California Medi-Cal Share of Cost FAQs

• What is Medi-Cal share of cost in California?
  • Share of cost is the monthly amount a California Medi-Cal member must pay or incur in medical expenses before Medi-Cal begins paying for services.
• Does share of cost reset every month in California?
  • Yes. California Medi-Cal share of cost resets every calendar month.
• Is share of cost the same as a deductible?
  • No. A deductible is usually annual and based on an insurance plan. Share of cost is monthly and based on income.
• Who has to pay share of cost in California?
  • Typically seniors, individuals with disabilities, or people whose income exceeds standard Medi-Cal limits but still qualifies after deductions.
• Do prescription drugs count toward share of cost?
  • Yes, prescription medications usually count toward share of cost in California.
• Can unpaid medical bills count toward share of cost?
  • In many cases, yes — including certain unpaid bills from prior months.
• Can my share of cost change?
  • Yes. Changes in income, household size, or deductions can change your share of cost.
• What about Estate Recovery?  Can they take my home?
  • Here’s our webpage on  Estate Recovery
• Should I talk to an agent about share of cost?
  • Absolutely. California Medi-Cal rules are complex, and a licensed agent can help identify better options.  Also, ask your Social Worker and BenefitCal.com
• What about a cancer or hospital indemnity plan?
  • Short and honest answer: no — a cancer policy or hospital indemnity policy does not count as health insurance that lowers a Medi-Cal Share of Cost (SOC).Here’s the plain-English breakdown 👇
    

    ---

    Why these policies don’t reduce Share of Cost

    Medi-Cal only gives SOC credit for actual medical expenses or true health insurance premiums.

    Cancer and hospital indemnity policies are considered “supplemental” or “limited benefit” policies, not comprehensive health insurance.

    What that means in practice

    • They pay you cash, not doctors or hospitals directly
    • The money can be used for anything (rent, food, gas, etc.)
    • Because of that, Medi-Cal treats them as income-replacement or cash benefit policies, not medical coverage

    So:

    • ❌ Premiums do not reduce countable income
    • ❌ Benefits do not count as medical expenses to meet SOC

    ---

    Common examples that do NOT lower SOC

    • Cancer-only policies
    • Hospital confinement / hospital indemnity plans
    • Accident-only cash benefit plans
    • Critical illness lump-sum policies

    Even if the policy says “medical” in big letters — Medi-Cal looks at how it pays, not how it’s marketed.

    ---

    What does lower Medi-Cal Share of Cost

    These can reduce SOC if structured correctly:

    ✔ Major medical insurance premiums
    ✔ Certain dental insurance plans
    ✔ Vision insurance premiums
    ✔ Medicare premiums (Parts B, D, Medicare Advantage)
    ✔ Actual out-of-pocket medical bills

    • See FAQ on Adult Diapers below.
  • ✔ In some cases, long-term care insurance
    

    The key rule: the expense must be tied directly to medical care or medical insurance — not cash benefits.

    ---

    Important warning (this trips people up)

    Some agents sell hospital indemnity or cancer plans claiming they lower Share of Cost.
    That’s usually incorrect, and Medi-Cal caseworkers routinely deny those deductions.

    If someone is trying to use one of these policies to reduce SOC:

    • It may work temporarily
    • But it often gets reversed later — sometimes with back bills

    ---

    Bottom line

    Cancer and hospital indemnity policies do NOT count as health insurance for lowering Medi-Cal Share of Cost.

    If your goal is:

    • Reducing SOC
    • Qualifying for full Medi-Cal
    • Coordinating with IHSS

    …you need a policy designed specifically for Medi-Cal rules, not a cash-benefit plan.

    If you want, tell me:

    • County (sounds like California, possibly LA County?)
    • Approximate income sources
    • Current Share of Cost

    This was Chat GBT – references on this page or our main share of cost page 

Need Help With Share of Cost in California?

If you’re confused or frustrated by Medi-Cal share of cost, you’re not alone.

👉 Here’s the application with premiums up to $425 
👉 Email us [email protected]  please include all paperwork you have

• Can Medi Cal take our home when we pass away?
  • See our webpage on estate recovery  

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

---

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

---

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]

 

FAQ’s

 

