Despite the recent and upcoming federal and state cuts and threats to Medicaid (Medi-Cal), the program continues to be a lifeline for the 15 million low-income Californians who rely on it as their primary source of health care coverage. Medi-Cal is a vital component of California’s efforts to achieve universal care and the promise that every resident of the State should have access to medically necessary care when needed regardless of their background and identities. The program would not be effective, however, without a robust package of benefits that address the widespread needs of low-income families and the specific health needs of populations traditionally neglected by our health care system, including BIPOC individuals, LGBTQI+ people, individuals with disabilities, immigrants, among others.
Over the past few decades, California has taken advantage of the opportunities the Medicaid program presents and has steadfastly implemented a comprehensive Medi-Cal services package. Through different legal authorities (state plan amendments, section 1115 waivers, section 1915(b) waivers, and section 1915(c) waivers, to mention a few), the State has engaged in concerted efforts to increase availability and accessibility of evidence-based services, while at the same time implementing creative solutions to improve care coordination in a highly fragmented system, providing low-income and marginalized individuals access to services for which they otherwise would be ineligible, and connecting beneficiaries with social services in order to improve the living conditions that contribute to health problems.
For example, to address the behavioral health crisis that is impacting the State, California has implemented various initiatives to expand the number of mental health and substance use disorder services covered by Medi-Cal; allowed individuals to access services irrespective of their first point of contact with the Medi-Cal system; and allowed individuals experiencing incarceration to receive essential behavioral health services. Similar initiatives have also enabled California to cover and connect individuals with housing and food services, recognizing that housing instability and food insecurity are key factors that contribute to health complications. In recent years, California has also secured, expanded, and maintained access to important health care services that are increasingly under attack throughout the country. Medi-Cal offers a robust package of gender affirming care for individuals with gender dysphoria, abortion and contraceptive care, and vaccines and other preventive services for adults and children.
These and other benefits are the subject of An Advocate’s Guide to Medi-Cal Services, a resource created by the National Health Law Program’s California Advocacy Strategy Area (CASA), which aims to educate advocates and stakeholders about some of the most important benefits available to Medi-Cal beneficiaries, their limits, and recent changes. The Guide is divided into chapters by categories of benefits and the 2025–2026 update includes new chapters that take into account recent developments both at the state and federal level. The new Chapter 2 of the Guide, for example, discusses important information about California’s efforts to protect access to vaccines and other preventive services in the wake of recent federal action that effectively limits availability of and access to certain vaccines. The updated guide also includes extensive information about care coordination and community supports services, which have now been split up into two separate chapters given the amount of new information available through state guidance and through the first-hand experience of beneficiaries and advocates involved with implementation. Likewise, all other chapters incorporate recent changes to federal or state law and newly available information made available through administrative Medi-Cal guidance.
The Guide is not only valuable as an explainer of the Medi-Cal benefits package for advocates whose clients are experiencing difficulty accessing medically necessary care, but it is also an essential resource for advocates and stakeholders to effectively engage in broader policy advocacy with the Department of Health Care Services, the California Legislature, and the Governor’s office. In the coming months and years, California policymakers will face difficult decisions, mainly as a result of the Medicaid cuts associated with the so-called One Big Beautiful Bill (or H.R. 1), that may push them to eliminate certain covered services, impose utilization management barriers and cost-sharing on key services, or further restrict the populations who are eligible for certain services in an effort to cut down on costs. For some of the innovative services recently adopted, many of which have been implemented through temporary pilot programs or federal waivers, the State may even be pressured to discontinue these important and innovative programs.
Given this new reality, it is important for advocates to understand the holistic nature of the entire benefits package of the Medi-Cal program and how losing or restricting access to any of these benefits may have dire consequences for California’s most underserved communities. Any type of cuts will likely contribute to widening health inequities, increase uncompensated care, and negatively impact the ability of low-income individuals to participate in the State’s economy. In times of uncertainty and with Medicaid under attack from different fronts, understanding the importance of the program as a source of coverage for basic and medically necessary care will enable advocates throughout the Golden State to protect and defend the Medi-Cal program. We are confident that the updated Advocate’s Guide will be an important tool at their disposal and we encourage readers to contact NHeLP’s CASA team for further assistance related to using the Guide. We also encourage advocates to remain on the lookout for announcements about future activities NHeLP will host as part of the release of the 2025–2026 version of the Guide.
