Can someone please explain what 'share of cost' is?

Question

I just found out im pregnant and applied for Medicaid because I dont have insurance. The unborn child is eligible for this monthly share of cost which totals $2480.03.

Can anyone explain to me what this means. Is that the amount im going to have to pay each month of medical bills or is that the total amount I will have to pay in the end....for the whole pregnancy? I DONT GET IT!

Our bills right now, without a child, total over $2000 a month. After bills are paid, we have roughly $500 to spend on groceries, gas, and whatever else we need. How can we afford to pay medical bills plus everything the child is going to need?

Answer 1

When in Florida my kids were eligible for the medicaid but my husband and I were only eligible for the share of cost.....which meant if we went over a certain amount (I do believe for us it was $1700) then they would pick up the next $1700. And yes that was on a per month basis. It was rather confusing to me as well as it doesn't really help out much....if we had $1700 a month to spend on medical care we wouldn't be asking for help.

Answer 2

Not sure what state you're in, but this is for California.

Share of cost is a term that refers to the amount of health care expenses a recipient must accumulate each month before Medi-Cal begins to offer assistance. Once a recipient's health care expenses reach a predetermined amount, Medicaid will pay for any additional covered expenses for that month. Share of cost is an amount that is owed to the provider of health care services, not to the state.

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:

Share of Cost = Net Income - Maintenance Need

Net income is established by subtracting any allowable exclusions from the gross household income. Gross income includes earned income (earnings from a job), as well as other sources of income like disability payments or alimony. There are approximately 40 allowable exclusions from gross income, including deductions for educational expenses, dependent care, alimony payments, and an earned income deduction.

The earned income deduction is the amount deducted for earnings from a job; it is intended to encourage recipients to work. For aged, blind, and disabled, the main earned income deduction is determined by the 65 1/2 rule: The first $65 is deducted off the monthly gross earned income, and the balance is divided in half. For families, the first $90 of monthly gross earned income is deducted. Additional earned income deductions may apply depending upon individual circumstances.

The maintenance need level is determined by state law, subject to federal guidelines. California is required by federal law to set maintenance need levels that will permit medically needy persons to meet their basic needs for food, clothing, and shelter. However, federal law also limits maintenance need by establishing a maximum allowable level. The following table outlines the monthly maintenance need level by family size for Medi-Cal in 1998:

Answer 3

Share of cost means that each month you will have to pay the first $2480.03 out of pocket and medicaid will pick up the rest of it.