Medi-Cal Spend Down in California: Share of Cost and Deductions

California’s Medi-Cal spend-down rules in California, formally the Share of Cost program, let people whose income is too high for free Medi-Cal still get coverage by spending a set amount on medical care each month. Your Share of Cost is what’s left over after subtracting allowable deductions and a maintenance need standard from your countable income. Once your medical bills for the month reach that figure, Medi-Cal pays for everything else through the end of that calendar month. If you don’t use any medical care in a given month, you owe nothing and simply have no Medi-Cal coverage that month.¹

Who Owes a Share of Cost

The Share of Cost applies to people in Medi-Cal’s Medically Needy program: adults who are 65 or older, blind, or disabled, and whose countable income sits above 138 percent of the federal poverty level.² Below that line, Medi-Cal is free and there is no spend-down. Above it, the spend-down is how you buy your way into coverage each month.

How Your Monthly Amount Is Calculated

Start with your gross countable income. Subtract a $20 general income disregard, then subtract any health insurance premiums you pay, then subtract the maintenance need standard. What’s left is your Share of Cost.³

The maintenance need standard is the income the state lets you keep for rent, food, and other living costs before requiring any spend-down. For 2026, it’s roughly $1,836 per month for a single person and $2,490 for a couple, and it adjusts upward for larger households.⁴

Here’s the math for a single person in 2026 with $2,500 in gross monthly income who pays the standard Medicare Part B premium of $202.90:⁵

Gross monthly income: $2,500
Minus $20 general income disregard: $2,480
Minus $202.90 Medicare Part B premium: $2,277
Minus $1,836 maintenance need standard: $441 monthly Share of Cost

If you don’t have Medicare, skip that line, and your Share of Cost will be higher.

Why Amounts Dropped in 2025

Before January 1, 2025, the maintenance need standard was just $600 for an individual and $934 for a couple, figures that hadn’t been updated in more than three decades. Effective January 2025, the standard jumped to 138 percent of the federal poverty level and now updates each year with new poverty guidelines.³ Many people who previously owed $1,000 or more each month now owe a few hundred or nothing at all. If you had a Share of Cost before the reform, your county should have recalculated automatically; if the new figure still looks wrong, you can challenge it.

Lowering Your Share of Cost With Premium Deductions

Premiums you pay for health insurance come off your countable income before the Share of Cost is calculated. Medicare Part B, Medicare supplement plans, and dental or vision insurance all qualify.¹ A supplemental plan can reduce your Share of Cost dollar-for-dollar, and in some cases eliminate it. If you pay a higher income-adjusted Medicare Part B premium, the full amount counts. Check your Notice of Action to make sure every premium you pay is listed; this deduction sometimes gets missed.

Expenses That Count

Once your Share of Cost is set, any medical expense you incur counts toward meeting it. The bills can be paid or unpaid, and the provider doesn’t have to accept Medi-Cal, as long as the service was medically necessary and the provider is licensed.¹ Qualifying costs include:

Doctor visits, emergency care, surgery, and hospital stays
Prescription drugs and co-payments
Dental and vision care, including glasses and contacts
Prescribed medical equipment like wheelchairs, walkers, and glucose monitors
Transportation to and from medical appointments

Bills from your spouse and minor children also count, even if they aren’t on Medi-Cal.¹ Bills from grandparents or adult children don’t.

Meeting Your Share of Cost Each Month

How you clear the amount depends on where you get care.

At a Medi-Cal Provider

The provider swipes your Benefits Identification Card through a point-of-service device, which shows your remaining Share of Cost. You pay or promise to pay that amount, the system updates, and once the balance hits zero, Medi-Cal covers the rest of the calendar month.¹

At a Non-Medi-Cal Provider

Submit proof of payment to your county eligibility worker. Receipts, invoices, billing statements, and credit card statements showing the medical charge all work.¹ Once the county confirms your expenses meet the Share of Cost, Medi-Cal activates for the rest of the month.

The counter resets on the first of every month. If you spend $200 above your Share of Cost in March, that overage doesn’t carry into April.

Using Old Bills and Retroactive Coverage

Unpaid medical bills from earlier months, including bills from before you enrolled in Medi-Cal, can be applied to your current Share of Cost.¹ This is one of the most underused features of the program. If you’re sitting on unpaid medical debt, bring it to your eligibility worker; those bills may satisfy the current month with no new spending on your part.

California also allows retroactive Medi-Cal for up to three months before your application date. If you had qualifying expenses during that window and would have been income-eligible, Medi-Cal may reimburse them or apply them toward your Share of Cost.⁶ Ask about retroactive coverage when you apply; it’s not automatic.

What About Assets

Since January 1, 2024, California no longer counts assets when determining Medi-Cal eligibility under the Medically Needy program. Bank accounts, savings, vehicles, and real estate are all excluded, and you can hold substantial savings and still qualify.⁷ Income generated by those assets, though, still counts: interest, dividends, and rental income go into the Share of Cost calculation.

Challenging a Wrong Share of Cost

If your county miscounted your income, missed a premium deduction, or used the wrong maintenance need standard, you can request a state fair hearing. You have 90 days from the date you receive your Notice of Action to file.⁸ The form on the back of the Notice lists the mail, fax, phone, and online options.

File before the effective date on the Notice and your existing benefits continue while the case is reviewed, a protection called aid paid pending.⁸ You can review your case file, bring witnesses, and present evidence at the hearing. The state generally must issue a final decision within 90 days of receiving your request.⁹

1
Los Angeles County Department of Public Social Services (DPSS). Share of Cost Flyer
2
Cornell Law School. California Code of Regulations Title 22, 50062 – Medically Needy (MN) Person or Family
3
DHCS – CA.gov. County Welfare Directors Letter No 23-31
4
Covered California. Program Eligibility by Federal Poverty Level for 2026
5
Centers for Medicare & Medicaid Services (CMS). 2026 Medicare Parts A and B Premiums and Deductibles
6
DHCS. Supplement to Statement of Facts for Retroactive Coverage
7
Los Angeles County Department of Public Social Services (DPSS). Medi-Cal Asset Elimination Frequently Asked Questions and Answers
8
DHCS – CA.gov. Medi-Cal Fair Hearing
9
eCFR. Title 42 Part 431 Subpart E – Fair Hearings for Applicants and Beneficiaries