Understanding Share of Cost in California’s Medi-Cal Program

Do you have a plan for your assets so that you could qualify quickly for Medicaid if you needed it? It can be overwhelming to try to uncover all the resources around qualifying for Medicaid. Often, when we first sit down with clients in our Pasadena elder law office, they have many questions about qualifying for Medicaid and whether or not any extra costs could be passed on to the nursing home resident even when Medicaid has been approved.

The Medi-Cal program, which is California’s Medicaid Service, requires beneficiaries to pay a monthly portion of cost towards the overall health care expenses. This is known as share of cost and is calculated based on the beneficiary’s monthly income minus any deductions, such as the monthly maintenance needs allowance and a personal allowance.

Share of cost can also be used to pay for necessary remedial drugs or medical services that Medi-Cal does not pay for in and of itself and those expenses can apply in either an at-home or nursing home setting.

If you have a loved one in a nursing home, the share of the cost through Medi-Cal can be used to pay for all necessary supplies, equipment, or medical or remedial care so long as the physician has documented these as necessary in a plan of care or a prescription order. Every skilled nursing facility is required by federal law to have a written plan of care for each resident. Ensure that the physicians working with your loved one are keeping this document updated.

Stuck on your next steps for a loved one who needs elder law planning? Discuss your options with our experienced California elder law attorneys today.

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