Beginning January 1, 2027, certain adults receiving Medi-Cal will need to demonstrate participation in qualifying activities, generally totaling 80 hours per month, to obtain or maintain coverage.

Qualifying activities include employment, education, job training, and community service. Certain combinations of activities can satisfy the requirement.

Who may be affected: Adults ages 19–64 covered under the applicable Medi-Cal eligibility categories.

Who may be exempt: Individuals age 65 and older, qualifying parents and caregivers, pregnant individuals, people with disabilities, individuals with serious health conditions, and certain Medicare beneficiaries.

Impact on San Mateo County: Some low-income residents who currently receive Medi-Cal may need to submit additional information documenting their eligibility or qualifying activities. Residents who do not complete required documentation could experience interruptions in coverage.

Note: not every Medi-Cal member is subject to these requirements and that exemptions are available.

Beginning January 1, 2027, certain Medi-Cal members, including undocumented residents and some lawful permanent residents, will transition from managed care plans to Fee-for-Service Medi-Cal.

For San Mateo County, this is especially important because affected residents currently enrolled with the Health Plan of San Mateo (HPSM) may need to change how they access their medical providers.

Under Fee-for-Service:

• Members can receive services from providers accepting Medi-Cal Fee-for-Service.
• Their current physician or dentist may not participate in the new arrangement.
• Members will generally use their Medi-Cal Benefits Identification Card rather than their former health plan card.
• The transition itself does not mean automatic loss of Medi-Cal eligibility.

Contact your healthcare providers before December 31, 2026, to confirm whether they accept Fee-for-Service Medi-Cal.

Currently, eligible applicants can generally receive up to three months of retroactive Medi-Cal coverage.

Starting January 1, 2027:

• Certain adults ages 19–64 will qualify for only one month of retroactive coverage.
• Other eligible members will generally qualify for up to two months.

This means residents who delay applying for Medi-Cal may have fewer past medical expenses covered.

DHCS identifies March 1, 2027, as the effective date for six-month eligibility checks for certain adults, although San Mateo County's public guidance currently groups this change with January 2027 updates.

Instead of renewing once annually, some residents will need to verify their eligibility every six months.

The distinction between the state implementation date and the county's communication timeline should be confirmed before PHCD publishes its newsletter.

Please update your contact information, open all Medi-Cal notices, and respond to renewal requests by the stated deadlines.

• 2026 Out of Pocket Cap: $2100
• 2027 Out of Pocket Cap: $2400

The annual out-of-pocket limit for covered Medicare Part D prescription drugs will increase by $300 in 2027. The maximum Part D deductible will also increase from $615 to $700, although individual plans may have lower deductibles. 

Medicare Advantage plan availability, premiums, provider networks, and benefits may change for 2027.

CMS reports that California will have 394 Medicare Advantage plans in 2027, compared with 402 in 2026. The statewide average monthly plan premium is projected to increase slightly, from $13.77 to $14.12. These are statewide figures, not San Mateo County-specific rates.

Centers for Medicare & Medicaid Services

Residents should review their coverage during Medicare Open Enrollment, October 15–December 7, 2026, with changes generally taking effect January 1, 2027.

Some residents enrolled in both programs, commonly called dual-eligible beneficiaries, may experience additional changes.

Certain individuals affected by the Medi-Cal Fee-for-Service transition will also leave their integrated Medi-Medi plan and need to review how they receive Medicare benefits.

This is especially important for older adults who depend on coordinated medical care, prescription coverage, and supportive services.

January 1, 2027: Certain HPSM Dental members will transition to Medi-Cal Dental Fee-for-Service. Their full dental benefits can continue, but they may need to find a participating dentist.

July 1, 2027: Certain adult immigrants will lose full-scope dental benefits and retain emergency dental coverage only. Some affected adults ages 19–59 will also face a $30 monthly Medi-Cal premium. Exceptions to dental restrictions include children, pregnant individuals, and qualifying former foster youth.

The state's guidance also identifies the end of San Mateo County's Dental Managed Care pilot on December 31, 2026. PHCD should confirm the full scope of the transition with HPSM, since this could affect dental provider access beyond the immigration-related changes.

San Mateo County has identified approximately 59,000 Medi-Cal beneficiaries who could be affected by new eligibility and renewal requirements. The county has also identified potential increases in uninsured residents and pressure on healthcare safety-net providers.

County of San Mateo, CA+1

For PHCD's service area, the potential implications include:

• Community clinics and healthcare providers: Greater demand for enrollment assistance, eligibility navigation, and support maintaining care.
• Older adults: Increased need for Medicare plan counseling, particularly among dual-eligible beneficiaries.
• Immigrant families: Potential disruption to established medical and dental provider relationships.
• Behavioral health: Possible interruptions in care if residents lose coverage or need to change providers.
• Dental providers: Increased demand for appointments before July 2027 and assistance finding Fee-for-Service dentists.Approximately 59,000