State of California—Health and Human Services Agency
California Department of Public Health

ADAP MM 2025-14

December 22, 2025

TO:

ADAP and PrEP-AP Enrollment Workers

SUBJECT:

Medi-Cal Expansion Freeze for Adults Aged 19 and Older Without Satisfactory Immigration Status

The purpose of this memo is to inform ADAP and Pre-Exposure Prophylaxis Assistance Program (PrEP-AP) Enrollment Workers (EW) about policy updates due to Medi-Cal eligibility changes in 2026.

Background

Starting January 1, 2026, the Department of Health Care Services (DHCS) will freeze full scope Medi-Cal enrollments for new applicants who are 19 or older and who do not have satisfactory immigration status (SIS).

Existing Medi-Cal enrollees who are 19 and older and who do not have SIS can remain on Medi-Cal and must complete their annual renewal to remain eligible. If they do not renew and lose coverage, they will not be eligible for full scope Medi-Cal again and will only be eligible for emergency and pregnancy care.

ADAP

Individuals without SIS who are not enrolled in full scope Medi-Cal are eligible to apply to ADAP, which provides medication assistance and insurance assistance to people living with HIV and AIDS. These clients can also apply to the OA Health Insurance Premium Payment Program (OA-HIPP) and enroll in an off-exchange health plan during open enrollment. They have until January 29, 2026, to enroll for a February 1, 2026 start date. It is recommended that the client make the initial premium payment to secure their health insurance.

Individuals without SIS who lose Medi-Cal coverage will have a 60-day Special Enrollment Period to apply for an off-exchange plan.

PrEP-AP

Individuals without SIS who are not enrolled in full scope Medi-Cal are eligible to apply to PrEP-AP, which provides assistance with the cost of medications, lab tests, and medical services related to HIV prevention.

Scenarios

Please review the scenarios below as it relates to the Medi-Cal expansion freeze for adults aged 19 and older without SIS:

Scenario 1: A new ADAP/PrEP-AP client who is age 19+, does not have SIS, has income below 138% FPL, and is not enrolled in Medi-Cal, applies for ADAP/PrEP-AP after January 1, 2026.

The client is not eligible for Medi-Cal. The EW enrolls the client into ADAP/PrEP-AP.

Scenario 2: A new ADAP/PrEP-AP client who is age 19+, does not have SIS, has income below 138% FPL, and is currently enrolled in Medi-Cal, applies for ADAP/PrEP-AP after January 1, 2026.

The client is not eligible for ADAP/PrEP-AP due to full scope coverage through Medi-Cal.

Scenario 3: An existing ADAP client, does not have SIS, with income below 138% FPL, re-enrolls into ADAP and one of the insurance assistance programs: Employer Based Health Insurance Premium Payment (EB-HIPP), OA-HIPP, or Medicare Premium Payment Program (MPPP).

The client will be screened for existing Medi-Cal coverage. If there is no coverage, the EW can enroll into ADAP. If the client has Medi-Cal coverage, the client will be disenrolled from ADAP.

Scenario 4: A new ADAP/PrEP-AP client with SIS and with income below 138% of the FPL, applies for ADAP/PrEP-AP.

The EW must refer the client to Medi-Cal. While awaiting Medi-Cal determination, the client is placed on a Temporary Access Period (TAP) and receives ADAP/PrEP-AP benefits. If the determination exceeds the 30-day TAP, the EW must submit a Medi-Cal Eligibility Exception Request (MEER) to extend eligibility.

DHCS - Medi-Cal Resources

For more information regarding the upcoming changes to Medi-Cal, please review the DHCS website: https://www.dhcs.ca.gov/Medi-Cal/Pages/changes.aspx

If you have any questions regarding the information provided in this memo, please contact your OA Advisor.

Thank you,