people losing coverage or keeping it.
Fortunately, state lawmakers announced a package of four bills aimed at mitigating the impact of H.R.1 and lessening the harm to Medi-Cal enrollees and applicants. These bills, and funding for the Medi-Cal program broadly, will be debated over the next few months through the budget and legislative process. We are counting on our state leaders to pass these four critical bills and keep California from going backwards on Medi-Cal coverage for children and youth.
What is Children Now doing to protect Medi-Cal coverage for children and families?
Building power for kids is what Children Now does. Today, that mission has never mattered more.
We are mobilizing and building collective power alongside organizations and families across the state through the Fight For Our Health Coalition and beyond to push back against cuts that threaten millions of California children. As legislative committees hold hearings on H.R.1’s implementation, Children Now is showing up to testify and remind lawmakers why Medi-Cal for kids matters and that children are not safe from these cuts, despite what supporters of the law have claimed. As the Department of Health Care Services navigates implementation, Children Now will serve as a trusted thought partner to ensure that every decision made along the way does the least possible harm to kids. We will also use our position on the Medi-Cal Voices & Visions Council to ensure the future of Medi-Cal is designed for and responsive to the kids and families who depend on it.
Over the coming months, as critical budget and policy decisions are made in Sacramento, Children Now will be at every table that matters, advocating for every child who relies on Medi-Cal.
