Effective January 1, 2026, IEHP members with UIS already enrolled in Medi-Cal will continue to receive full scope Medi-Cal coverage, EXCEPT for members 19 years of age or older who allow their eligibility to lapse. If these members do not renew on time, they will only be able to receive emergency care (Restricted Scope Medi-Cal).
Additional Policy Change Information:
- UIS members not renewing their benefit prior to their redetermination date will lose their full scope Medi-Cal benefits forever.
- UIS members under 19 years of age are still eligible for reinstatement to full scope Medi-Cal if their eligibility lapses.
- Effective January 1, 2026, others with UIS who are not currently enrolled in Medi-Cal are no longer eligible for full scope Medi-Cal benefits under the enrollment freeze but can apply for Restricted Scope Medi-Cal (emergency care, pregnancy-related care, nursing home care).
- Effective July 1, 2026, UIS members 19 years of age or older (and not pregnant) will lose dental coverage, except emergency dental care.
- Full dental coverage for pregnant UIS members and children under 19 will remain in effect, regardless of immigration status.
It will be critically important for those UIS members who are already on the Medi-Cal program to renew their coverage in a timely manner. UIS members who allow their Medi-Cal eligibility to lapse will be removed from Primary Care Provider (PCP) panel assignment.
Impact for Providers:
- Lower capitation payments
- Lower targeted rate increase (TRI) payments
- Lower qualifying Global Quality Pay for Performance payments
- Specialists and Ancillary providers may see a potential decrease in referral volume
However, with every challenge comes opportunities to help our collective health care mission and partnership grow even stronger.
IEHP takes this challenge seriously, and we are committed to helping all IEHP members keep their Medi-Cal coverage and our provider network keep their assigned members.