From Policy Agenda to Action: What Xavier Becerra Means for California Healthcare

Direction: Healthcare Agenda Takes Shape 

Xavier Becerra will come to the governor’s office with an unusually deep healthcare background, including serving as U.S. Secretary of Health and Human Services. His record and platform offer insight into his priorities: protecting coverage, lowering costs, strengthening primary care, and expanding the workforce. His campaign laid out a 12-point healthcare policy agenda, offering a more detailed view of how those priorities could take shape in California. 

                             Source: Xavier Becerra 2026 campaign, “Health Care”, xavierbecerra2026.com 

Although Becerra has indicated broader coverage goals, his near-term proposals emphasize protecting existing coverage and making the current system more affordable and accessible.  

Federal policy will continue to shape what California can deliver.  With Democrats controlling both chambers of Congress, there may be opportunities to revisit Medicaid cuts and other coverage policies. However, major legislative reversals remain unlikely during the Trump Administration, leaving California to navigate continued uncertainty around federal funding, regulation, and implementation. 

Coverage: From Enrollment to Continuity of Care 

Becerra’s coverage agenda focuses not only on protecting eligibility, but on keeping eligible individuals enrolled. Operationally, he proposes using existing state data to automate Medi-Cal renewals, consolidating county-based enrollment administration, and taking early executive action to protect coverage continuity amid federal cuts or Medi-Cal rollbacks. 

As HHS Secretary, Becerra oversaw the return to regular Medicaid eligibility reviews after the pandemic, providing relevant context for his focus on administrative coverage losses. That challenge will intensify in 2027, when new federal work requirements and more frequent eligibility reviews take effect for certain adults. 

To avoid a coverage lapse and maintain continuity of care, plans and providers need coordinated outreach. Exemption documentation, renewal support, and clear escalation paths across care management, revenue cycle, and clinical teams are good places to start. 

Performance measurement must extend beyond enrollment totals. Preventable disenrollment, renewal completion, time to reinstatement, and continuity of active treatment can help leaders assess whether coverage protection is translating into uninterrupted care. 

Capacity: Protect the Care Behind the Coverage  

California already faces capacity constraints in primary care, behavioral health, rural communities, and other underserved areas. Becerra’s agenda treats workforce capacity as essential to making expanded coverage meaningful. He proposes a dedicated healthcare workforce investment fund, incentives and loan assistance for providers in high-need areas, partnerships to expand the workforce pipeline, and greater accountability for health plans to maintain adequate networks. He also proposes expanding telehealth access and investing in prevention and community-based care. 

For plans and providers, a contracted network alone is not enough; patients must be able to obtain timely care. Plans need visibility into provider availability, appointment access, geographic gaps, and specialty capacity. Provider systems need to understand the community providers, care relationships, and specialty services they rely on. 

Beginning January 1, 2027, certain Medi-Cal members who do not meet federal immigration requirements will transition from managed care to fee-for-service. The transition does not end Medi-Cal eligibility, but it changes how members receive care. Enhanced Care Management and Community Supports are not available through fee-for-service, creating care coordination and service continuity challenges. 

This also creates a test for CalAIM and for organizations that have built care models around it. As some members move outside managed care, the question is whether California can preserve the infrastructure and community partnerships developed to support complex populations.

Affordability: Using More Than One Lever 

A central theme of Becerra’s affordability strategy is using California’s size and market influence to drive down costs. That includes expanding CalRx, promoting appropriate lower-cost drug alternatives, and potentially partnering with other Western states on purchasing. 

His record suggests a broader approach to healthcare costs. During his tenure at HHS, CMS conducted Medicare’s first prescription-drug negotiation cycle. As California attorney general, Becerra challenged healthcare contracting and market practices he viewed as contributing to higher costs. 

Those experiences do not tell us exactly how he will govern, but they suggest that affordability efforts could extend across pharmacy pricing, purchasing, contracting, and other drivers of healthcare costs. Plans and providers should expect those areas to remain under scrutiny at both the state and federal levels. 

Financing: Follow the Money  

Many of Becerra’s healthcare commitments ultimately depend on how California chooses to pay for them, especially since so many of them compete for finite resources. His agenda calls for full implementation of Proposition 35, which directs how revenue from California’s managed care organization tax is used to support Medi-Cal and other health programs. He also proposes modernizing Medi-Cal financing by consolidating duplicative payment structures, strengthening base rates, and tying funding to clear performance and accountability standards. 

Plans could see changes in rates, contracting expectations, network requirements, and reporting. Providers will be watching whether reimbursement keeps pace with operating costs and whether Medi-Cal participation remains financially viable in key markets. State and county leaders will have to balance immediate program needs against investments whose benefits may take years to materialize. 

His first budget proposal will provide an early indication of those choices: what gets funded, what gets phased in or deferred, and where plans, providers, or public agencies may be expected to do more with existing resources. 

Organizations do not need to wait for final policy to start preparing. Plans and providers should model potential scenarios around enrollment, reimbursement, utilization, and supplemental funding, identify material exposure, and develop mitigation and contingency plans for the highest-risk outcomes. 

First 100 Days: From Priorities to Decisions  

Some signals could come quickly. His platform promises a Day One executive order directing state agencies to maintain coverage continuity for people affected by federal cuts or Medi-Cal rollbacks, along with an immediate assessment of at-risk rural hospitals, community clinics, and safety-net providers. Healthcare leaders should watch not only whether those actions occur, but what funding, legal authority, and implementation guidance accompany them. Three areas warrant particular attention: 

1. Leadership appointments. Who will run the state’s major healthcare agencies, and what experience and priorities do they bring? 
2. Where the money goes. Which coverage protections, provider payments, workforce investments, and delivery initiatives receive funding? 
3. What changes operationally. Watch how Medi-Cal enrollment, CalAIM, pharmacy purchasing, provider support, and administrative requirements shift in response to state and federal policy. 

Becerra’s healthcare agenda establishes direction. The first appointments, budget choices, and operating decisions will reveal which priorities California intends to protect, which may be deferred, and where the healthcare system will be expected to absorb additional pressure.  For healthcare leaders, those early moves will offer the clearest indication of what comes next.