• IHSS webpage
  .
  .
• Question With SOC Share of Cost at 770.00 do I need to present the card at routine office visits, or present it only if medical expense is greater than 770.00. ?
  .
  • Answer Yes, that way you get the Medi-Cal Negotiated Rate.
    •  
  • Dual Coverage & Medicar
• Question If I have Share of Cost, can I get a Covered CA plan with Subsidies? APTC
  .
  • Yes, since SOC is NOT  minimum essential coverage so they can qualify for financial assistance through Covered California.
    • Minimum essential coverage includes:
      • Full-scope Medi-Cal programs, including the Targeted Low-Income Children’s Program (former Healthy Families program),43 Medi-Cal Access Program (MCAP – former AIM program), and Refugee Medical Assistance programs administered by Medi-Cal;44
      •  Medi-Cal Share of Cost programs and programs with limited scope of services such as Minor Consent), individuals enrolled in these programs can simultaneously enroll in a Covered California plan with advanced premium tax credits so long as they meet Covered California’s eligibility criteria.
      • Medi-Cal only covers what Covered California does not, such as In-Home Supportive Services, adult dental, or long-term care, so individuals should check provider networks before picking a Covered California plan for most regular health services.    ^{Western Poverty Law} *
      • Plans with Covered CA subsidies? Get quote…
      • Get Covered CA quotes.
        .
• Question How does Medi-Cal share of cost work with Medicare Part D Rx Prescription coverage?
  .
  • Answer If you are receiving both Medicare and Medi-Cal benefits, the Medicare Part D drug benefit will provide your prescription-drug coverage instead of Medi-Cal.
    • Low-Income Subsidy (LIS) program, also known as the “Extra Help” program, will pay for part or all Medicare Part D drug-benefit plan premiums, depending on the plan in which you are enrolled. Learn more about the Extra Help program and the Medicare Part D drug benefit.
      .
• ..
• See situation # 16 above, it looks to me like you can get Medi Gap guaranteed issue.
  • Here’s a video explanation of our research and answer to your question.
  • You can also get dental & vision coverage.
  • I will grant that it’s very confusing on the time periods that you can enroll or exit a Medicare Advantage Plan.
    .
• Question Does veteran aid & attendance or death benefits as unearned income count towards share of cost?.
  .
  • t seems like the best and understandable explanation
    • Countable Income for SSI Program

FAQ’s 

Getting additional Insurance to #lower SOC Share of Cost

IHSS In Home Supportive Services  

Please send us [email protected] all the paperwork from Medi Cal so that we can review it and see above for various plans once Medi Cal tells you how much you need to spend

 

When you’re dealing with Medi-Cal Share of Cost (SOC) in California, the key question is whether a payment is considered countable (unearned) income or excluded income under Medi-Cal rules.

Here’s how Veterans Aid & Attendance (A&A) is generally treated:

---

1️⃣ What Is Veterans Aid & Attendance?

Aid & Attendance (A&A) is an increased pension amount paid by the U.S. Department of Veterans Affairs to eligible veterans or surviving spouses who:

• Need help with activities of daily living (ADLs), or

• Are housebound, or

• Reside in assisted living or a nursing facility

It is paid as part of a VA pension, not as a separate disability compensation program.

---

2️⃣ Is Aid & Attendance Countable for Medi-Cal Share of Cost?

✔️ In Most Cases — Yes, It Is Countable Income

Under California Medi-Cal rules:

• VA pension payments (including the A&A portion) are treated as unearned income.

• Unearned income counts toward the Medi-Cal Share of Cost calculation.

• The full gross amount is typically included before standard Medi-Cal deductions.

So if someone receives:

• $2,000/month in VA pension (including A&A),
  that $2,000 is generally included as countable income when calculating Share of Cost.

---

3️⃣ How It Affects Share of Cost

For Aged, Blind, and Disabled (ABD) Medi-Cal:

Share of Cost formula (simplified):

Gross monthly income
– $20 general income disregard
– Maintenance Need Level (MNL)
= Share of Cost

Since A&A counts as income:

• It increases gross income.

• That usually increases Share of Cost unless offset by medical expenses.

---

4️⃣ Important Exception: Long-Term Care Medi-Cal

If someone is in a nursing facility under long-term care Medi-Cal, treatment can be slightly different:

• Most income (including VA pension) goes toward the “patient pay amount.”

• The individual keeps only a small personal needs allowance.

• Spousal impoverishment rules may apply.

In those cases, VA pension is still income — but applied toward facility cost rather than traditional Share of Cost.

---

5️⃣ Can Aid & Attendance Ever Be Excluded?

There are limited circumstances where:

• Certain VA reimbursements for medical expenses

• Or unusual retroactive payments

might be treated differently.

But regular ongoing monthly Aid & Attendance pension payments are countable income for Medi-Cal purposes in California.

---

6️⃣ Practical Example

Let’s say a client receives:

• $2,200/month VA pension with Aid & Attendance

• No other income

Medi-Cal calculation might look like:

$2,200
– $20 disregard
– $600 (approx. Maintenance Need Level for 1 person)
= ~$1,580 Share of Cost

That means the client would need to incur $1,580 in medical expenses each month before Medi-Cal pays.

---

7️⃣ Strategic Planning Considerations (Where It Gets Interesting)

Because you work heavily with:

• Medi-Cal Share of Cost strategies

• Medical expense offsets

• Long-term care scenarios

It becomes important to coordinate:

• Proper documentation of recurring medical expenses

• Adult diaper receipts

• Home care invoices

• Assisted living contracts

Those can reduce or eliminate Share of Cost each month.

---

Bottom Line

Veterans Aid & Attendance is generally countable as unearned income for Medi-Cal Share of Cost in California.

It increases gross income and therefore usually increases Share of Cost unless offset by allowable medical expenses.

---

If you’d like, I can:

• Draft a short consumer-friendly explanation block for your website

• Or create a compliance-oriented FAQ version with regulatory citations

• Or map out how this interacts with spousal impoverishment rules

Just let me know which direction you want to take it.