Report Changes That Affect Your Medi-Cal Share of Cost

Do not wait for your annual Medi-Cal renewal when something changes that may lower—or increase—your Share of Cost.

The practical answer: If you begin paying a new dental, vision, Medicare supplement, prescription-drug or other health-insurance premium, report the change promptly through BenefitsCal or your county Medi-Cal office. Ask the county to review the new information and recalculate your Share of Cost.

The California Department of Health Care Services tells Medi-Cal members to report changes within 10 days. Changes involving private health coverage must also be reported so Medi-Cal has accurate insurance and eligibility information.

See the DHCS instructions for updating Medi-Cal information and the

DHCS Other Health Coverage page.

For address, income, marriage, household and other general changes, see our separate page:

How to Report Changes to Medi-Cal

Annual Renewal Is Not the Same as Reporting a Change

Annual renewal is Medi-Cal’s scheduled review of the information in your case. The county may be able to renew your Medi-Cal using information it already has. When more information is needed, you may receive a renewal form or a renewal task in BenefitsCal.

Reporting a change happens when something important changes before your scheduled renewal. This may cause the county to perform what DHCS calls a change-in-circumstances redetermination.

• Annual renewal: A scheduled review of your complete Medi-Cal case.
• Report a change: A midyear update involving income, property, household information, insurance or another fact that may affect eligibility.
• Share of Cost request: A request for the county to apply the updated information and determine whether your Share of Cost should change.

Do not wait for renewal when you purchase insurance specifically to reduce your Share of Cost. Report the premium and provide proof as soon as possible.

• Official references:
  • DHCS—Keep Your Medi-Cal and
  • DHCS ACWDL 22-33—Annual Renewals and Changes in Circumstances.

Your Share of Cost Resets Each Month—but the Dollar Amount Is Not Automatically Recalculated Each Month

A Medi-Cal Share of Cost applies separately to each month. When a new month begins, the amount that must be met before Medi-Cal begins paying for covered services starts over.

That does not mean the county automatically performs a new eligibility calculation every month. The amount shown in the county’s records normally remains in place until the county processes new information, completes a renewal or otherwise redetermines eligibility.

• Monthly reset: The existing Share of Cost must be met again in a new month when covered services are needed.
• Recalculation: The county reviews updated income, premiums, deductions, household or property information and determines a new amount.
• See the official
  • DHCS My Medi-Cal Guide and the
  • Medi-Cal Share of Cost Provider Manual.

What Changes May Affect Your Share of Cost?

Report changes that may affect the income, deductions or other information used in your Medi-Cal calculation. Examples may include:

• A new health-insurance premium: Dental, vision, Medicare supplement, Medicare prescription-drug or another health-related policy for which you pay a monthly premium.
• A premium increase or decrease: The policy remains active, but the amount you pay changes.
• A policy cancellation: Insurance previously used as an income deduction ends or is no longer being paid.
• A change in Medicare premiums: The amount paid for Medicare coverage changes.
• Income changes: Social Security, pension, wages, disability income or another source increases, decreases, starts or stops.
• Household changes: Marriage, separation, death or another change affecting the Medi-Cal household.
• Property or asset changes: When property rules apply to the person’s Medi-Cal eligibility category.

DHCS states that health-insurance premium payments may be deducted in applicable Non-MAGI Medi-Cal calculations. The official Medi-Cal renewal form also tells beneficiaries that reporting other health-insurance premiums they pay may lower the income Medi-Cal uses to determine eligibility.

See the DHCS Non-MAGI Medi-Cal Guide and

Medi-Cal Renewal Form MC 217.

Insurance Premiums and Medical Bills Are Not Handled Exactly the Same Way

Recurring health-insurance premiums may be allowable deductions from income when the county calculates eligibility and Share of Cost. Examples can include premiums for health, dental, vision, Medicare prescription-drug and Medicare supplemental coverage.

Doctor, hospital, prescription and other medical bills may instead be used to meet the Share of Cost for a particular month. They do not necessarily create the same recurring income deduction as an insurance premium.

For medical bills and expenses, see:

Using Medical Expenses for Share of Cost

The county makes the final decision about which premium, deduction or expense applies to an individual Medi-Cal calculation.

What BenefitsCal May Ask You to Review During Renewal

The current BenefitsCal renewal process may pull information already contained in the county’s case records and ask the beneficiary to review and correct it.

