(Editor’s note: This story was originally published by Fresnoland, a nonprofit news organization.)
For Lorenza Cortez and her husband, Eleuterio Mexicano, Medi-Cal is nothing short of a lifeline.
Cortez, 67, lost her vision to diabetes while her 72-year-old husband faces several high-risk chronic health challenges, including a thyroid condition. The couple, longtime Fresno residents who immigrated from Mexico years ago, rely solely on occasional help from their son, who is raising a family of his own.
Recently, they received letters from Medi-Cal stating there were no immediate changes to their coverage, despite hearing news reports about major changes coming early next year. In an interview with Fresnoland, the couple described feeling left in the dark, uncertain about the future of their only health insurance and afraid they might lose it altogether.
Cortez said that stress and anxiety is compounded by the fact that neither of them can work—a significant qualification change brought on by President Donald Trump’s “One Big Beautiful Bill” and expected to take effect in 2027.
Without insurance, she asked, how would they afford their medicine?
“We’re anxious about all of this because you don’t know what to do about these changes,” Cortez said. “If they take our insurance, we don’t know what we would do. The stress and anxiety can make you sicker.”
In Fresno County, about 52% of residents—more than half a million people—rely on Medi-Cal, the state’s Medicaid program. According to a Fresnoland review of state health data, Fresno has the third-highest Medi-Cal enrollment rate out of all 58 California counties.
California and the federal government have approved major healthcare cuts that could reverse more than a decade of expanded coverage, hitting low-income, immigrant and rural communities hardest.
State budget changes reinstate Medi-Cal asset limits for seniors and people with disabilities, impose a $30 monthly premium for people who do not have “satisfactory immigration status” starting in 2027, freeze enrollment for certain undocumented immigrants in 2026 and end full dental benefits that same year.
Federally, $1 trillion in Medicaid cuts over 10 years will bring new eligibility hurdles, including work-reporting requirements starting in early 2027, semiannual renewals and possible co-pays of up to $35 per visit.
The cuts help finance permanent tax breaks for the wealthiest Americans and boost funding for Immigration and Customs Enforcement (ICE).
Governor Gavin Newsom estimates California’s potential losses at $28.4 billion, with 3.4 million residents losing coverage.
Advocates warn the combined state and federal changes will deepen inequities, push more people into emergency rooms and saddle many with skyrocketing healthcare costs in the coming years.
Effects on Underrepresented Communities
Justin Preas, CEO of United Health Centers of the San Joaquin Valley, said about 120,000 patients are under Medi-Cal out of the 180,000 patients seen across all locations in the central San Joaquin Valley.
“These cuts and changes are very devastating for everyone here in the Central Valley,” said Preas. “It definitely becomes an access issue for people when they’re no longer able to access their healthcare services because they’re uninsured, and things become a lot more expensive.”
He warned that when low-income people face expensive medical bills, many forgo primary and preventive care, leading to more severe health problems that eventually push them into emergency rooms. And local emergency departments are already overburdened and will not be able to handle the influx, creating longer wait times for everyone—including those with private insurance.
The result, Preas said, could be a dire situation where conditions that could have been treated early in a primary care setting instead become costly emergencies, placing a heavier strain on both patients and the overall healthcare system.
Health experts like Preas say the new work requirements create unnecessary bureaucratic obstacles that many people will struggle to overcome to stay in the program. As a result, many could lose access, leading to greater hardship, increased poverty and worse health outcomes.
While the work requirement is a federal law, Medicaid programs are regulated and operated at the state level. The federal exemptions include people of dependent children under age 13, those with disabilities and those pregnant or receiving postpartum coverage.
The Urban Institute projects that as many as 1.4 million Californians could lose health coverage by 2026—a little less than five months—due to the challenges posed by the work requirements. This includes workers like housekeepers and gardeners who can lack the necessary documentation to verify their employment.
Preas recommends that patients keep current documentation, such as proof of income and residence, readily available for verification to comply with the new work requirements, especially with the requalification period changing from once a year to every six months.
He noted that United Health Centers’ enrollment department will continue assisting patients and the community with Medi-Cal applications and renewals after the changes take effect.
“That’s definitely part of the reason this provision was included in the bill,” said Preas. “It’s bureaucratic, meant to frustrate people, and make it extremely challenging for them to maintain their eligibility.”
