Program Information Page 4
Share of Cost (SOC)
Members cannot apply for CalAIM with a SOC. It must be eliminated before becoming eligible to apply for CalAIM.
A Share of Cost (SOC) is like a monthly deductible for Medi-Cal. It's the amount of money you may have to pay each month towards medical-related services or supplies before your Medi-Cal coverage begins to pay.
This happens when your income is above the limit for free Medi-Cal but you still qualify for the program.
Read more about eliminating share of cost at the California Advocates for Nursing Home Reform (CANHR).
Eliminating Medi-Cal Share of Cost: The Key to CalAIM
If you have Medi-Cal with a Share of Cost, you may be missing out on life-changing benefits. Programs like CalAIM (which provides care coordination and placement in residential care homes) generally require members to have Full-Scope, $0 Share of Cost Medi-Cal.
For many seniors and disabled individuals, a monthly income above $1,856 (the 2026 limit) triggers a high Share of Cost. However, California's 250% Working Disabled Program (WDP) offers a legal way to eliminate that cost and keep more of your money.
How the 250% Working Disabled Program Works
- Higher income allowed: up to $3,260 per month with a $0 monthly premium and $0 Share of Cost.
- Broad definition of "work": no traditional full-time job required. "Working" can include part-time tasks like pet sitting, consulting for a neighbor, or even recycling. No minimum hours required.
- Income protection: most disability-related income (like SSDI or private disability) is not counted toward the limit. Even if SSDI converted to Social Security Retirement, it may still be exempt.
- CalAIM ready: once Share of Cost is $0, you can qualify for CalAIM services, including Enhanced Care Management and Community Supports for care home placement.
Additional SOC Reduction Strategies (County Eligibility Process)
1. The "Excess Income" Room and Board Adjustment
Under California law (and often reflected in RCFE admission agreements), there is a distinction between what an SSI recipient pays and what a private-pay or high-income resident pays.
- The SSI Rate Cap: for residents on SSI, room and board is strictly capped (around $1,444.07 for 2026).
- The Non-SSI Exception: if a member has income other than SSI, the facility may charge the basic room and board amount plus additional contract-based charges.
- The Strategy: increasing room and board obligations on the admission agreement (minus the $182 personal needs allowance) may reduce countable income.
- Practical rule of thumb: paying about 90% of monthly income toward room and board can eliminate SOC. This method can only be implemented once the member has moved into assisted living.
2. Purchase Supplemental Insurance (Often the Cleanest Fix)
Lower gross countable income before SOC calculation by documenting deductible premiums and insurance deductions.
- Dental/Vision/Health premiums: monthly premiums are deductible by the county.
- Medicare Part B/D: ensure all premiums are captured by the county eligibility worker.
3. Use Spousal Impoverishment Protections (HCBS Waiver)
Married couples or registered domestic partners may reduce SOC by applying HCBS spousal protections.
- Spousal deeming protection: the community spouse's income is excluded; SOC is based on the applicant spouse's countable income.
- MMMNA allocation: if the community spouse's income is below $4,066.50 (2026 MMMNA), income can be allocated to reach that floor.
- SOC outcome: once county staff apply these protections correctly, SOC is often lowered substantially and may be reduced to $0.
Summary of Where to Go
Take the following to the County Social Services Eligibility Worker (not the health plan):
- Revised admission agreement: showing higher room and board obligation up to available income.
- Insurance proof: monthly supplemental premium documentation.
Crucial note: once county deductions are entered and the case reflects zero SOC, the CalAIM managed care plan typically sees eligibility updates in about 24-48 hours.
Who to Contact for Help
1. HICAP (Health Insurance Counseling & Advocacy Program)
Free, unbiased counseling on Medicare and Medi-Cal. Experts at the Working Disabled Program.
Phone: 1-800-434-0222
Website: aging.ca.gov/hicap
2. Health Consumer Alliance (HCA)
Free legal assistance for Californians struggling with Medi-Cal eligibility or high Share of Cost.
Phone: 1-888-804-3536
Website: healthconsumer.org
3. Your Local County Social Services (DPSS)
Contact your local county eligibility worker and ask for an "evaluation for the 250% Working Disabled Program."
Online Portal: BenefitsCal.com