The sections may include:

• Personal and contact information;
• People in the household;
• Household circumstances;
• Income;
• Expenses;
• Medicare and other health insurance;
• Financial assets and bank accounts;
• Homes, other property and vehicles;
• Long-term care or other special circumstances;
• Document upload; and
• Final review and submission.

BenefitsCal may state that documents do not have to be uploaded at the beginning of the renewal and that the county will identify what is needed. However, when you are asking the county to count a paid insurance premium, be prepared to provide proof.   The official MC 217 renewal form specifically requests proof such as a billing statement showing the monthly premium.

Watch the BenefitsCal How-to Video About Submitting a Medi-Cal Renewal

What to Check During Your Annual Medi-Cal Renewal

Even when changes were reported earlier, use the renewal to confirm that the county’s records remain accurate.

• Review every income source.
  Confirm that the amounts and people receiving the income are correct.
• Review Medicare and other insurance.
  Make sure every policy, premium and effective date is accurately listed.
• Remove insurance that has ended.
  Do not leave a canceled premium in the case information.
• Review household information.
  Correct names, addresses, household members and special circumstances.
• Review expenses and deductions.
  Check that the county has the current information it needs.
• Review assets when the asset rules apply.
  Report requested financial accounts, property and other assets accurately.
• Upload or provide requested proof.
  BenefitsCal may allow documents to be supplied later, but respond promptly when the county asks for them.
• Submit before the due date.
  Save the confirmation and watch for a Notice of Action or a request for additional information.

DHCS permits renewal through BenefitsCal, mail, telephone or the county office. See the official Medi-Cal renewal instructions.

Remember: Annual renewal is an opportunity to confirm and correct the complete case. It is not a reason to delay reporting an important change during the year.

Report It When the Insurance Premium Changes or Ends

If a premium was used to reduce your countable income or Share of Cost, report it when:

• The policy is canceled;
• The premium increases or decreases;
• The insurance company refunds the premium;
• You stop making payments;
• Coverage changes from one person to another; or
• A different policy replaces it.

The county should not continue using an old premium amount that is no longer being paid. Outdated information may result in an incorrect Share of Cost, eligibility decision or Notice of Action.

Report the change through BenefitsCal or the county office and save proof of the report.

What If the County Does Not Change the Share of Cost?

When the Share of Cost remains incorrect after you report the change:

• Review the written Notice of Action;
• Ask the county for the income and deduction calculation;
• Confirm that the worker received every document;
• Resubmit missing or unclear proof;
• Ask whether the premium was treated as an allowable deduction;
• Ask for a corrected written decision; and
• Review the hearing or appeal rights and deadline stated on the notice.

When the error affects previous months, the rules and available correction may be different from a change for future months.

Medi-Cal Appeals

Correcting Past Months

Official References

1. California Department of Health Care Services—Update Your Information
   DHCS instructions to report changes within 10 days and update information through BenefitsCal or the county.
2. DHCS—Keep Your Medi-Cal
   Explains updating information, scheduled renewal and checking the renewal date through BenefitsCal.
3. DHCS—How to Renew Medi-Cal
   Official renewal options through BenefitsCal, mail, telephone or in person.
4. DHCS All County Welfare Directors Letter 22-33
   Defines annual renewals and change-in-circumstances redeterminations and explains county processing requirements.
5. DHCS Medi-Cal Renewal Form MC 217
   States that reporting health-insurance premiums paid may lower the income Medi-Cal uses and requests proof such as a monthly billing statement.
6. DHCS Non-MAGI Medi-Cal Guide
   Explains that health-insurance premium payments may be deducted in applicable Non-MAGI calculations.
7. DHCS ACWDL 11-15
   Explains that other-health-coverage premiums, including certain dental and vision premiums, may lower Share of Cost.
8. DHCS—Other Health Coverage
   Explains reporting private medical, dental, vision, pharmacy and Medicare supplemental coverage.
9. DHCS My Medi-Cal Guide
   Explains how Share of Cost works and that the obligation resets each month.
10. DHCS—Current Medi-Cal Changes
    Official information concerning 2026 asset rules and other current Medi-Cal changes.

Important: These materials provide general educational and insurance information. Medi-Cal eligibility, the amount of Share of Cost, allowable deductions and the effective date of any adjustment are determined by the county Medi-Cal office after reviewing the complete case.