How Medical Expenses Can Lower Your Medi-Cal Share of Cost

If you qualify for Medi-Cal with a Share of Cost (SOC), your monthly medical expenses may be used to reduce—or even eliminate—your share of cost. This process is often called “spend down,” but no cash payment is required. Instead, documented medical expenses are subtracted from your countable income.

What Is Countable Income?

Countable income is the income Medi-Cal uses to determine whether you must meet a Share of Cost. If your income is above the Medi-Cal limit, (income chart) approved medical expenses can be used to bring that income down to the allowed level.

What Medical Expenses Can Be Used

The following expenses are commonly accepted when properly documented:

• Health, dental, or vision insurance premiums  visit our webpage 
• Dental insurance premiums (often very effective for SOC reduction)  visit our webpage 
• Doctor visits, hospital bills, and lab work
• Prescription medications
• Medicare premiums (Part B, Part D, Medigap)  visit our webpage 
• Long-term care or home care expenses
• Medical equipment and supplies our webpage on DME
  • Get much more detail on the Cal Fresh website 
  • 

Expenses may be current, ongoing, or unpaid, as long as they are legitimate medical costs and clearly documented.

How the Share of Cost Is Reduced

1. Medi-Cal determines your monthly countable income
2. Approved medical expenses are subtracted from that income
3. If expenses reduce income to the Medi-Cal limit,  (our FPL webpage) your Share of Cost becomes $0
4. Medi-Cal coverage then pays according to program rules.    See IHSS website

This process can be repeated monthly or updated when expenses change.

How to Upload Medical Expense Proof to BenefitsCal.com

Step-by-Step Instructions

1. Go to BenefitsCal.com and log in
2. Select your case under My Benefits
3. Choose Upload Documents
4. Select Medical Expenses / Proof of Medical Costs
5. Upload:
   • Insurance premium statements
     • We can help you set up Dental, Vision and Medi Gap Coverage our webpage 
   • Bills or invoices
   • Explanation of Benefits (EOBs)
6. Submit and keep confirmation for your records

Once uploaded, the county reviews the documents and recalculates your Share of Cost.

Important Tips

• Upload clear, readable documents
• Include monthly premium amounts whenever possible
• Keep copies of everything you submit
• Processing times vary by county, so follow up if needed

If documents are approved, your Share of Cost may be reduced retroactively to the start of the month.

Need Help?

If you’re unsure which expenses to use, how much income needs to be reduced, or how to upload documents correctly, assistance is available. Many people miss out simply because paperwork isn’t submitted the right way.

Citations & References

• California Welfare & Institutions Code §14005.37
• California Code of Regulations, Title 22, §50555
• California Department of Health Care Services (DHCS) – Medi-Cal Eligibility Manual
• BenefitsCal User Guide – Document Upload Instructions
• DHCS All County Welfare Directors Letters (ACWDLs) on Share of Cost

Does Medicare Cover Incontinence?

See our webpage on DME  Durable Medical Equipment

Here’s a 2nd AI answer…  

To lower your Medi-Cal Share of Cost (SOC), you can use payments for medically necessary services, supplies, and equipment, even if they aren’t covered by Medi-Cal or are from non-participating providers, including doctor visits, prescriptions, dental care, hospital stays, prosthetics, transportation, and sometimes IHSS/in-home care, by submitting detailed receipts and physician orders to your county worker. [1, 2, 3, 4, 5]

What Counts (Examples)

• Services: Doctor/dentist visits, hospitalizations, mental health, rehab (PT/OT), acupuncture, chiropractic, specialist care, lab tests.
• Medications: Prescription drugs, certain prescribed over-the-counter meds (like insulin, vitamins), but not nutritional supplements.
• Supplies & Equipment: Wheelchairs, oxygen, hearing aids, dentures, eyeglasses, incontinence supplies, special phones for disabilities, medical equipment.
• Insurance Costs: Your Medicare premiums, health insurance premiums, co-pays, and deductibles (if not covered by Medi-Cal).
• Care-Related Costs:
  • Transportation: Reasonable costs for travel to medical appointments.
  • Lodging: Needed to get medical treatment.
  • In-Home Care: IHSS or prescribed home care services beyond standard hours.
  • Service Animals: Costs for specially trained animals for the disabled.
• Unpaid Bills: Past, unpaid medical bills can count for future months, and you can get retroactive coverage if your SOC was met in prior months. [1, 2, 3, 5, 6, 7, 8]

How to Get Expenses Applied

1. Pay the Provider: Pay for the medically necessary service or item.
2. Get Proof: Keep detailed receipts and, if possible, a doctor’s order or prescription.
3. Contact Your County: Submit these documents to your county Medi-Cal worker so they can be applied to your Share of Cost. [3, 5, 7]

AI responses may include mistakes.

[1] https://canhr.org/understanding-the-share-of-cost-for-medi-cal/

[2] https://calfresh.guide/medical-expense-deductions/

[3] https://www.chcf.org/wp-content/uploads/2017/12/PDF-ShareOfCostMediCal2010.pdf

[4] https://mcweb.apps.prd.cammis.medi-cal.ca.gov/file/manual?fn=share.pdf

[5] https://dpss.lacounty.gov/content/dam/dpss/documents/en/medical/Share%20of%20Cost%20Flyer.pdf

[6] https://www.dhcs.ca.gov/Get-Medi-Cal/Pages/coverage-for-all.aspx

[7] https://www.disabilityrightsca.org/publications/using-your-medi-cal-share-of-cost-if-you-are-a-nursing-facility-resident

[8] https://cahealthadvocates.org/low-income-help/medi-cal-for-people-with-medicare/