California AB 133, signed in July 2021, is a wide-ranging healthcare law best known for extending Medi-Cal to undocumented adults aged 50 and older, but it also removed the Medi-Cal asset test, created a statewide health Data Exchange Framework, launched the Office of Health Care Affordability to cap the growth of medical spending, and funded a major buildout of behavioral health treatment facilities. Several of its provisions have shifted since 2021, and one — the asset test — has been partially reversed. Here is what the law did, what has changed, and what to watch.
Who Can Now Get Medi-Cal Regardless of Immigration Status
AB 133 made California the first state to offer full-scope Medi-Cal to low-income adults 50 and older regardless of immigration status. That expansion took effect on May 1, 2022, and covered roughly 235,000 people who had previously been limited to emergency and pregnancy-related services.1Governor of California. California Expands Medi-Cal to All Eligible Adults 50 Years of Age and Older Newly eligible beneficiaries gained access to preventive care, long-term care, and In-Home Supportive Services.2Governor of California. Governor Newsom Signs Into Law First-in-the-Nation Expansion of Medi-Cal to Undocumented Californians Age 50 and Over
The state then closed the remaining age gap. On January 1, 2024, full-scope Medi-Cal was extended to adults 26 through 49 regardless of immigration status.3Department of Health Care Services. Age 26-49 Adult Expansion Webinar Children and young adults under 26 had already been covered by earlier expansions, so every income-eligible California resident can now qualify for Medi-Cal regardless of documentation.
The Medi-Cal Asset Test Is Back for Some Populations
When AB 133 passed, it eliminated the Medi-Cal asset test for older adults and people with disabilities. That test had disqualified people who were income-eligible but had modest savings above a very low threshold. The 2025–2026 state budget then reinstated an asset limit for certain Medi-Cal populations, though at a far higher level than the old rule.
The reinstated limit is $130,000 per individual, with an additional $65,000 for each additional household member. It applies to people aged 65 and older, people with disabilities, nursing home residents, and families whose income exceeds federal tax-based thresholds.4Department of Health Care Services. Asset Limits FAQs
Some assets are exempt. Your primary home and one vehicle do not count, and the balance of a 401(k) or other retirement account is excluded, though withdrawals from those accounts count as income. Cash, savings accounts, life insurance policies, and additional real property do count. Transfers of assets made before January 1, 2026 are not penalized. Transfers made on or after that date can trigger a penalty period that delays coverage for long-term care services.4Department of Health Care Services. Asset Limits FAQs
The $130,000 figure is far higher than the $2,000 limit that existed before AB 133, so most current beneficiaries will not lose coverage. If you are a senior or a person with a disability and your non-exempt assets exceed that amount, this is the AB 133-related change most likely to affect your eligibility.
Office of Health Care Affordability and Spending Growth Targets
AB 133 established the Office of Health Care Affordability (OHCA) within the Department of Health Care Access and Information. OHCA’s job is to track total healthcare spending in California and enforce caps on how fast that spending grows.5California Department of Health Care Access and Information. OHCA Background and Resources
The statewide spending growth target for 2026 is 3.5 percent per capita, unchanged from 2025. The target drops to 3.2 percent in 2027 and 2028, and to 3.0 percent by 2029. For seven hospitals identified as high-cost, the 2026 target is tighter at 1.8 percent.6California Department of Health Care Access and Information. Slow Spending Growth
Healthcare entities including hospitals, health plans, and physician groups must submit expenditure data to OHCA, which analyzes and publicly reports the results. Enforcement escalates in steps: technical assistance first, then public testimony before the Health Care Affordability Board, then a required performance improvement plan, and finally financial penalties that increase for repeated failures.5California Department of Health Care Access and Information. OHCA Background and Resources The first enforcement period evaluates performance against the 2026 target, with actions potentially beginning around 2028.6California Department of Health Care Access and Information. Slow Spending Growth
OHCA also tracks quality, equity, workforce stability, and investment in primary care and behavioral health, and the Board can weigh those factors when setting targets or reviewing an improvement plan.
