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Adult #Diapers to lower Medi Cal Share of Cost 

 

 

How to Use Adult Diaper Receipts to Lower Medi-Cal Share of Cost

If you have Medi-Cal with a Share of Cost (SOC), medically necessary expenses may be used to meet or reduce your monthly Share of Cost. This can include incontinence supplies (adult diapers) — if properly documented.

Below is what county Medi-Cal offices typically require.

1. Medical Necessity Documentation

Because adult diapers are sold over the counter, Medi-Cal generally requires proof they are medically necessary, not just a personal convenience item.

Acceptable documentation may include:

• A written prescription
  • See page 5 of Medi Cal Incontinence Supplies  Medi Cal.gov  pdf 
• A physician’s note
• Medical record documentation stating:
  • The medical condition (e.g., incontinence)
  • That incontinence supplies are medically necessary
  • Expected frequency or ongoing need

Tip: Ask the doctor to include language such as:

“Patient requires ongoing incontinence supplies due to medical condition.”

This helps establish recurring eligibility for SOC credit.

• Clinical Guidelines…
  • Medi Cal.gov
  • How to Get Incontinence Supplies Covered by California Medicaid (Medi-Cal)  Byram Health Care.com
  • An Advocate’s Guide to Medi-Cal Services January 2020 Chapter X: Durable Medical Equipment, Orthotics and Prosthetics, and Other Non-Pharmaceutical Items   National Health Law pdf

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2. Detailed Purchase Receipts

Receipts should clearly show:

• Store or supplier name
• Date of purchase
• Item description (must identify adult diapers or incontinence supplies)
• Amount paid
• Proof the item was paid (not just ordered)

Best examples:

• Pharmacy receipts (e.g., retail pharmacy)
• Medical supply company invoices
• Online purchase invoices with payment confirmation

Generally not sufficient by themselves:

• Bank or credit card statements (unless matched to itemized receipt)
• Generic receipts with no product description

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3. Proof of Payment

If the receipt does not show “Paid,” include:

• Credit card transaction receipt
• Bank statement showing the charge
• Cancelled check copy

The expense must be incurred and paid (or legally owed) to be applied toward Share of Cost.

4. Timing Rules for Share of Cost

Under Medi-Cal Share of Cost rules:

• Medical expenses may be used to meet the SOC in the month they are incurred.
• Unpaid medical bills may sometimes be applied depending on case circumstances.
• Ongoing recurring expenses may be treated as predictable monthly medical costs.

Each county may review documentation differently, so keep copies of everything submitted.

5. How to Submit Through BenefitsCal

When uploading documents:

• Select “Medical Expenses”
• Clearly label documents (example: “Incontinence Supplies – SOC”)
• Upload both the prescription/doctor note and the receipt together

Clear labeling can help prevent processing delays.

See our webpage on uploading documents

Important Notes

• Expenses must be for the Medi-Cal beneficiary.
• Expenses cannot be reimbursed by insurance or another source.
• Documentation requirements may vary by county.
• This information is for educational purposes only and is not legal advice.

Regulatory Authority

Medi-Cal Share of Cost expense deductions are governed under:

• California Code of Regulations, Title 22
• Federal Medicaid regulations, including 42 CFR § 435.831 (d) 

These rules allow medically necessary health care expenses to offset Share of Cost for eligibility purposes.

If you would like assistance reviewing documentation before submitting it to your county Medi-Cal office, please contact our office for guidance.

A Quick Note About This Information

We created this page to help explain how Medi-Cal Share of Cost works and how medical expenses — including incontinence supplies — may be documented.

Every Medi-Cal case is different.

County eligibility workers make the final decision about what counts toward your Share of Cost based on your individual situation and current program rules. Requirements can vary by county and may change over time.

This page is for general educational purposes only. It is not legal or tax advice, and we cannot guarantee that any specific expense will be approved.

If you need legal advice about Medi-Cal eligibility, estate recovery, or planning strategies, we recommend speaking with a qualified elder law attorney.

If you would like help understanding how Share of Cost works in practical terms, feel free to contact our office for guidance.  [email protected]

 

IRS Publication 502 pdf * html

Medical & Dental #Expenses

• • Aetna Listing of HSA allowable expense
  • Topic no. 502, Medical and dental expenses  IRS.Gov 
    • expenses exceed 7.5% of your adjusted gross income for the year may be deductiblexxx
  • Medical Necessity? Our webpage
    • The Tax Definition of "Medical Care:"  Repository Law.com
  • Medical expenses also include amounts paid for qualified long-term care services and limited amounts paid for any qualified long-term care insurance contract.
  • Turbo Tax
  • Schedule A 1040 Itemized Deductions

Child & Sibling Pages

Site Map 

• How to Fix Medi-Cal Share of Cost Retroactively

• “How to Eliminate Medi-Cal Share of Cost with the 250% Working Disabled Program”
• Appeals Medi Cal
• Calculate Instantly Medi Cal Share of Cost and Zero it out!
• FAQ’s Share of Cost
• How to upload documents to BenefitsCal.com
• How to use medical expenses to lower share of cost
  • How to Fix Medi-Cal Share of Cost Retroactively
• IHSS In Home Supportive Services
• Medi Gap to lower share of cost Medi Cal IHSS
• Timing & Redetermination Medi Cal Share of Cost