Medi-Cal with a Share of Cost (SOC)
Medically Needy
Lower your Share of Cost with Medi Gap or Dental Coverage

Explanation of Share of Cost #SOC

If your monthly income is higher than the limits to qualify for SSI or the A&D FPL program, but you meet the criteria of the low  asset-level requirements, you may still qualify and  be eligible for Medi-Cal with a share of cost (SOC).

SOC functions like a deductible, it’s not a percentage, like a Co-Pay. You must pay this amount in any month you incur medical costs. After your SOC is paid, Medi-Cal will pay the remaining amount of your medical bills for that month.

Note: A SOC is not a monthly premium. It is more like a deductible. It is the amount of medical expenses you are responsible to pay for before you can get full Medi-Cal coverage for the remainder of the month. If you have no medical expenses, you pay nothing.

More detail on how & where to pay your share of cost when you have IHSS In-Home Supportive Services   Scroll down and see our references & links too.

• VIDEOs
  • Med-Cal FAQ: What Is Share Of Cost? Can I Eliminate It?  Bridget McKay Esq
    • bridget mackay law.com
  •  MEDI-CAL CONSULTING SERVICES
    • medi helper.com/informative-videos

Income Limits

To be eligible for the A&D FPL or the Blind FPL Medi-Cal programs, an applicant’s Countable Income for SSI Program cannot exceed a level set by the state that is based on the Federal Poverty Level. The countable monthly income limit for an individual adult or child is based upon the Federal Poverty Level (100% FPL), plus $230.37 ^{Welf. & Inst. Code § 14005.40(c)(1)  See Western Poverty Law Page 91 for what seems like the best and understandable explanation}

Cal Matters – Problems with Income Limits – Inflations – Numbers haven’t changed in 30 years.

 

 

 

References & Links

• 

  3 page pdf summary from DPSS.Gov

• CHCF explanation SOC Share of Cost Rev December 2017
  • Includes cost calculation worksheets 
• CANHR Aged & Disabled Program
• CA Health Care Advocates
• Health Consumer Alliance Fact Sheet
• Disability Rights CA Share of Cost – Nursing Home Resident
• Bridget MacKay Law
• Medi-Cal What it means to you Phamplet   outdated?
• Covered CA Agent Certification Circa 11.2013  Page 5 et seq)
• Health Rights Hotline. Our number is 1-888-354-4474.
  • 1-800-952-5253 to get a fair hearing
• Medi-Cal Contact Info
• Working Disabled Program – Premium may be less than Share of Cost
• Nolo – Spend Down 
• Health Consumer Alliance  Helping Californians get the health care they need
• McKay Law Medicaid Qualification
• CA Department of Aging Find Services
• This overview of the Medi-Cal program addresses issues relevant to older adults and persons with disabilities. At the end of this chapter is a listing of other sources of information about Medi-Cal, including information about consumer informational fliers and Medi-Cal mental health services.  Bet Tsezak
  • Eligibility Procedure Manual dhsc.gov
• Medi Cal Provider Manual SOC
• IHSS Share of Cost
• AB 1900 to Relieve California’s Seniors, the Disabled, and Low-Income Families from the Hardship of Medi-Cal ‘Share of Cost’ Expenses
  • It’s Time to Ditch the Deductible
  • Fact Sheet
• Ways to Lower or Stop your Medi-Cal Share of Cost
• Medi-Cal Notice of Action (NOA) – Frequently Asked Questions
• Medi Cal Forms

FAQ’s 

Getting additional Insurance to #lower SOC Share of Cost

Question  Hi, My father was approved for IHSS In Home Supportive Services  under Medi-Cal with share of cost. His SOC is $1723 which extremely high. His income from SS and pension is about $2,500. He currently has senior advantage with Kaiser. NO additional insurance. How could he spend $646 in insurance premium to eliminate his share of cost?

Answer  – Please send us [email protected] all the paperwork from Medi Cal so that we can review it.  We will not post any confidential or identifying information.  Would you consider dropping Kaiser to get a Medi Gap plan?

