What is "Share of Cost" Medi-Cal

Contrary to common misperception, many Medi-Cal participants are not on welfare. In addition to covering individuals who receive cash assistance from government, Medi-Cal offers health care coverage to individuals and families who have incomes too high to qualify for welfare, but too low to cover health care costs.
 

Some Medi-Cal beneficiaries do not get free Medi-Cal, but instead are required to pay or incur a certain amount of medical expenses each month before Medi-Cal pays for their health services.
 

This amount is called a “share of cost.” Many of these beneficiaries cannot access health care services because their share of cost far exceeds their ability to pay.

How is Share of Cost Determined?

Share of cost is calculated on a monthly basis by deducting a set amount called a "maintenance need level" from the net income. That is, Share of cost = Net Income - Maintenance Need. A Medi-Cal beneficiary’s share of cost is the difference between her income after allowable deductions and the Maintenance Need Level (MNL), which is a set amount allocated for her living expenses.
 

The MNL has not changed since 1989 and is $600 for an individual. Thus, anything an individual earns over $600 a month becomes that individual’s share of cost. For example, if an individual earns $1,100 a month, that person must incur $500 in medical costs each month before receiving any coverage from the Medi-Cal program. For consumers with a high share of cost, Medi-Cal provides little more than catastrophic coverage and does not enable them to access health care services.

Who is Eligible?

Families and individuals on Medi-Cal who receive cash assistance through CalWORKs or SSI are not required to pay a share of cost.
 

It applies to those recipients who opt not to receive cash assistance or whose income and resources are too high to qualify under the cash assistance programs.
 

Not all Medi-Cal recipients are required to pay a share of cost. In fact, the majority have incomes so low that they receive Medi-Cal without having to pay any share of cost.

What Does it Cost?

The California Department of Health Services estimates an overall cost of share in 1997 at $480. Today a Medi-Cal beneficiary’s share of cost is the difference between her income after allowable deductions and the Maintenance Need Level (MNL), which is a set amount allocated for her living expenses.
 

The MNL has not changed since 1989 and is $600 for an individual. Thus, anything an individual earns over $600 a month becomes that individual’s share of cost.
 

For example, if an individual earns $1,100 a month, that person must incur $500 in medical costs each month before receiving any coverage from the Medi-Cal program. For consumers with a high share of cost, Medi-Cal provides little more than catastrophic coverage and does not enable them to access health care services.

Help in Meeting the Share of Cost Needs with Dental Insurance

We have custom designed dental insurance indemnity plans to help meet your threshold obligations or requirements.

Thus, our online dental insurance premiums are flexible with affordable adjustable rates to qualify you for your share of cost suggested by your advocate in meeting your obligation threshold. After you meet your share of cost state assistance pays for your care the rest of that month.

 

County Welfare Departments Generally Determine the Share of Cost Amount

Some Medi-Cal subscribers (recipients) must pay, or agree to pay, a monthly dollar amount toward their medical expenses before they qualify for Medi-Cal benefits. This dollar amount is called Share of Cost (SOC). A Medi-Cal subscriber’s SOC is similar to a private insurance plan’s out-of-pocket deductible.

If you are a spouse or a parent, you have the choice of listing your medical expenses in any case number on the reverse side of this form in which your name appears. You may list all your medical expenses in a single case number, or you may divide up the expense and list it in two or more case numbers in which your name appears. However, the total being reported for the single service cannot be more than the original bill.

 

Changes to Denti-Cal not Affected by Share of Cost

The Denti-Cal handbook contains basic information about the California Medi-Cal dental program. This is different than the Share of Cost dental plans offered at this web site. The criteria and policies contained in this Handbook are subject to the provisions of the Welfare and Institutions (W & I) Code and regulations under California Code of Regulations (CCR), Title 22. When changes in these criteria and/or policies occur, bulletins and revised pages will be issued for purposes of updating the information in this Handbook.

 

Effective July 1, 2009 what optional adult dental services will be eliminated? Effective July 1, 2009, all optional adult dental services will be eliminated. Optional services are services that are not mandated by the federal government to be provided. Optional services that are being eliminated include:

  1. Comprehensive oral evaluations for new or established patients.
  2. Prophylaxis and fluoride treatments.
  3. Amalgam and resin based composite restorations.
  4. Prefabricated and laboratory processed crowns.
  5. Endodontic treatment.
  6. Periodontal procedures including scaling and root planing.
  7. Removable prosthodontic treatment including complete and partial dentures, relines and tissue conditioning and adjustment and repairs.
  8. Fixed prosthodontic procedures.
  9. Implant procedures.

