Gizmo Warehouseby Joe Eichenbaum | 17A

Medicaid work requirements · California

Medicaid work requirements in California: who is subject and who loses coverage (2027)

Data snapshot 2026-06-03 · part of These 5 Million People Are About to Lose Their Medicaid — But They Don't Have To

California expanded Medicaid, so the federal work requirement that takes effect January 1, 2027 applies to its expansion adults. About 4,700,448 of them (19.6% of an expansion pool of 5,024,843) will have to prove 80 hours a month of work, school, or service, or an exemption, to keep coverage.

This model's bottom-up estimate is that 1,022,390 people in California lose coverage by 2034: 881,376 of them still eligible but lost to paperwork and reporting failures, and 141,013 not meeting the requirement. Nationally the same model gives 5,461,400, against CBO's 5,200,000.

Whether those eligible people keep coverage depends on the state's ability to renew them automatically (ex parte) from data it already holds. California scores 74 of 100 on this model's ex parte capability index, a low band; its eligibility system is CalSAWS.

Key figures

Model v2-2026-06-03. "Strict" counts adults whose ACS record shows them subject with no observable exemption; "permissive" allows the broader exemption reading.
MeasureCalifornia
Expansion stateYes
Subject to the requirement via waiverNo
Expansion pool (adults 19 to 64)5,024,843
Adults subject, strict definition4,700,448
Adults subject, permissive definition4,606,439
Share of expansion pool subject19.6%
Projected coverage loss by 20341,022,390
Hardship exception statusAdopting
Early implementerNo
Ex parte capability score (0 to 100)74 (low)

Who is subject in California

Of the 4,700,448 subject adults, 34% already work 80 or more hours a month and 58% are not working. 29% have a child under 14 at home. Among those not working, 38% report a disability and 19% are caregivers.

ACS PUMS 5-year 2020 to 2024, subject adults only.
CharacteristicShare of subject adults
Age 19-2419%
Age 25-3420%
Age 35-4417%
Age 45-5418%
Age 55-6426%
Not working58%
1 to 19 hours a month1%
20 to 79 hours a month7%
80 or more hours a month (meets the bar)34%
Not working: Disabled38%
Not working: Caregiver19%
Not working: Postpartum0%
Not working: Student7%
Not working: Other36%

Why eligible people lose coverage

Of the 1,022,390 projected to lose coverage in California, 881,376 meet the requirement or qualify for an exemption but fail to document it. 405,559 of those are working people who cannot prove their hours through data the state can see, and 475,817 qualify for an exemption the state does not detect automatically.

Bottom-up model v8.0-2026-05-30; documentation-failure buckets compound over the 14 six-month renewal cycles through 2034.
GroupProjected to lose coverage
Multiple part-time jobs (aggregation failure)122,306
Self-employed (other)90,807
Variable shifts / on-call work74,637
Full-time students not auto-verified36,983
Seasonal: agriculture, hospitality, food service24,876
Cash-paid construction & trades23,056
Volunteering / job training17,336
Gig / courier (DoorDash, Uber, Lyft, Instacart)15,559
Medically frail without auto-match183,651
Caregivers of a disabled adult146,213
American Indian / Alaska Native (tribal exemption)41,703
SUD treatment not flagged in claims data35,394
Kinship caregivers (non-parent) of children ≤1328,546
Parent caregivers of children ≤13 without auto-match22,690
Other categorical exemptions (foster, AYA cancer, SNAP/TANF)12,135
Recent incarceration (data-match gap)4,068
Pregnancy / postpartum data lag1,417

Can the state renew people automatically?

The ex parte capability index blends the state's observed automatic-renewal rate (76% in CMS eligibility-processing data), the wage, disability, and other data sources it can query, and its history of churn. California's composite score is 74 (low band). A low score means more eligible people will be dropped for paperwork unless the state changes its process before January 1, 2027.

