Restricted Scope Medi-Cal: Coverage, 2026 Limits, and Enrollment Freeze

Restricted scope Medi-Cal is California’s limited health coverage for residents who meet Medi-Cal’s income and residency rules but do not have a satisfactory immigration status. It pays for emergency treatment, pregnancy-related care, and medically necessary long-term care in a nursing facility, and nothing else. For a single person in 2026, income generally must fall at or below $22,025 per year, which is 138 percent of the federal poverty level.¹ Starting January 1, 2026, California froze new full-scope enrollments for undocumented adults 19 and older, so restricted scope is now the only Medi-Cal option for many adults who would previously have qualified for the full program.²

What Restricted Scope Medi-Cal Covers

Coverage is narrow by design. California Code of Regulations Section 50302 limits benefits to emergency services and pregnancy-related care, and a Medi-Cal card issued under restricted scope entitles you to those categories only.³⁴ Medically necessary long-term care in a nursing facility is also covered.⁵

Emergency Services

State law defines an emergency medical condition as one with symptoms severe enough that, without immediate care, you could face serious harm to your health, serious damage to how a bodily organ functions, or serious damage to a body part.⁶ The treating physician decides whether your condition meets that standard. Both inpatient hospital stays and outpatient visits qualify when they are needed to treat the emergency and any directly related follow-up care.

Dialysis for end-stage renal disease is covered, but only as emergency-related treatment rather than as a standalone benefit.⁷

Pregnancy-Related Services

Restricted scope covers prenatal care, labor and delivery, and a full 365 days of postpartum services regardless of immigration status. The postpartum year covers the full range of medically necessary services, not just emergencies, whether the pregnancy resulted in a live birth, stillbirth, miscarriage, or termination.⁸ Family planning services may continue beyond the postpartum year.

One practical detail matters here. For the system to reflect your postpartum eligibility, you or your provider must report the pregnancy or its end to your county Medi-Cal office. If that step is missed, the expanded postpartum aid code may not be applied automatically and you could have trouble getting services covered.⁸

Long-Term Care

If a physician determines that skilled nursing care is medically necessary, restricted scope Medi-Cal can pay for it. This is a significant benefit that is easy to overlook. Long-term institutional care is also the one Medi-Cal benefit that can figure into a federal public charge determination, so weigh that separately if it applies to your situation.

What Restricted Scope Does Not Cover

Everything outside the categories above is excluded, and the gaps catch many people off guard. Restricted scope does not pay for:

Routine doctor visits, checkups, physicals, or ongoing management of chronic conditions like diabetes or high blood pressure, unless the condition becomes an emergency
Prescription drugs for non-emergency conditions
Dental care, including cleanings, fillings, and extractions
Vision care, including eye exams and glasses
Mental health services, including therapy, counseling, and psychiatric treatment for non-emergency conditions

The line between “emergency” and “non-emergency” is where most frustration comes in. A condition you consider urgent, such as worsening back pain or an infected tooth, may not meet the statutory emergency definition unless it has progressed to the point of threatening serious harm. The treating provider makes that call. You can appeal a coverage determination, but not the medical judgment itself.

Who Qualifies

Eligibility is set by Welfare and Institutions Code Section 14007.5. Any non-citizen who meets Medi-Cal’s general eligibility rules but does not hold a satisfactory immigration status receives restricted scope benefits rather than full-scope coverage. In practice, this category includes undocumented immigrants and certain people with pending or unverifiable immigration applications. The county reviews each applicant’s documentation to decide whether a qualifying status exists; if one cannot be confirmed within 30 calendar days (or the actual processing time, whichever is longer), the applicant is placed in restricted scope.⁶

You must also be a current California resident who intends to stay in the state. Residency can be shown with a utility bill, a lease, or mail addressed to you at a California address.

2026 Income Limits

Most adults qualify if household income is at or below 138 percent of the federal poverty level.⁹ For 2026, the annual limits are:¹

1 person: $22,025 ($1,836/month)
2 people: $29,864 ($2,490/month)
3 people: $37,702 ($3,143/month)
4 people: $45,540 ($3,795/month)
5 people: $53,379 ($4,450/month)
6 people: $61,217 ($5,102/month)

Each additional household member adds roughly $7,838 per year to the limit.

Assets

California no longer counts assets for most Medi-Cal applicants. Asset tests still apply if you are 65 or older, have a disability, live in a nursing home, or are in a household that earns too much to qualify under standard income rules. For those groups the limit is $130,000 for one person, plus $65,000 for each additional family member. If you are in a nursing home, asset transfers made on or after January 1, 2026 can trigger a 30-month look-back penalty that delays coverage.¹⁰

The 2026 Enrollment Freeze

Starting January 1, 2026, California froze new enrollments in full-scope Medi-Cal for undocumented adults 19 and older.² Before the freeze, California had been expanding full-scope coverage to all income-eligible adults regardless of immigration status. That expansion is now paused.