Processing Procedures for Space Maintainers and New Adjudication Reason Codes

 

Which beneficiaries or services will not be affected? The following beneficiaries or services administered by the Department of Health Care Services for adults will not be affected by this policy on or after July 1, 2009:

  1. Medical and surgical services provided by a doctor of dental medicine or dental surgery, which, if provided by a physician, would be considered physician services, and which services may be provided by either a physician or dentist in this state. Federal law requires the provision of these services. The services that are allowable as Federally Required Adult Dental Services (FRADS) can be found in Table 1 in the Denti-Cal Bulletin Volume 25, Number 22, May 2009.
  2. Pregnancy-related services and services for the treatment of other conditions that might complicate the pregnancy. This includes 60 days of post partum care. Services for pregnant beneficiaries who are 21 years of age or older are payable if the procedure is listed in either Table 1 (FRADS) or Table 2 (Allowable Procedure Codes for Pregnant Women) as found in the Denti-Cal Bulletin Volume 25, Number 22, May 2009.
  3. Beneficiaries under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program (under the age of 21).
  4. Beneficiaries receiving long-term care in an intermediate care facility (ICF) or a skilled nursing facility (SNF), as defined in the Health and Safety Code (H&S Code), Section 1250, subdivisions (c) and (d), and licensed pursuant to H&S Code Section

Providing and Billing for Anesthesia Services for Denti-Cal Beneficiaries, Registering and Using the National Provider Identifier (NPI)

 

1250, subdivision (k). Dental services do not have to be provided in the facility to be payable. See Denti-Cal Bulletin Volume 25, Number 22, May 2009 for further details. Dental service precedent to a covered medical service. Beneficiaries may receive dental services that are necessary (precedent) in order to undergo a covered medical service. The majority of these dental services are covered under the FRADS procedures. A precedent dental service that is not on the FRADS list will be evaluated and adjudicated on a case by case basis. An adult dental service may be reimbursable if any one of the above exceptions is met. The Manual of Criteria (MOC) will remain in effect and unless otherwise stated all policies remain the same for payable dental services.

Effective January 31, 2011 Denti-Cal will Begin Processing Claims and Treatment Authorization Requests (TARS) for the Genetically Handicapped Person’s Program (GHPP)

 

How to Contact the Department of Health Care Services

Medi-Cal Website Link Click Here: Phone Support: 1-800-541-5555 The Telephone Service Center (TSC) is available 8 a.m. to 5 p.m., Monday through Friday, except holidays -border providers and out-of-state billers billing for in-state providers, call 916-636-1200.

 

State of California - Health and Human Services Agency, Department of Health Care Services: SHARE-OF-COST MEDI-CAL PROVIDER LETTER The California Code of Regulations, Title 22, Section 51471.1, requires providers to cooperate with the Department of Health Care Services in making reimbursements to the beneficiaries for Medi-Cal program underpayments. The Welfare and Institutions Code, Section 14019.3 and the regulations further require that the provider accept an underpayment adjustment from the Medi-Cal program for such beneficiaries and reimburse such beneficiaries the full amount of that adjustment, up to the actual amount received in payment from the beneficiary for medical services in question.

 

 

share of cost california

 

County Offices to Apply for Medi-Cal

County Offices  

County Name / Website

County Address

Phone

Alameda County

Social Services Agency
8477 Enterprise Way
Oakland, CA 94621

(510) 639-1090

Alpine County

Department of Social Services
75A Diamond Valley Road
Markleeville, CA 96120

(530) 694-2235, ext. 241

Amador County

Department of Social Services
1003 Broadway
Jackson, CA 95642

(209) 223-6550

Butte County

Department of Employment and Social Services
78 Table Mountain Blvd.
Oroville, CA 95965

Other offices:
2445 Carmichael, Chico, CA 95928

(530) 538-7711
(800) 499-9189


(530) 879-3479

Calaveras County

Calaveras Works and Human Services
Government Center
509 East Saint Charles Street
San Andreas, CA 95249-9701


(209) 754-6448

Colusa County

Department of Social Services
251 East Webster Street
Colusa, CA 95932

(530) 458-0250

Contra Costa County

Employment and Human Service Department
Aging & Adult Services Bureau
40 Douglas Drive
Martinez, CA 94553