ComponentScore
Composite74
Observed ex parte76
Core capability100
Data sources80
Historical churn50

How subjects overlap across exemption categories

Each subject adult sits in exactly one cell. Categories: Working ≥ qualifying hours / income; Parent caregiver of child ≤13; Medically frail; Full-time student.
CombinationAdultsShare
None of the four1,950,21641.5%
Working ≥ qualifying hours / income1,058,82022.5%
Medically frail603,59312.8%
Full-time student378,3688.1%
Working ≥ qualifying hours / income + Parent caregiver of child ≤13298,9896.4%
Working ≥ qualifying hours / income + Full-time student183,2823.9%
Parent caregiver of child ≤13124,3432.6%
Working ≥ qualifying hours / income + Medically frail39,0430.8%

Counties in California

Subject adults concentrate: Los Angeles County (1,135,381), Orange County (388,787), and San Diego County (380,226) account for 41% of the state's subject population.

All 58 counties in California with subject adults, sorted by count. County figures are model allocations of the state estimate by ACS tract characteristics.
CountyAdults subjectSubject rateProjected lossPoverty rateWorking-age population
Los Angeles County1,135,38118.4%246,95614.0%6,179,654
Orange County388,78720.0%84,56510.0%1,944,130
San Diego County380,22618.6%82,70311.0%2,048,204
Riverside County304,92220.8%66,32311.0%1,463,871
San Bernardino County256,91619.3%55,88114.0%1,329,721
Santa Clara County225,17918.7%48,9787.0%1,206,320
Alameda County185,89417.7%40,4349.0%1,049,320
Sacramento County183,52519.0%39,91813.0%967,520
Contra Costa County141,59520.3%30,7988.0%696,179
Fresno County120,70520.5%26,25420.0%588,426
Kern County108,70420.4%23,64419.0%532,014
Ventura County105,77321.2%23,0079.0%498,372
San Joaquin County94,44020.1%20,54113.0%469,876
San Francisco County89,26915.8%19,41710.0%563,228
San Mateo County88,28119.3%19,2026.0%457,478
Stanislaus County66,60620.6%14,48714.0%322,646
Sonoma County63,38822.4%13,7879.0%282,528
Santa Barbara County61,04923.4%13,27914.0%260,404
Tulare County57,59421.2%12,52718.0%271,918
Placer County53,43422.5%11,6227.0%237,540
Solano County52,93719.7%11,5149.0%269,364
Monterey County52,81720.8%11,48812.0%253,490
San Luis Obispo County43,43026.6%9,44613.0%163,028
Santa Cruz County38,38824.1%8,35011.0%159,568
Merced County36,35821.7%7,90819.0%167,269
Marin County34,43623.9%7,4907.0%143,769
Yolo County31,67022.7%6,88817.0%139,434
Butte County29,32323.7%6,37818.0%123,644
El Dorado County26,87324.9%5,8459.0%107,884
Shasta County23,73323.4%5,16213.0%101,347
Imperial County21,14120.8%4,59821.0%101,788
Madera County19,34321.1%4,20720.0%91,723
Humboldt County17,81722.1%3,87520.0%80,476
Napa County17,70622.5%3,8518.0%78,544
Kings County16,48017.6%3,58516.0%93,568
Nevada County14,46026.7%3,14510.0%54,205
Mendocino County12,26025.4%2,66716.0%48,258
Sutter County11,98021.2%2,60613.0%56,494
Yuba County9,51419.3%2,06915.0%49,348
Lake County8,91524.5%1,93917.0%36,358
Tehama County8,34723.4%1,81616.0%35,604
San Benito County8,19120.4%1,7828.0%40,115
Tuolumne County7,54225.7%1,64011.0%29,350
Calaveras County6,57826.8%1,43113.0%24,577
Siskiyou County6,15327.7%1,33817.0%22,220
Amador County5,27222.6%1,1478.0%23,358
Glenn County3,73723.9%81315.0%15,631
Lassen County3,35317.2%72915.0%19,443
Del Norte County3,22520.5%70114.0%15,711
Plumas County3,12431.7%68011.0%9,852
Colusa County2,88823.2%62811.0%12,460
Mariposa County2,51728.0%54716.0%9,003
Inyo County2,46824.3%53712.0%10,136
Trinity County2,13226.0%46422.0%8,202
Mono County1,69620.1%36911.0%8,454
Modoc County1,27030.6%27617.0%4,150
Sierra County46036.0%10013.0%1,280
Alpine County24726.6%5414.0%930

State brief and methodology

Estimates, not counts. The model rakes to CBO's national subject total and allocates by ACS microdata; state agencies hold the administrative data that would replace these figures.

Sources

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