What the freeze means in practice:

New applicants aged 19 and older who are undocumented or lack a satisfactory immigration status can only enroll in restricted scope. Full-scope coverage is not available to them.
Current full-scope enrollees can keep their coverage if they complete their annual renewal on time. If coverage lapses because of a late or incomplete renewal, the enrollee generally cannot re-enroll in full-scope and drops to restricted scope.⁷
Children under 19 and pregnant individuals (through one year after the pregnancy ends) are not affected. They can still enroll in full-scope Medi-Cal regardless of immigration status.²

The Legislative Analyst’s Office has flagged a separate October 2026 proposal that would shift certain immigrant groups who currently hold federally funded full-scope coverage, such as refugees, asylees, and battered noncitizens affected by federal funding changes, into restricted scope as well.¹¹

How to Apply

You can apply through several channels. The fastest option is the BenefitsCal online portal at benefitscal.com, where you can complete and submit the application digitally.¹² You can also apply in person at your county social services office, by phone, or by mailing a paper application.

Have these ready:

Identity documents such as a birth certificate, foreign passport, or other government-issued ID
Proof of California residency, such as a utility bill, lease, or mail addressed to you at a California address
Income verification: recent pay stubs showing gross income, an employer letter, or your most recent federal tax return. Self-employed applicants can provide a tax return or profit-and-loss statement.
Household information, including names and income for everyone in your home, because income limits scale with household size

A quick note on forms: the initial application is not the MC 210. The MC 210 RV is a separate redetermination form used for annual renewals. For a first application, use BenefitsCal or the paper application available at your county office.

Renewing Your Coverage

Every Medi-Cal member’s eligibility is reviewed once a year. Your renewal date varies; you can check it by logging into your BenefitsCal account or waiting for the renewal letter that arrives by mail. In many cases the county can confirm continued eligibility automatically using government databases and renews you without any action on your part. If the county needs more information, a renewal form arrives in a bright yellow envelope; complete it and return it with any requested documentation.¹³

Under the 2026 freeze, missing a renewal is more consequential than it used to be. If full-scope coverage lapses because you did not complete your renewal, you generally cannot re-enroll in full-scope and drop to restricted scope only.⁷ There is a limited safety net: if you act within 90 days of the notice date, you can submit the renewal form or missing information and have your case reviewed without filing a brand-new application. After 90 days you must start over.¹³

You must also report changes throughout the year that affect eligibility, including changes to income, household size, address, pregnancy status, immigration status, or other health coverage. You do not need to report or provide proof of non-income assets like bank accounts, homes, or vehicles.¹³

Public Charge and Immigration

Fear of immigration consequences keeps many eligible people from applying, so this point deserves a direct answer. Using restricted scope Medi-Cal, including emergency services and pregnancy-related care, does not count against you in a public charge determination. Federal immigration officials do not consider emergency Medicaid, health clinics, or short-term rehabilitation services when deciding whether someone is likely to become a public charge.¹⁴

The one exception is long-term institutional care. If Medi-Cal is paying for a nursing home or another long-term care facility, that benefit could factor into a public charge analysis for someone entering the country or applying for lawful permanent resident status. Outside of that narrow scenario, applying for and using Medi-Cal will not affect your immigration status, your path to a green card, or your eligibility for citizenship.¹⁵

1
Covered California. Program Eligibility by Federal Poverty Level for 2026
2
Department of Health Care Services. Immigration Status and Changes to Medi-Cal Eligibility
3
Legal Information Institute. California Code of Regulations Title 22 50302 – Restricted Medi-Cal Benefits
4
Legal Information Institute. California Code of Regulations Title 22 50740 – Medi-Cal Cards for Restricted Medi-Cal Benefits to Certain Aliens
5
California Department of Health Care Services. Medi-Cal Help Center
6
California Legislative Information. California Welfare and Institutions Code 14007.5
7
Department of Health Care Services. Medi-Cal Eligibility Division Information Letter No. I 25-27
8
Medi-Cal Providers. Postpartum Care Expansion for Medi-Cal and MCAP Beneficiaries
9
Department of Health Care Services. Eligibility by Federal Poverty Level
10
Department of Health Care Services. Asset Limit Frequently Asked Questions
11
California Legislative Analyst’s Office. The 2026-27 Budget: Medi-Cal Analysis
12
BenefitsCal. Home – BenefitsCal
13
Department of Health Care Services. FAQs – Keep Your Medi-Cal
14
U.S. Citizenship and Immigration Services. Public Charge Resources
15
Covered California. Public Charge