 

FAQ’s

 

• Question If my father has private pay providers in the home or 160 hours per week and IHSS has granted him 90 hours per month how is the share of cost met?
  .
• Answer Visit the IHSS webpage
  • Twice a month, both you and your provider who works for you will receive an “Explanation of IHSS SOC” letter that will tell you how much money to pay the provider. Remember, the SOC is part of provider’s salary. You, as the IHSS recipient, must pay the SOC, if any, to the provider monthly. The SOC may change from month to month.
  • For questions regarding SOC, contact your Social Worker at (888) 822-9622,.
    .
    .
• 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.
  • Do you have another ID card to present to get services?
  • Are you in a Managed Care Plan?
  • Also, it let’s Medi-Cal keep track of the “deductible”
  • Yes, Medicare.
  • If the medical cost is 1000.00, Medicare would pay 80% .
  • Is the 770.00 covered by that, then, Medi-cal would pay the 20% ?
• I do not have part D. Would Medi-cal cover prescriptions for the above situation?
  • Yes, but check, Medi Cal may have assigned you to a Part D Plan
• And, if I have a routine office visit and present the Medical card, do I have to pay 770.00 for that one visit during the month?
  • Let’s check our page on Dual Coverage & Medicare
  • You’re question goes beyond my pay grade (Zero, I don’t get paid) Try asking [email protected] Please post her response in comments below.  Or Medi Cal and Social Service agencies.
    .
• Question My Dad is in skilled nursing but WILL be coming home in a few months.
  • Medi-Cal says his share of cost is all of his income, less $50 (he gets to keep $50).
  • The problem with this is that he and I share a rented house. He also has a car payment. Neither of these things are taken into account?
  • So they don’t take into account that he needs a home to go home to?
    .
• Answer  You’re questions probably goes beyond my pay grade (Zero).
  • We’ve done a lot of updating to this page, since the question was originally asked.  Please review the entire page

    .

• 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.
  • You must be enrolled in a Medicare Part D drug plan or a Medicare Advantage prescription drug plan to get these benefits.  Medi-Cal, however, will pay for certain categories of drugs not covered by Part D, including:
    • Drugs used for smoking cessation
    • Certain cough and cold drugs
    • Certain over-the-counter drugs
    • Vitamins and minerals
  • With Medicare Part D drug coverage, you must make copayments of no more than $1.30 for generic drugs and $8.95 brand name drugs in 2020. The 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.
    .
• Question My elderly mother has dementia and we applied to In home supportive services with a Medi Cal share of cost of $993 dollars
  • to qualify for full medi cal she would need to purchase $111 in extra insurance a month and
  • she currently has AARP united healthcare Medicare Advantage insurance.
  • Due to pre existing conditions and medical underwriting we are having trouble trying to switch to traditional Medicare with a Medicap supplement and
  • we are wondering what other insurance options could qualify her for full medi cal with no share of cost.
    ..
• 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.
  • So, if you want Medi Gap, you might enroll in a Part D Rx plan. That would then cancel your MAPD with AARP. Then you could enroll in Medi Gap guaranteed issue.
  • Let me know if you want to do this, send all of the documentation from Medi Cal and I will double check with the higher ups in the “Chain of Command.”
  • Do you have LIS Low Income Subsidy, to help with Part D Rx costs?
  • Excerpt from Medicare.Gov Publication 11219.
    .
• Question Does veteran aid & attendance or death benefits as unearned income count towards share of cost?.
  .
• Answer Your question is beyond our pay grade. Which is Zero. We don’t make a nickel unless you were to get a Medi Gap plan where we make say a 10% commission, paid by the Insurance Company, so there is no additional charge to you.
  • Thus, here’s our research, not legal advise.
  • The simple answer is MAGI Income, what’s on the Tax Return…
  • What if one has a million dollar income from investments? That’s unearned, right?
  • Income Limits.
  • To be eligible for the A&D FPL or the Blind FPL Medi-Cal programs, an applicant’s countable income cannot exceed a level set by the state that is based on the Federal Poverty Level. The countable monthly income limit for an individual adult or child is based upon the Federal Poverty Level (100% FPL), plus $230.37 Welf. & Inst. Code § 14005.40(c)(1)
  • See Western Poverty Law Page 91 for what seems like the best and understandable explanation
  • Countable Income for SSI Program
  • Income definition
    • Income is anything you receive during a calendar month and can use to meet your needs for food or shelter. It may be in cash or in kind.
    • In-kind income is not cash; it is food or shelter, or something you can use to get food or shelter.
    • Countable Income definition
      • Countable income is the amount left over after:
      • Eliminating from consideration all items that are not income; and
        Applying all appropriate exclusions to the items that are income.
        Countable income is determined on a calendar month basis. It is the amount actually subtracted from the maximum Federal benefit to determine your eligibility and to compute your monthly payment amount.
      • (a) Gross unearned income includes:
      • (6) Veterans payments which include:
        • (A) Pensions based on need.
        • (B) Compensation payments.
        • (C) Educational assistance.
          • Section 50507 – Gross Unearned Income
          • California Code of Regulations Article 10 Income Section 50501 – 50571

