By Greg Bradbard and Deanna Hendrick | IEHP Foundation When you’re healthy, talking about medical insurance can be boring. But when you’re sick, have an injury, or are managing a chronic health condition, access to quality medical care becomes essential. This year, Medi-Cal (California’s Medic aid program) will begin undergoing policy shifts affecting eligibility, benefits and enrollment rules. Although these changes aim to rein in costs, curb misuse, and focus resources on the most vulnerable, they will have significant consequences for the Inland Empire’s health care system. Not only will the over 1.8 million residents enrolled in Medi-Cal be affected, but it will also increase strains on the same doctors, clinics and hospitals serving those with private insurance. Why are these changes happening? In July 2024, Congress passed H.R.1, known as the Big Beautiful Bill Act, supported by most Republicans, which extended the 2017 tax cuts, removed taxes on tips and boosted the child tax credit. To pay for those changes, lawmakers trimmed programs like Medicaid and Supplemental Nutrition Assistance Program, or SNAP. Democrats opposed the bill, warning that cuts would hit vulnerable families hardest. The biggest changes to Medicaid come through stricter eligibility rules, caps on state provider taxes, and limits on state-directed payments, which limit reimbursement options, reduce payment rates to medical providers and ultimately reduce access and funding. Currently, each year Medi-Cal enrollees go through “redetermination” to confirm they still qualify and are eligible for benefits. By Dec. 31, 2026, that process will be increased to every six months for adults ages 19-64 without dependents. Although increasing accountability is good in theory, keeping up with these new regulations will prove challenging for both individuals and the system. Miss a notice or make a paperwork mistake? You could lose coverage — even if you’re eligible. Increasing the frequency of redetermination also doubles the workload for local county offices responsible for enforcing the new requirements. Starting in 2027, those same adults will also be required to verify at least 80 hours a month of work, education or community service. For some, this will provide new motivation to increase employment or community service hours, and for others who work without employer-sponsored insurance, it will be another hoop to jump through to maintain coverage. To address challenges to already-limited healthcare access in rural and remote areas, H.R. 1 created the $50 billion Rural Health Transformation Program, funding new care models, workforce training, and technology from 2026-2030. California will receive $233.64 million in 2026, although it’s yet to be determined how funds will be distributed. Gov. Gavin Newsom’s office estimates up to 3.4 million Californians could lose Medi-Cal coverage under these federal changes. And it’s not just Medi-Cal — about 40% of the nearly 2 million middle-income people with Covered California plans may lose coverage now that Affordable Care Act premium tax credits have ended. Nearly 90% of people enrolled in Covered California rely on federal subsidies to keep costs manageable. California is also tightening its eligibility requirements for undocumented immigrants enrolled in Medi-Cal. Starting Jan. 1, adults with unsatisfactory immigration status, or UIS, can no longer enroll in Medi-Cal, although current enrollees can maintain coverage if they renew on time. By July 2027, some members of the UIS population will need to pay a $30 monthly premium to retain coverage. Inland Empire Health Plan, one of the region’s largest health insurance providers, serving 1.5 million individuals across Riverside and San Bernardino counties, reports that service impacts are already apparent. In January, IEHP lost 35,000 Covered California members and 50,000 members overall across its three lines of business: Medi-Cal, DualChoice and Covered California. “For nearly 30 years, IEHP has been the region’s partner in health and will continue to champion for low-cost affordable health care options for our communities,” said Michelle Rai, IEHP chief communications and marketing officer. “IEHP will be here to help members and medical providers navigate these changes every step of the way.” So, what’s the bigger picture here? Collectively, these well-intentioned changes will have deep impacts on funding and access to quality healthcare for all children, adults and seniors throughout the Inland Empire. When people lose health insurance, they delay care, avoid seeing a primary care physician, and use emergency rooms often for non-urgent issues. As a result, people get sicker, some facilities will close due to financial pressure, and we can all expect longer ER and specialist wait times. When government programs are reduced, people often turn to local nonprofit organizations such as Catholic Charities San Bernardino Riverside Counties which serves more than 18,000 people each year, many of whom depend on Medi-Cal or Affordable Care Act coverage.  Tim Ney, CEO of Catholic Charities, reports increased demand for Medi-Cal enrollment and redetermination assistance, with more clients delaying care due to confusion or loss of coverage.  “In the Inland Empire, we are seeing families lose health coverage not because they are ineligible, but because the renewal process is complex and easy to miss. When coverage lapses, people delay care, medications are interrupted, and the impact shows up immediately in food insecurity, housing instability, and mental health needs,” Ney said. “Nonprofits like Catholic Charities are helping people re-enroll, but the scale of this challenge … is significant.” Currently, Catholic Charities focuses on immediate needs and Medi-Cal navigation, providing assistance with utilities, rent, or mortgage when funding permits. They also connect individuals to trusted community partners for additional support. Pacific Clinics, a nonprofit provider of mental health and substance use services across the state, provides behavioral health care at no cost to patients.  Related Articles Days before strike begins, Kaiser fires legal salvo to break up nurses alliance California’s politicians and ultra-wealthy are divided over a proposed billionaire tax Florida deregulated nursing schools. Scam colleges and failing students followed States race to launch rural health transformation plans Health insurance increase of $1,100 (or around $4,000 for a family of 4) creates big questions “With our family resource center model in San Bernardino, we can provide mental health services to our clients without insurance – remaining focused on our main goal of serving our community,” shared Executive Director Maria Murillo.  As California and the Inland Empire adjust to these extensive changes to Medi-Cal and related health policies, the region’s health care providers, community organizations, and residents will need to adapt to new requirements and ongoing uncertainties. Continued collaboration among policymakers, health systems and local nonprofits will be essential to ensuring that everyone across our region retains access to vital services to experience vibrant health for years to come. IEHP Foundation provides resources and support to strengthen the local leaders and nonprofit organizations that make Inland Empire families healthier. Because when everyone in the Inland Empire lives a full and vibrant life, our region thrives. ...read more read less