1 (800) 709-8348

Del Norte County

Department of Health and Human Services
880 Northcrest Drive
Crescent City, CA 95531-3485

(707) 464-3191

El Dorado County

Department of Social Services
3057 Briw Road
Placerville, CA 95667-1637

(530) 642-7300

Fresno County

Department of Human Services

Regional Offices:
Heritage Center, Fresno
Coalinga Regional Center
Selma Regional Center




(559) 453-4262
(559) 935-6300
(559) 898-5100

Glenn County

Human Resources Agency
P.O. Box 611, 420 East Laurel Street,
Willows, CA 95988-0611

(530) 934-6514
(530) 934-6510

Humboldt County

Department of Social Services
929 Koster Street
Eureka, CA 95501

(707) 476-4700

Imperial County

Department of Social Services
2995 South Fourth Street, Suite 105,
El Centro, CA 92243

(760) 337-6800

Inyo County

Department of Social Services
912 N. Main Street
Bishop, CA 93514

(760) 872-1394

Kern County

Department of Human Services
100 E. California Avenue,
Bakersfield, CA 93307

(661) 631-6807

Kings County

Human Services Agency
1400 W. Lacey Blvd., Building #8
Hanford, CA 93230

(559) 582-3241

Lake County

Department of Social Services
15975 Anderson Ranch Parkway, P.O. Box 9000
Lower Lake, CA 95457-9000

(707) 995-4200
(800) 628-5288

Lassen County

Lassen WORKS
Roosevelt Annex, 720 Richmond Road
Susanville, CA 96130

(530) 251-8152

County of Los Angeles

Medi-Cal Offices

Department of Public Social Services
(Apply at the nearest District office)

Refer to the White Pages under COUNTY GOVERNMENT
of your phone book

(877) 481-1044 Toll Free

(Limited Service Area)
(213) 639-6300

Madera County

Department of Social Services
720 E. Yosemite Avenue
Madera, CA 93639-0569

(559) 675-7841

Marin County

Dept Health & Human Services (Public Assistance)
120 N. Redwood Dr-West Wing
San Rafael, CA 94903

(415) 473-3400

Mariposa County

Department of Human Services
5186 Highway 49 North
Mariposa, CA 95338

(800) 266-3609
(209) 966-3609

Mendocino County

Department of Social Services
825 S. Franklin Street, Fort Bragg, Ca 95482

737 South State Street, P.O. Box 8508
Ukiah, CA 95482

(707) 962-1000


(707) 463-7700

Merced County

Human Services Agency
2115 West Wardrobe Avenue,
Merced, CA 95340

(209) 385-3000

Modoc County

Department of Social Services
120 North Main Street,
Alturas , CA 96101

(530) 233-6501

Mono County

Department of Social Services
85 Emigrant Street, P.O. Box 576
Bridgeport, CA 93517

Other Offices:
Mammoth

(760) 932-5600


(760) 924-1770

Monterey County

Department of Social Services
100 South Main Street- Suite 216
Salinas, CA 93902

Other Offices:
Seaside
King City

(831) 755-8500



(831) 755-4650
(831) 385-7400

Napa County

Department of Health and Human Services
2261 Elm Street
Napa, CA 94559

(707) 253-4511

Nevada County

Human Services Agency
950 Maidu Avenue, P.O. Box 1210
Nevada City, CA 95959

(530) 265-1340
(888) 809-1340 - Toll Free

Orange County

Social Services Agency
(Call for nearest district office)

Orange County Regional Centers:
Anaheim
Santa Ana
Aliso Viejo
Garden Grove



(714) 575-2400
(714) 435-5800
(949) 389-8200
(714) 741-7100

Placer County


Health and Human Services
11519 B Avenue
Auburn, CA 95603

Other offices:
Rocklin Office
North Lake Tahoe

(530) 889-7610


(916) 784-6000
(530) 546-1900

Plumas County

Dept of Social Services
270 County Hospital Rd, Suite 207
Quincy, CA 95971

(530) 283-6350

Riverside County

Department of Public Social Services
4260 Tequesquite Avenue
Riverside, CA 92501

11060 Magnolia Avenue
Riverside, CA 92505

(Call for nearest office)
(951) 955-6400


(951) 358-3400

Sacramento County

Sacramento County
Countywide Services Agency
Department of Human Assistance

Medi-Cal Service Center





(916) 874-3100
(209) 744-0499
(916) 874-2599 - TDD/TTY, Hearing Impaired

San Benito County

Human Services Agency
1111 San Felipe Rd, Ste 206
Hollister, CA 95023-3801

(831) 636-4180

San Bernardino County

Human Services System
Transitional Assistance Department
(Call for nearest district office)

