Share of Cost Advisors · Checked September 30, 2026 · 4 min read
Spend down vs. share of cost at a glance
| Topic | Spend down | Share of cost |
|---|---|---|
| Where the term is used | Most states, federal Medicaid rules | California Medi-Cal |
| What it means | Medical costs you must incur before Medicaid pays | Medical costs you must pay or owe before Medi-Cal pays |
| How often | Varies by state | Every month |
| How it is figured | Income minus a state “medically needy” limit | Countable income minus the maintenance need level |
How the monthly spend down works in Medi-Cal
Each month, Medi-Cal compares your countable income with the maintenance need level for your household. The amount over that level is your share of cost. When the medical expenses you pay or owe that month reach the amount, your share of cost is met and Medi-Cal covers eligible care for the rest of the month.
Providers report the expenses to Medi-Cal. Tell every doctor, pharmacy, and dentist you see that you have a share of cost so the expense is recorded.
Share of cost Medicaid: why other states’ rules differ
Many states have a Medicaid spend down, and the limits and budget periods vary. If you are reading about “share of cost Medicaid” rules from another state, check that they apply to California before acting. This site covers Medi-Cal only.
Can you avoid the spend down?
Sometimes. You may qualify for a Medi-Cal program with no share of cost, or eligible premium deductions may bring your countable income down. See the ways to lower or eliminate it.
Your next step
Estimate your monthly spend down, then ask the county to confirm the calculation.
Common questions
Is spend down the same as share of cost in California?
Yes. California’s Medi-Cal uses the term share of cost for what most states call a Medicaid spend down.
Do I have to pay my spend down every month?
A share of cost applies month by month. You only meet it in months when you have medical expenses. In a month with no medical costs, you owe nothing.
How do I lower my Medi-Cal spend down?
Lower your countable income through eligible deductions, like health insurance premiums you pay, or qualify for a program without a share of cost. The county decides.
Check the sources
Start with the official rules. Ask your county how they apply to you.