If you are applying for Medi-Cal or are currently receiving benefits and want to know more about Medi-Cal Share of Cost (SOC), we can help. In this post, we will explain in detail who is eligible for Share of Cost, what the income limits are, how it is calculated, and provide examples on how you can determine your SOC based on your household income.
Table of Content:
- What is Medi-Cal Share of Cost?
- What is Maintenance Need Level?
- Who typically Pays Medi-Cal Share of Cost?
- 7 facts you should know about Medi-Cal Share of Cost
- How is Share of Cost calculated?
What is Medi-Cal Share of Cost?
The Medi-Cal share of cost (SOC) program extends Medi-Cal eligibility to low-income older adults and people with disabilities who have significant health care needs but are just above the free Medi-Cal income limit.
Those that fall into this category qualify for “Medically Needy” Medi-Cal.
With the share of cost program, individuals whose net monthly income is higher than the Medi-Cal eligibility limit – which is above 138% of the Federal Poverty Level – may qualify for the Medi-Cal program if they pay (or agree to pay) a portion of their income on monthly medical costs.
Individuals eligible with a SOC must pay or take responsibility for a portion of their medical bills (their “SOC”) each month before they receive Medi-Cal coverage.
SOC Medi-Cal works much like an insurance deductible, except it must be met each month, instead of once a year the way an insurance deductible works.
The amount of a person or couple’s SOC is equal to the difference between the “maintenance need level” and the
individual or family’s net non-exempt monthly income.
What is Maintenance Need Level?
The monthly maintenance need level (MNL) is the budget allocation for a person to pay for basic needs, such as living expenses for food, housing, and clothing each month.
However, the maintenance need income level, currently $600 for an individual, has not been updated since 1989, despite the fact that the cost of living has increased greatly in the past three decades.
The Medi-Cal share of cost is based on the difference between a person’s income and the California Maintenance Need Level (MNL).
Here’s the California Med-Cal Maintenance Need Level for 2022
|Medi-Cal Monthly Maintenance Need Level (MNL) for 2022|
|Number of People|
(In Medi-Cal Family Budget Unit)
|Monthly Maintenance Need Level|
|2 (one adult, one child)||$750|
|Each additional person||$14|
Who typically Pays Medi-Cal Share of Cost?
Here are the three groups of Medi-Cal recipients that typically have Share of Cost (SOC):
- Long Term Care Coverage – Support for Nursing home care or in-home support services (IHSS).
- Coverage for costly chronic conditions – This is for health care services for an illness that is costly and/or chronic enough to generate high monthly medical expenses.
- Catastrophic coverage – Medical expenses for a major health event such as an injury or accident.
Here are 7 facts you should know about Medi-Cal Share of Cost
- If your income is more than the Medi-Cal income limits, you can still qualify for Medi-Cal, but you will have a share of cost.
- A share of cost is not an amount that you must pay every month. Share of cost is like a deductible; it is the share of your medical bills that you are liable for before Medi-Cal pays the rest of your expenses for that month.
- If in any given month, your medical expenses do not exceed your share of cost amount, Medi-Cal will not pay any of your medical bills.
- Medi-Cal will pay medical bills that exceed your share of cost amount in a month.
- To find your approximate share of cost, subtract $620 for an individual ($954 for a couple) from the amount of your monthly income along with any health insurance premiums you may be paying (including Part B premium). The result is your share of cost.
- The resource limits for Medi-Cal with a share of cost are the same as those for regular Medi-Cal with no share of cost.
- Additionally, Medi-Cal will pay the Medicare Part B premium only for the months when share of cost is met.
How is Share of Cost calculated?
Here’s the formula for how to calculate Share of Cost (SOC).
Income – maintenance need level – applicable deductions = SOC
As shown above, the current maintenance need level is $600 per month for a single adult.
The level increases with each additional adult and child living in the household.
Here are examples of share of cost calculations for two Medi-Cal beneficiaries using the IHSS program.
Peter is an IHSS consumer who lives alone and has an income of $1,300 per month.
Peter’s Medi-Cal SOC is:
$1,300 – $600 – $20 (a standard deduction) = $680 per month
Peter is responsible for paying $680 per month for IHSS and other Medi-Cal-approved services before his Medi-Cal coverage kicks in to pay any remaining amount.
Susan is an IHSS consumer who lives with his son and has an income of $1,550 per month.
Susan’s Medi-Cal SOC is:
$1,550– $750 – $20 (a standard deduction) = $780 per month
Susan is responsible for paying $780 per month for IHSS and other Medi-Cal-approved services before his Medi-Cal coverage kicks in to pay any remaining amount.
Medi-Cal Share of Cost Summary
We hope this post on Medi-Cal Share of Cost was helpful.
If you have further questions about Medi-Cal, please let us know in the comments section below.
Be sure to check out our other articles about Medi-Cal and California Medicaid program, including: