Findings from focus groups with Californians enrolled in Medi-Cal and CalFresh
As Medi-Cal and CalFresh rules change, people need to know whether a change applies to them and what they need to do. The California Health Care Foundation funded this research, which Culture IQ conducted in partnership with the California Health and Human Services Agency, the Department of Health Care Services, and the Department of Social Services, to test public outreach materials with current enrollees. The research tested public outreach materials with current enrollees to explore which messages caught participants’ attention, earned their trust, and helped them understand the next step.
Lead with the Information People Need to Act
Participants responded positively to materials that made three things easy to find:
- Does this change apply to me? Explain who is affected and who may be exempt.
- When does it take effect? Put the date where readers will see it.
- What should I do next? Give a specific action and a clear way to get help.
Participants looked for information about exemptions as readily as they looked for the new requirements. An effective date helped convey urgency, while “Don’t lose your benefits” drew attention in testing. These elements worked best when the material also explained what the reader should do.
Show That the Message Is Legitimate
Across groups, participants looked for signs that a communication came from a trustworthy source. Government seals, Medi-Cal or CalFresh branding, recognizable websites that end in .gov or .org, and phone numbers helped them judge whether to engage with a message.
Some participants wanted several of these cues together, particularly those in the Mandarin-speaking groups. Spanish-preferred participants also relied on program branding to distinguish official information from advertisements or scams. A QR code alone did not establish trust; the type of device people were using when they encountered the code mattered.
Design opportunity: Show the source prominently and provide a website or phone number that readers can recognize or verify.
Make the Path Through the Message Obvious
Participants preferred materials with fewer words, clear sections, and prominent actions. They responded more positively to versions that used layout, color, and type size to guide them through the information.
A suggested order is: who is affected → when the change happens → what to do → where to get help. This structure also makes it easier for readers to find the one piece of information they need.
Match the Link to Where People See It
Participants liked QR codes when they could scan them easily. On a social media post viewed on a phone, many preferred a clickable link or visible URL. They expected the destination to offer practical help, such as eligibility information, renewal tools, forms, FAQs, or a way to find a local office.
Keep Different Program Changes Distinct
Some Spanish-preferred participants had heard about Medi-Cal changes affecting undocumented Californians and did not clearly distinguish those changes from the work requirements and six-month renewals discussed in this study. Outreach should name the population and the specific rule each time, especially when several changes are being discussed at once.
CalFresh participants also wanted help understanding how rules would apply to situations involving student status, caregiving, disability, changing work, or multiple people receiving benefits in one household. Short messages can point readers to a reliable place for those details.
About the Research
Culture IQ conducted 18 Zoom focus groups in March 2026 and 12 in May 2026 with Californians enrolled in full-scope Medi-Cal and/or CalFresh. Groups included English-speaking participants of diverse backgrounds, Spanish-preferred Latino/x participants, and Mandarin-speaking participants. In all, 117 people participated in the first phase; 77 returned for the second, when they reviewed outreach materials developed using earlier input. Participants were selected for research about changes affecting adults age 19–64 without young dependent children. These qualitative findings describe participants’ responses to the materials; they are not estimates of how all enrollees would respond. This message testing did not include undocumented Californians; findings should not be assumed to reflect their communication needs.