(909) 388-0245

San Diego County


Dept of Health & Human Srvs Agency
(Call for the nearest district Office)

(866) 262-9881

City & County of San Francisco

San Francisco Medi-Cal Health Connection
1440 Harrison Street,
San Francisco, CA 94120

(415) 863-9892

San Joaquin County

Human Services Agency
333 E. Washington Street
Stockton, CA 95202

(209) 468-1000

San Luis Obispo County

Department of Social Services
3433 S. Higuera Street
San Luis Obispo, CA 93403

Other Offices:
Atascadero
Paso Robles
Morro Bay

(805) 781-1600


(805) 461-6000
(805) 237-3110
(805) 772-6340

San Mateo County


Human Services Agency
400 Harbor Boulevard, Building "B"
Belmont, CA 94002


(650) 802-5018

Santa Barbara County


Department of Social Services
1100 W. Lompoc
Lompoc, CA 93436


(805) 681-4401

Santa Clara County


Social Services Agency
(Call for nearest district office)


(408) 271-5600

Santa Cruz County


Human Resources Agency
1020 Emeline Street
Santa Cruz, CA 95060

Other Office:
Watsonville

(831) 454-4165


(831) 763-8500

Shasta County


Department of Social Services
2460 Breslauer Way, P.O. Box 496005
Redding, CA 96001


(530) 245-6680

Sierra County


Social Services
202 Front Street, P.O. Box 1019
Loyalton, CA 96118

Other offices:
Downieville

(530) 993-6700


(530) 289-3711

Siskiyou County

Human Services
818 S. Main Street
Yreka, CA 96097

(530) 841-2700

Solano County

Health and Social Services
Medi-Cal and County Medical Services Program (CMSP)
(Call for the nearest office)

Office Locations:
Fairfield
Vacaville
Vallejo

 

 


(707) 784-8050
(707) 469-4500
(707) 553-5000

Sonoma County

Human Services Department
2550 Paulin Drive
P.O. Box 1539
Santa Rosa, CA 95402-1539

1 (877) 699-6868

Stanislaus County

Community Services Agency
251 East Hackett Road, P.O. Box 42 95353
Modesto, CA 95355

(209) 558-2777

Sutter County

Department of Human Services
Welfare Social Services Division
539 Garden Highway, P.O. Box 1535,
Yuba City, CA 95991

(530) 822-7230

Tehama County

Department of Social Services
310 South Main Street, P.O. Box 1515,
Red Bluff, CA 96080

Other offices:
Corning

(530) 527-1911


(530) 824-9182

Trinity County

Dept of Health and Human Services
#51 Industrial Parkway, P.O. Box 1470,
Weaverville, CA 96093-1470

(530) 623-1265

Tulare County

Health & Human Services Agency
(Call for nearest Office)

In-Take Office
Dinuba
Lindsay
Porterville
Tulare
Visalia



(559) 595-7103
(559) 562-7400
(559) 793-3600
(559) 687-6700
(559) 624-8110

Tuolumne County

Department of Social Services
20075 Cedar Road North
Sonora, CA 95370

(209) 533-5711

Ventura County

Human Services Agency
855 Partridge Drive
Ventura, CA 93003

Regional Offices:
Oxnard
Ventura
Santa Clara Valley

(805) 477-5100


(805) 385-9363
(805) 658-4100
(805) 933-8300

Yolo County

Department of Employment & Social Services
25 N. Cottonwood Street
Woodland, CA 95695

Other offices:
West Sacramento Office, 500-A Jefferson Blvd.,
West Sacramento, CA 95605

(530) 661-2750




(916) 375-6200

Yuba County

Health and Human Services Agency
5730 Packard Avenue, Suite 100, P.O. Box 2320,
Marysville, CA 95901-9987

(530) 749-6311

 

We support: HICAP (the Health Insurance Counseling & Advocacy Program) provides free and objective information and counseling about Medicare.

 

California County Office Information Updated January 3, 2011

 

Members can save on all dental charges and procedures including dental restorative cosmetic work (fillings, dental crowns, dental braces, dental implant's) and dental product related items, etc.), dental hygiene services, preventative work (teeth cleaning, x-rays, etc).  General dentistry, dental hygienist, dental assistant, dental assisting and all specialties where available are covered.

 

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