(b) (1) No sooner than January 1, 2026, an individual who is 19 years of age or older, who does not have satisfactory immigration status as required by Section 14011.2, who is otherwise eligible for Medi-Cal services pursuant to subdivision (d) of Section 14007.5, and who applies for Medi-Cal on or after January 1, 2026, shall only be eligible for medically necessary pregnancy-related services, and care and services necessary for the treatment of an emergency medical condition and medical care directly related to the emergency, as defined in federal law.
(2) Notwithstanding paragraph (1), an individual who is 19 years of age or older, who does not have satisfactory immigration status as required by Section 14011.2, who was enrolled in full-scope Medi-Cal and was not pregnant, but loses coverage for full-scope Medi-Cal, shall be eligible to reenroll in full-scope Medi-Cal within three months from the date of disenrollment for full-scope Medi-Cal, pregnancy-only Medi-Cal, or postpartum Medi-Cal. Payment of outstanding premium balances prior to the initiation of the three-month cure period shall be a condition of reenrollment under this subdivision for individuals disenrolled from Medi-Cal due to nonpayment of premiums. For purposes of this paragraph, “full-scope Medi-Cal” means the full scope of Medi-Cal benefits, subject to the service limitations described in subdivision (k).
(3) Paragraphs (1) and (2) shall not apply to nonminor dependents, as defined in Section 11400, and individuals who but for their immigration status are eligible for Medi-Cal pursuant to Section 14005.28. These individuals shall remain eligible for the full scope of Medi-Cal benefits until their 26th birthday.
(4) Subdivision (b) shall be inoperative in whole or in part as follows:
(A) (i) On or before August 1, 2027, and each year thereafter until all individuals described in subdivision (a) are no longer subject to the service limitations described in this subdivision, the Director of Finance shall annually report to the Governor and the Legislature both of the following:
(I) The annual General Fund cost of implementing eligibility for the full scope of Medi-Cal benefits for each age group described in subdivision (a) without service limitations described in this subdivision on the following January 1.
(II) Whether, including the General Fund costs described in subclause (I), the General Fund would be in deficit in the current fiscal year, or any of the following two fiscal years.
(ii) A report submitted pursuant to this subparagraph shall be submitted in compliance with Section 9795 of the Government Code.
(B) Notwithstanding paragraphs (1) through (3), inclusive, of this subdivision, or subdivisions (a) or (l), on January 1 of the year following a determination that the General Fund would not be in deficit in the current fiscal year, or any of the following two fiscal years, pursuant to subclause (II) of clause (i) of subparagraph (A), the service limitations described in this subdivision shall end for the next group of individuals described in subdivision (a). The individuals described in subdivision (a) shall be grouped by age and the removal of the service limitations described in this subdivision shall proceed in the following order:
(i) Individuals over 49 years of age.
(ii) Individuals between 19 and 25 years of age, inclusive.
(iii) Individuals between 26 and 49 years of age, inclusive.
(C) No later than 60 days prior to any age group listed in subparagraph (B) no longer being subject to the services limitations described in this subdivision, the department shall post on its internet website which age groups are or are not eligible to enroll in the full scope of Medi-Cal benefits and the relevant time periods.
(D) For the purposes of this subdivision, deficit is defined as a negative balance in the Special Fund for Economic Uncertainties, as provided for in Section 16418 of the Government Code, based on the most recent Department of Finance estimates required by Section 12.5 of Article IV of the California Constitution.
(c) (1) No sooner than January 1, 2026, if an individual described in subdivision (a) who is 19 years of age or older loses eligibility for full-scope Medi-Cal on or after January 1, 2026, the individual shall only be eligible for medically necessary pregnancy-related services, and care and services necessary for the treatment of an emergency medical condition and medical care directly related to the emergency, as defined in federal law.
(2) No sooner than January 1, 2026, notwithstanding paragraph (1), if an individual described in subdivision (a) who is 19 years of age or older loses eligibility for full-scope Medi-Cal while pregnant, the individual shall remain eligible for the full scope of Medi-Cal benefits, subject to the service limitations described in subdivision (k), throughout the pregnancy and for 12 months after the pregnancy ends.
(3) Paragraphs (1) and (2) shall not apply to nonminor dependents, as defined in Section 11400, and individuals who but for their immigration status are eligible for Medi-Cal pursuant to Section 14005.28. These individuals shall remain eligible for the full scope of Medi-Cal benefits until their 26th birthday.
(4) Subdivision (c) shall be inoperative in whole or in part as follows:
(A) (i) On or before August 1, 2027, and each year thereafter until all individuals described in subdivisions (a) are no longer subject to the service limitations described in this subdivision, the Director of Finance shall annually report to the Governor and the Legislature both of the following:
(I) The annual General Fund cost of implementing eligibility for the full scope of Medi-Cal benefits for each age group described in subdivision (a) without service limitations described in this subdivision on the following January 1.
(II) Whether, including the General Fund costs described in subclause (I), the General Fund would be in deficit in the current fiscal year, or any of the following two fiscal years.
(ii) A report submitted pursuant to this subparagraph shall be submitted in compliance with Section 9795 of the Government Code.
(B) Notwithstanding paragraphs (1) through (3), inclusive, of this subdivision, or subdivisions (a) or (l), on January 1 of the year following a determination that the General Fund would not be in deficit in the current fiscal year, or any of the following two fiscal years, pursuant to subclause (II) of clause (i) of subparagraph (A), the service limitations described in this subdivision shall end for the next group of individuals described in subdivision (a). The individuals described in subdivision (a) shall be grouped by age and the removal of the service limitations described in this subdivision shall proceed in the following order:
(i) Individuals over 49 years of age.
(ii) Individuals between 19 and 25 years of age, inclusive.
(iii) Individuals between 26 and 49 years of age, inclusive.
(C) No later than 60 days prior to any age group listed in subparagraph (B) no longer being subject to the services limitations described in this subdivision, the department shall post on its internet website which age groups are or are not eligible to enroll in the full scope of Medi-Cal benefits and the relevant time periods.
(D) For the purposes of this subdivision, deficit is defined as a negative balance in the Special Fund for Economic Uncertainties, as provided for in Section 16418 of the Government Code, based on the most recent Department of Finance estimates required by Section 12.5 of Article IV of the California Constitution.