Behavioral Health Continuum Infrastructure Program
AB 133 created the Behavioral Health Continuum Infrastructure Program (BHCIP) to fund construction, renovation, and acquisition of treatment facilities for mental health conditions and substance use disorders.7Department of Health Care Services. Behavioral Health Continuum Infrastructure Program The program targets a longstanding shortage of physical treatment capacity: crisis stabilization beds, residential treatment slots, and outpatient facilities.
The program’s scale grew in 2024 when California voters approved the Behavioral Health Infrastructure Bond Act, authorizing $6.38 billion in bonds to develop behavioral health facilities and supportive housing. Up to $4.4 billion of that total goes to BHCIP competitive grants, with the first round making up to $3.3 billion available for construction and rehabilitation.8State of California. Behavioral Health Infrastructure Bond Act of 2024 – BHCIP Round 1 Launch Ready
The Statewide Data Exchange Framework
AB 133 required the California Health and Human Services Agency to build a statewide Data Exchange Framework (DxF): a single data sharing agreement and a common set of policies governing how health information moves between providers, health plans, labs, and government agencies.9California Legislative Information. California Code HSC 130290 Under the DxF, participating entities exchange health information in real time for treatment, payment, and healthcare operations.
As of January 1, 2026, responsibility for the DxF transfers from the California Health and Human Services Agency to the Department of Health Care Access and Information.9California Legislative Information. California Code HSC 130290
Compliance Deadlines
Most mandated entities were required to sign the data sharing agreement by January 31, 2023 and begin exchanging health information with other participants by January 31, 2024.10California Data Exchange Framework. Frequently Asked Questions Smaller and rural organizations received an extended deadline of January 31, 2026. That extended category includes:
- Small physician practices with fewer than 25 physicians, including solo practices
- Rehabilitation hospitals, long-term acute care hospitals, acute psychiatric hospitals, critical access hospitals, and rural general acute care hospitals with fewer than 100 beds
- State-run psychiatric hospitals
- Small nonprofit clinics with fewer than 10 healthcare providers
The broader list of entities required to participate includes general acute care hospitals, physician organizations and medical groups, skilled nursing facilities, health plans (including Medi-Cal managed care plans), clinical laboratories, and acute psychiatric hospitals.11California Data Exchange Framework. For Participants If your organization falls into any of those categories and has not yet signed the agreement or begun exchanging information, January 31, 2026 is the final extension.
What the DxF Does Not Change About Your Privacy
The DxF does not override existing privacy law. It operates within HIPAA and California’s Confidentiality of Medical Information Act. If a provider is currently required to obtain your consent before sharing certain records, such as substance use disorder treatment or HIV-related data, that requirement still applies under the DxF.12California Data Exchange Framework. Can Patients Opt Out of Their Information Being Shared Under the DxF
The DxF does not create a new blanket opt-out mechanism, but it also does not take away privacy rights you already have. Each participating organization remains responsible for making sure what it shares through the framework complies with applicable law.12California Data Exchange Framework. Can Patients Opt Out of Their Information Being Shared Under the DxF
Estate Recovery for Newly Eligible Older Adults
If you gained Medi-Cal through the expansion and you are 55 or older, one rule worth knowing is estate recovery. California is required to seek repayment from the estates of certain deceased Medi-Cal beneficiaries for benefits received after age 55. If a beneficiary owned nothing at the time of death, no repayment is owed.13Department of Health Care Services. Estate Recovery Program
For beneficiaries who died on or after January 1, 2017, the rules are narrower than they used to be. Recovery applies only to assets that go through probate, so assets held in a living trust, joint tenancy, or with a named beneficiary are generally not subject to recovery. The services subject to recovery are also limited to nursing facility care, home and community-based services, and related hospital and prescription drug costs incurred while the beneficiary was in a nursing facility or receiving home-based services.13Department of Health Care Services. Estate Recovery Program Routine medical visits and preventive services are not subject to recovery.