This story was published in partnership with Public Health Watch
For months, millions of immigrants in California received the same message: Get ready to lose your Medi-Cal dental benefits.
Two rounds of notification letters, roughly 4.6 million in all, were sent to affected immigrants statewide.
Families were horrified to learn that certain adults — undocumented individuals, deferred action recipients, many green card holders and others — could no longer access dental cleanings or common treatments through California Medicaid, or Medi-Cal, starting July 1, 2026. Only dental emergencies would be covered.
As word spread, patients streamed into dental offices seeking last-minute care and cleanings, providers told Public Health Watch. Many were still clutching the letters they’d received.
But a sudden change occurred: In late June, state legislators and Gov. Gavin Newsom agreed to postpone a range of Medi-Cal budget cuts by one year, including the reduction in immigrant dental benefits.
Lawmakers who had pushed for the delay celebrated. Providers exhaled. But many thousands of immigrants remained in flux, unaware of the state’s vote to preserve their dental benefits or confused over conflicting messages — the letters they’d received versus a flurry of news reports about the legislative deal.
Official guidance was in short supply. California’s Department of Health Care Services, or DHCS, which oversees Medi-Cal, didn’t start notifying immigrants by letter for up to a month. Correction letters were mailed “by the end of July 2026,” said Anthony Cava, a DHCS spokesperson. Unlike the agency’s earlier notices, “a second round of letters will not be sent,” he added.
By September, the DHCS also hadn’t formally instructed its health insurers to call Medi-Cal members to let them know they still had dental coverage. By contrast, in May, the agency had ordered insurers to call affected immigrants up to three times about their soon-to-vanish dental benefits.
Cava told Public Health Watch that in July, the DHCS verbally instructed insurers to make those calls, but the official order is “currently in draft and has not been issued.”
Meanwhile, the clock is ticking again for roughly 2.3 million immigrants set to lose their dental benefits on July 1, 2027.
Esperanza, an unauthorized immigrant in Tulare County, still hasn’t received her correction letter from the DHCS. She asked to remain anonymous because of her legal status.
A former farm worker who spent years harvesting fruits, nuts and vegetables in the San Joaquin Valley, Esperanza can no longer work due to a chronic hand injury. She depends on Medi-Cal for her healthcare.
When she received the first notification letter from DHCS about her dental coverage cancellation in May, she wept. “Es una tristeza,” she said. It’s heartbreaking. Since then, a growing ache has formed in her teeth — a constant, numbing pain in her lower jaw. The discomfort prevents her from eating normally at times, but she has yet to see a dentist.
“I don’t know if they will still help me,” she said. “It might be too late to do anything.”
Lingering Effects
Dental care for low-income people is often overlooked in policy debates on Medicaid funding.
Federal law doesn’t require Medicaid to cover oral health, so coverage varies widely by state. But the need is great. According to the Centers for Disease Control and Prevention, roughly 20% of adults in the U.S. have untreated tooth decay.
Without dental care, cavities and other dental diseases can spur life-threatening infections and stoke overall health problems, including diabetes, cardiovascular disease and arthritis.
“Oral health and systemic health are so interconnected,” said Dr. Mackenzie Martin, government affairs council member for the California Dental Association. “Infection in the mouth can go straight to the heart, to the brain. … And [in] quality of life, in terms of eating and chewing and function, nothing will replace your teeth.”
Dental issues can be particularly severe among immigrants who have little access to affordable oral health care. A study published by the Journal of the American Dental Association in 2018 found that more than 50% of noncitizens in the U.S. were diagnosed with periodontal disease and 38% had cavities, compared to 34% and 27% for native-born citizens. The gaps close when the data is adjusted to account for health insurance, the study said.
The Road Ahead
California is one of only three states with Medicaid or other programs that extend oral health benefits to low-income immigrant adults, regardless of age or legal status. The expanded coverage can be costly for states, since many immigrants are barred from receiving federally funded Medicaid. The arrangement also makes immigrant health programs much more vulnerable to year-to-year instability.
A growing question is whether immigrants will stop seeking Medi-Cal dental care because they think incorrectly that their benefits have ended or they’ve given up in fear over government efforts to deny them subsidized care.
Across the U.S., state-level programs offering health coverage to undocumented, deferred action and other immigrants who are ineligible for federal Medicaid are being closed. Authorities are using hospitals and health clinics to carry out immigration arrests. In October, roughly 1.4 million lawfully present immigrants, including asylees and refugees, will lose their federal Medicaid coverage because of eligibility changes in the federal budget bill of 2025, H.R. 1.
The once-signature “Health Care for All” movement in California has sharply declined. A Medi-Cal enrollment freeze began this year, blocking undocumented and other immigrants from enrolling in the state-funded program. Those now enrolled could lose their coverage permanently if they fail to meet paperwork deadlines for more than 90 days. And next year, immigrants will have to pay $50 monthly premiums to keep their coverage.
Ruqayya Ahmad, an oral and behavioral health policy manager at the California Pan-Ethnic Health Network, a nonprofit that advocates for health equity, said the turbulence has had a lasting effect on immigrants’ trust in Medi-Cal.
“The budget might change on paper, but people are not instantly going to regain their sense of security. … When the same communities keep seeing their benefits on the chopping block, that can really discourage people from seeking care,” she said.
From January through May, over 220,000 immigrants, or 16% of total enrollees in California’s Medi-Cal expansion program, have dropped or lost their Medi-Cal coverage, the most recent state data show.
For Esperanza, a number of health problems keep her motivated to stay enrolled in Medi-Cal. She reached out to a local clinic to get her dental pain checked, but appointments weren’t available until October.
Until then, she’s rinsing her mouth with hot water and salt to ease the pain. She already worries about how she’ll manage next year, when her dental benefits may be gone, “De verdad, es bien triste,” she said. Truly, it’s very sad.
This story is part of “Uninsured in America,” a project led by Public Health Watch, that focuses on life in America’s health-coverage gaps and the impact of potential Medicaid cuts and other changes.