Preas advises people to continue enrolling in Medi-Cal and to stay on top of the new semiannual renewal process. He stressed that it is especially important to apply now for those who are not yet enrolled, as maintaining coverage will likely be easier than applying for it later.
Miranda Dietz, interim director of the healthcare program at UC Berkeley Labor Center, said that work requirements have been previously implemented in a few states, including New Hampshire and Arkansas, but those efforts ultimately failed, with both states later ditching the work requirements. Currently, only the state of Georgia maintains a work policy for enrollees, but processing times have been slow and have left people without care.
Dietz explained that instead of boosting employment, the policies caused thousands of eligible people to lose their health insurance within months. She said work requirements don’t help people find or keep jobs—in fact, the opposite is true. Stable health insurance, she said, gives people the security they need to stay employed and imposing these requirements ends up being counterproductive.
“The whole concept of Medi-Cal is that it’s a safety net program,” said Dietz. “Freezing people out and preventing new enrollment means that it can’t serve that function. And if people can’t navigate the bureaucratic hurdles of redetermination, they won’t be able to get back in.”
How Medi-Cal Changes Affect Immigrants
Adriana Ramos-Yamamoto, senior policy analyst at the nonpartisan California Budget and Policy Center, said heightened immigration enforcement has made many immigrants, especially undocumented residents, fearful of seeking medical care.
Those fears include the fact that the state regularly shares Medi-Cal enrollment data with the Centers for Medicare & Medicaid Services (CMS) to ensure eligibility is accurate and payments are processed correctly, since Medi-Cal is state-administered but jointly funded by state and federal governments.
Recently, CMS shared that data with the Department of Homeland Security, raising concerns about privacy and potentially discouraging some people from enrolling.
These recent actions by the Trump administration, Ramos-Yamamoto said, have allowed immigration authorities to access some healthcare data, further escalating concerns over safety and privacy.
There are two state-level changes: a Medi-Cal enrollment freeze beginning in January 2026, which bars income-eligible undocumented adults over 19 from enrolling if they are not already covered, and the elimination of full-scope dental coverage for certain immigrants with “unsatisfactory” immigration status in July 2027, covering only emergency dental care afterward.
Ramos-Yamamoto urged Medi-Cal dental beneficiaries to complete any urgent dental work before coverage is reduced and to stay on top of appointments.
She added that immigrant communities should seek guidance from legal or advocacy groups that can explain upcoming changes and help them navigate enrollment.
In the Central Valley, health providers like Preas have expressed concerns about how upcoming Medi-Cal changes will affect immigrant patients, particularly migrant and seasonal farmworkers rooted in rural communities throughout the region.
The sweeping changes, coming with increased immigration enforcement, only make things harder in communities that have always struggled to find enough doctors.
“We’re obviously a safety net for everyone here in our valley, and we’re here to take care of everybody regardless of their ability to pay,” said Preas. “We’re trying to anticipate what these changes are going to look like and how we can still continue to provide the same level of services that we currently provide.”
Preparing for the Cuts
Livia Alejo, HOPE/PCH project manager at Cultiva la Salud, said her team connects community members to resources based on the risks they face, including applying for Medi-Cal and scheduling appointments. Most of the people coming to Cultiva la Salud are Medi-Cal recipients.
Alejo says many of her clients had no idea about the looming cuts until she warned them.
Alejo encourages people to stay current on medical appointments, get lab work done and speak with their primary care providers about their medications. If possible, she said, patients should get prescriptions filled for up to three months at a time.
A major barrier for many clients, especially seniors, is discomfort with digital systems. They often receive important letters in the mail that arrive late or are not in their language, causing them to miss reapplication deadlines.
To help, Alejo’s team assists with submitting applications online through BenefitsCal and gathers all necessary documents, like IDs, rental agreements and proof of income, to prevent delays.
She urges community members to stay informed by following trusted organizations, advocacy groups and public leaders, rather than relying solely on word-of-mouth or social media. While many in Latino communities turn to comadres, compadres, neighbors or Facebook for news, Alejo warns that such information isn’t always reliable.
“We encourage community members to voice their concerns for public comments, attend city and county meetings and join advocacy efforts to oppose harmful cuts,” said Alejo. “It’s important that we work together to protect healthcare access for all residents of the Central Valley.”
