Trump's Medicaid Work Mandate Threatens Coverage for Thousands of Unhoused Californians

Street medicine providers worry new Medi-Cal eligibility rules will cause many homeless individuals to lose health insurance.

Published on Mar. 5, 2026

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A new law signed by former President Donald Trump requires able-bodied Medicaid recipients in California to work at least 80 hours per month to maintain coverage. This poses a major challenge for the state's roughly 180,000 homeless people, who often struggle with mental health, addiction, and other conditions that make it difficult to meet work requirements. State officials estimate up to 2 million Medi-Cal recipients could lose coverage due to the new rules, including many unhoused individuals who may qualify for exemptions but face barriers to getting them certified by a doctor.

Why it matters

Losing Medi-Cal coverage will severely limit access to healthcare for unhoused Californians, who already have far worse health outcomes and a lifespan nearly 20 years shorter than the general population. Without insurance, they won't be able to get regular care, pick up medications, or see specialists, leading to worsening health conditions and increased reliance on emergency rooms. This could also jeopardize the state's investments in street medicine teams and housing programs that have been helping to address homelessness.

The details

The new Medi-Cal work requirement law, part of Trump's 'One Big Beautiful Bill', requires states starting in 2027 to verify that able-bodied adults under 65 without dependent children are working at least 80 hours per month to qualify for Medicaid. It also requires more frequent eligibility checks every six months instead of annually. State officials estimate up to 2 million of California's 14 million Medi-Cal recipients could lose coverage, either because they don't meet the work rules or get overwhelmed by the increased paperwork. This will be especially challenging for homeless individuals, who often lack access to phones, the internet, and other resources needed to comply. While the law includes exemptions for those with disabilities, mental health conditions, and other barriers to work, many unhoused people lack access to primary care providers who can certify these exemptions.

  • The new Medi-Cal work requirement law will go into effect in 2027.
  • In January 2026, volunteers conducted the annual Point-in-Time Count to survey California's homeless population, which is estimated at around 180,000 people.

The players

Brett Feldman

A physician assistant who leads the street medicine team at the USC Keck School of Medicine, providing primary care to thousands of homeless individuals in Los Angeles.

Kelly Bruno-Nelson

An executive director with CalOptima, an Orange County Medi-Cal plan that provides health insurance for an estimated 11,000 members with unstable housing.

Samantha Randolph

A 37-year-old woman who has been living on the streets of Los Angeles for more than five years and is seven months pregnant.

Tyler Sadwith

The state Medicaid director at the Department of Health Care Services, who is working to launch an eligibility verification system to try to minimize harm to Medi-Cal members.

Matt Beare

A street medicine physician in Kern County who says that unhoused people frequently 'fall through the cracks' when it comes to maintaining their Medi-Cal coverage.

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What they’re saying

“It's very possible over 90% of people experiencing unsheltered homelessness will lose insurance.”

— Brett Feldman, Physician Assistant (Los Angeles Times)

“This is going to be a huge issue for the unhoused.”

— Kelly Bruno-Nelson, Executive Director, CalOptima (Orange County Register)

“The cost of falling through the cracks is likely human life.”

— Matt Beare, Street Medicine Physician (Bakersfield Californian)

What’s next

State Medi-Cal officials are working to launch an automated eligibility verification system that would check for work requirement compliance and exemptions, in an effort to minimize the number of people who lose coverage. However, there are still many unanswered questions about how the system will work and whether it will be able to fully account for the unique challenges faced by California's homeless population.

The takeaway

This policy change threatens to undermine the progress California has made in expanding healthcare access and street medicine services for unhoused individuals, potentially leading to worsening health outcomes and increased strain on the state's emergency medical system. It highlights the need for more flexible, compassionate approaches to Medicaid eligibility that account for the complex barriers faced by homeless populations.