Problems with Share of Cost and spending $500 on a $2,500 Social Security Check

• I have already written to Steve lopez [Los Angeles Times]. I am looking to make a difference here and I have explained this to the social worker who called me just now from Medi-Cal. I asked her to pass the information up to her supervisor and to her supervisor supervisor and to the mayor of this city and to the representatives of this District until we get some satisfaction. Steve has already shown me that 70 organizations have already written to the governor on this matter.
• Further the social worker informed me that it is not retroactive meaning that I am responsible for the $1812 in April that were not paid to the IHSS caregiver involved at the time.
  • She now tells me that she is suing me and taking me to court to get the money. She also asked me to lie and approve all of her hours the rest of April even though she did not work those hours. She quit and abandoned me on April 23rd at 12:30 p.m.. I texted her as she going to return? The answer was unfortunately no.
• I did some calculations today and what we have done in terms of the expenses I now will have for the insurances to lower my income so that I don’t have an $1,800/month share of cost is going to eat up my fixed income per month.
  • $2,500 Social Security Income
  • – 430  Medi Gap Premium
  • –    93   Dental
• This is a huge tragedy that is going to prohibit me from having a caregiver until the earliest in July and maybe not even then. I can’t begin to tell you how much I have been suffering and now I have to pay my caregiver to come here privately to give me a shower and take care of some other things that I’m just unable to do now. The last shower I had taken before today was last Sunday. And I literally have worn the same clothes and had no shower until today, friday, and now he will return on Tuesday evening because I have another medical appointment on Wednesday.
• My strength and stamina are being depleted more and more each day. I believe that what is necessary is that if you can and are willing, please call and describe to my Social Worker at Bet Tzedek  what I’m experiencing and see if we can’t get some reporter to come here and interview me and make this story and travesty go Nationwide and also let me demand that this insanity of not taking into account a senior’s income level in the calculation of the share of cost.
• I literally am unable to pay what I already owe and I’m being dug into a deeper and deeper hole each month. The nation must be awakened to the fact that Medicaid and Medi-Cal are stifling out the lives of seniors like me and perhaps even killing them if stamina gives out and their life ends. I’ve already had three strokes. I have avoided a fourth since 2015 because of the excellent medical care I have received from Dr Leonard scuderi cardiologist and many others.
• How much stress can I take before the 4th stroke does occur and I become more debilitated than I am or in fact die? Has my time now caught up with me and my end of life is in sight?
• Feel free to send this email to G-d and everyone see if  there isn’t a way to stir up notoriety about this mess of my life now.
• I’m happy to represent any and every senior across this country who is facing the same insanity.

Resources & Links

• Using Your Medi-Cal Share of Cost if You are a Nursing Facility Resident  April 2017 Disability Rights
• Important Health Care Changes Coming in 2022 for Low-Income Older Californians  Justice in Aging
• In-Home Supportive Services (IHSS)
• Jewish Family Service LA – open to everyone
• UNDERSTANDING THE SHARED MONTHLY COST FOR MEDI-CAL  CANHR