Medi-Cal share of cost, explained

Share of Cost Advisors · Checked September 30, 2026 · 7 min read

What is share of cost?

A share of cost is a monthly amount of medical bills you are responsible for before Medi-Cal starts paying. It is part of Medi-Cal’s Medically Needy program, which covers people whose income is too high for free Medi-Cal. Nationally this is called a Medicaid “spend down.” See spend down vs. share of cost.

You do not pay a share of cost to Medi-Cal. You pay it to the doctor, pharmacy, dentist, or other provider when you get care. If you have no medical costs in a month, you owe nothing that month.

How does share of cost work?

1. Medi-Cal figures your countable income for the month.
2. It subtracts the maintenance need level for your household.
3. What is left is your share of cost for that month.
4. Medical expenses you pay or owe count toward it, including some services Medi-Cal does not cover.
5. Once you reach the amount, you are “certified,” and Medi-Cal pays for covered care for the rest of the month.
6. Next month it starts over.

How is share of cost calculated?

Countable income is your gross income minus allowed deductions. The main ones are:

• A $20 “any income” deduction.
• For earnings: $65, then half of what remains.
• Health insurance premiums you pay, including Medicare Part B when you pay it yourself, and often dental, vision, Medigap, and Part D.
• Certain work expenses related to a disability.

Try the share of cost calculator to see a rough estimate.

What is the maintenance need level in 2026?

The maintenance need level is the monthly amount Medi-Cal lets you keep for living expenses. It has not gone up in decades. A law passed in 2022 was set to raise it to 138% of the federal poverty level in 2025, but DHCS revoked that increase before it took effect. Some websites still show the higher number. The current levels are:

Why do I have a share of cost?

Most people with a share of cost have income, often Social Security or a pension, that is just over the limit for free Medi-Cal. For older adults and people with disabilities, the free Medi-Cal Aged and Disabled program (A&D FPL) allows countable income up to 138% of the federal poverty level: $1,836 a month for one person or $2,490 for a couple (as of April 2026). Above that, you may still get Medi-Cal, but with a share of cost.

The gap between those limits is why the share of cost can feel so high. With $1,900 of countable income, one person is just $64 over the free program’s limit, but their share of cost is $1,300 ($1,900 − $600).

Medi-Cal share of cost income limit

There is no maximum income for Medically Needy Medi-Cal. The share of cost just rises with income. The limits that matter are the ones for programs without a share of cost, like the Aged & Disabled program above and the 250% Working Disabled Program.

Is there an asset limit in 2026?

Yes. Starting January 1, 2026, California reinstated an asset limit for Medi-Cal programs for older adults and people with disabilities, including share of cost Medi-Cal: $130,000 for one person, plus $65,000 for each additional household member. Current members are checked at their next renewal. The 2026-27 state budget lowers the limit to $21,000 for one person and $31,000 for a couple, effective no sooner than July 1, 2027. Ask your county what counts and what is exempt.

Share of cost Medicaid: is this the same everywhere?

No. Many states have a Medicaid spend down, but the limits differ. Everything on this site is about California’s Medi-Cal.

How to lower your share of cost

You can lower a share of cost by lowering countable income, most often through premium deductions, or by qualifying for a program without one. Read the step-by-step guide.

Common questions