Medi-Cal ex parte renewal is the automated process California uses to confirm you still qualify for coverage without asking you to fill out any forms. The Department of Health Care Services (DHCS) checks federal and state databases against the information in your file, and if everything lines up, your coverage continues for another 12 months. Federal law requires the state to attempt this automated review before requesting paperwork from you.1eCFR. 42 CFR 435.916 – Renewal of Medicaid Eligibility
When the Renewal Process Starts
The ex parte review begins roughly 60 to 90 days before your current coverage period ends.2Medicaid.gov. Basic Requirements for Conducting Ex Parte Renewals of Medicaid During that window, the state runs its database checks quietly in the background. You won’t get a phone call or a request for pay stubs unless something in the data doesn’t match.
If the automated review succeeds, DHCS mails you a Notice of Action confirming that your coverage has been renewed for another 12 months. That notice is the only signal you’ll receive, and no further action is required.
What the State Checks During the Review
The state pulls from a network of government systems to verify what’s in your Medi-Cal file. The Federal Data Services Hub connects to IRS records and Social Security Administration data to verify income, citizenship, identity, and federal benefits. On the state side, DHCS checks Employment Development Department records for quarterly wages and unemployment insurance, and cross-references the Franchise Tax Board for state tax filings.3Medicaid.gov. MAGI-Based Eligibility Verification Plan DMV records and data from CalFresh and CalWORKs fill in the rest.
The system is looking for agreement between these databases and what’s already on file for you. If reported income, household size, and residency all match the electronic records, the review closes without human involvement. When sources conflict or a figure sits close to a cutoff, the case gets flagged for follow-up.
Income Limits Behind the Automated Check
For most adults and children, Medi-Cal uses Modified Adjusted Gross Income (MAGI), which is essentially your adjusted gross income with items like tax-exempt interest and the full amount of Social Security benefits added back in. The system compares your household MAGI against the threshold for your program category. For 2026, those limits are:4Covered California. Program Eligibility by Federal Poverty Level for 2026
- Adults: up to 138% of the federal poverty level, or $22,025 per year for a single person and $45,540 for a family of four.
- Children: up to 266% FPL, or $42,454 for a household of one and $87,780 for a family of four.
- Pregnant individuals: up to 213% FPL, or $33,995 for a single person and $70,290 for a family of four.
Each additional household member raises the limit. If you qualify based on age (65 or older), blindness, or a disability, non-MAGI rules apply and add an asset test. That asset limit returned to $130,000 for one person effective January 1, 2026, with an additional $65,000 for each extra household member.5Department of Health Care Services. Asset Limits FAQs Asset checks run through a separate Asset Verification System that queries financial institutions directly.6Medicaid.gov. Financial Eligibility Verification Requirements and Flexibilities
When the System Can’t Confirm Your Eligibility
If the ex parte review fails, DHCS mails you a pre-populated renewal form in a yellow envelope.7Department of Health Care Services. Renewal Form Getting the yellow envelope doesn’t mean you’re ineligible. It usually means the databases returned incomplete or conflicting information: a wage record that’s a quarter behind, a household size that doesn’t match your tax filing, or income from a new job that hasn’t shown up yet.
“Pre-populated” means the form already contains what the state has on file, so you’re mainly verifying and correcting. Federal law gives you at least 30 days from the date the form is sent to respond.1eCFR. 42 CFR 435.916 – Renewal of Medicaid Eligibility Before coverage can actually be terminated, the state must send a separate notice at least 10 days before the end date.8eCFR. 42 CFR 431.211 – Advance Notice
You can complete the renewal online through BenefitsCal by logging in, opening the “Things to Do” section, and clicking “Submit renewal.”9BenefitsCal. BenefitsCal – Renew Medi-Cal Update You can also mail or hand-deliver the paper form to your county social services office. The due date printed on the form is the one that counts.
If You Miss the Deadline: The 90-Day Cure Period
Miss the deadline and your coverage terminates, but federal regulations give you 90 days after termination to submit the requested information. If you get it in during that window, the agency must reconsider your eligibility without a brand-new application.10eCFR. 42 CFR Part 435 Subpart J – Redeterminations of Medicaid Eligibility California applies this 90-day cure period to both MAGI and non-MAGI beneficiaries.
This is where people get tripped up. They assume that once coverage ends it’s gone for good and they need to start over. Not true within those 90 days. Submit the paperwork, and if you still qualify, the state can reinstate your coverage. After 90 days, a full new application is the only path back in.
If Your Income Is Too High for Medi-Cal
If the renewal determines your income no longer qualifies you, the state doesn’t just close your file. Federal rules require DHCS to check whether you might qualify for subsidized coverage through the marketplace and transfer your information to Covered California automatically.11Medicaid.gov. Informational Bulletin – Account Transfer Functionality
Losing Medi-Cal also triggers a 90-day special enrollment period with Covered California, letting you buy a marketplace plan outside open enrollment.12Covered California. Special Enrollment Depending on your income, you may qualify for premium tax credits that reduce monthly costs. If you’re between 138% and 400% of the federal poverty level, marketplace subsidies are built for your situation.
Appealing a Denial
If your renewal is denied and you think the decision is wrong, you can request a state fair hearing. You normally have 90 days from the date the Notice of Action is mailed, though DHCS has temporarily extended the deadline to 120 days for Medi-Cal eligibility disputes.13California Department of Social Services. State Hearing Requests You can file online through the CDSS website, by phone at (800) 743-8525, or by mailing the hearing request form on the back of your Notice of Action.
One timing detail matters more than any other. If you request a hearing before the termination date listed on your 10-day advance notice, your Medi-Cal continues while the appeal is pending. This is called “aid paid pending.” Miss that window and coverage stops during the appeal. If the hearing decision ultimately goes against you, the state may seek to recover the cost of benefits paid during the appeal period.
Hearings are administrative proceedings, not trials. You can present documents showing income and household details and explain why you believe you still qualify. Federal law requires a decision within 90 days.14eCFR. 42 CFR Part 431 Subpart E – Fair Hearings for Applicants and Beneficiaries You don’t need a lawyer, and legal aid organizations in California often help with Medi-Cal hearings at no cost.
How to Keep Your Renewal on Autopilot
The single best thing you can do to keep next year’s ex parte review working is to keep your file current. You’re required to report changes within 10 days, including address, income, household size, pregnancy, and marital status.15Department of Health Care Services. Update Your Information Report through your BenefitsCal account or by contacting your county office.
When the databases and your file agree, the system confirms eligibility quickly and quietly. When they don’t, you get the yellow envelope. The most common reason the ex parte process fails isn’t that someone became ineligible; it’s that the data didn’t match because of an outdated address, an unreported household change, or wages from a new job that haven’t hit the state’s records yet. A few minutes updating your account after a life change can save you weeks of paperwork later.