What does the Medicaid Share of Cost represent for an individual or family?

The Medicaid Share of Cost refers to a monthly deductible amount that individuals or families must meet before they can receive full Medicaid benefits. This amount represents the portion of medical expenses that must be incurred and paid by the beneficiary each month before Medicaid starts to pay for covered services. It is particularly relevant for individuals who have income that exceeds the Medicaid eligibility threshold, as they may be required to "spend down" their income on medical expenses to qualify for Medicaid assistance.

This concept is essential to understanding how Medicaid operates for those with varying income levels, especially in cases where certain medical costs can lead to a pathway for eligibility for those who initially may not qualify based on income alone. As beneficiaries accrue eligible medical expenses that exceed their Share of Cost, they can access Medicaid benefits for subsequent healthcare costs. This process facilitates access to necessary medical services for individuals and families with limited financial resources after accounting for their healthcare expenditures.