In addition to covering individuals who receive cash assistance from the 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. Medi-Cal requires some of these recipients to contribute to their health care by paying a share of the cost of the services they receive.
Once a recipient's health care expenses reach a predetermined amount (the "share of cost"), Medi-Cal will pay for any additional covered expenses for that month. Share of cost is an amount owed to the health care provider, not to the state.
Beneficiaries with share of cost Medi-Cal account for a disproportionate amount of program expenditures. While individuals receiving share of cost assistance accounted for just over 1% of all Medi-Cal beneficiaries in October 2007, they consumed about 15% of total fee-for-service expenditures, or an estimated $2.2 billion for fiscal year 2006–07.
As California lawmakers consider budget actions that may have an impact on Medi-Cal, understanding the share of cost option and the people it serves is essential. This issue brief provides an overview of share of cost Medi-Cal, including an analysis of Medi-Cal data and a description of current policy issues that may affect the program.
The complete issue brief is available as a Document Download.