If you're enrolled in the Florida Medicaid Medically Needy "Share of Cost" program, you need to know how to use this complicated health insurance correctly. If you use it incorrectly, you’ll pay more than necessary or miss out on Medicaid coverage you could've received.
This article will explain what Florida Medicaid's "Share of Cost" program is, how it works, and what you need to know in order to maintain your benefits.
In Florida, the Medicaid Share of Cost program is a type of health insurance for the medically needy. This refers to people who make too much money to qualify for regular Medicaid, but not enough money to pay for their healthcare needs.
You have to meet all of the standard Medicaid eligibility requirements except the income requirement and also incur significant medical expenses each month.
So the program essentially allows you to subtract your medical expenses from your income and qualify for Medicaid if and when your medical expensesreach a certain amount. The program resets each month.
Note that although this article is about the specifics of Florida's program, 33 other states have similar medically needy pathways to Medicaid eligibility for people with high medical costs relative to their income.
Florida Share of Cost Basics
Your share of cost is the amount of healthcare expenses you must incur before Florida Medicaid coverage kicks in for the month.
You start each month without Medicaid health insurance coverage.
Each time you have a healthcare expense (including health insurance premiums, out-of-pocket medical costs, transportation costs to and from medical appointments, etc.), you notify Florida Medicaid of the expense by fax, mail, or in-person and keep track of a running total for the month.
The day your healthcare expenses for the month exceed your share of cost, your Medicaid coverage begins. From that day until the end of the month, you have full Medicaid coverage.
On the first day of the next month, you’re again without coverage until your healthcare expenses exceed your share of cost.
Other states have different approaches to Medically Needy Medicaid eligibility. New Jersey, for example, determines eligibility six months at a time. But in Florida, eligibility for the Medically Needy Medicaid program starts over each month.
Your Share of Cost Amount
When you get the notice that you’re accepted into the Medically Needy Program, it will tell you your monthly share-of-cost. This amount is related to how much your income exceeds the traditional Medicaid income limits.
The more money you make, the more your share-of-cost will be. If your household income changes, or if the number of people in your household changes, your share-of-cost will also change.
When You Must Pay Share-of-Cost
You don’t actually have to pay the healthcare expenses used to reach your share-of-cost. You just have to owe that much.
You can only use a particular medical bill one time; you cannot continue to use the same medical debt month after month to meet the share-of-cost requirements.
When Medicaid coverage begins, Medicaid pays for your healthcare expenses for the rest of that month, and it also pays the expenses used to meet your share-of-cost that month, if they were incurred on or after the date that your Medicaid coverage begins.
If you choose to pay those expenses yourself, they’ll still count toward meeting your share-of-cost, but you won’t be reimbursed by Medicaid for what you’ve paid.
Here’s an example:
Cindy has a $1,000 share-of-cost (based on her household size and monthly income).
Cindy has a doctor’s appointment on May 1 which results in a bill of $200.
She faxes the bill to Florida Medicaid so it's aware she's accumulated $200 toward her $1,000 share-of-cost for May.
Medicaid doesn’t pay the bill since Cindy hasn’t met her share-of-cost for the month yet.
Cindy has blood tests on May 4, gets a bill from the lab for $900, and faxes that bill to Medicaid.
Between her doctor visit and her blood tests, she’s now accumulated $1,100 in healthcare expenses for the month, which is more than her $1,000 share-of-cost.
Since Cindy’s total monthly expenses exceeded her share-of-cost on May 4, her full Medicaid coverage begins on May 4 and continues through the end of May.
Although it may take a few days for Medicaid to process Cindy’s expenses and grant the Medicaid coverage, the coverage will be retroactive to May 4. Medicaid now pays Cindy's medical expenses from May 4 through the end of the month.
That means they'll pay the $900 bill from the lab (assuming the lab accepts Medicaid's lower reimbursem*nt rates). Medicaid will also pay expenses for care that Cindy receives during the rest of the month.
However, Medicaid will not pay for the doctor's appointment that Cindy had on May 1, since her Medicaid coverage didn't take effect until May 4.
At all times during the month, it's important to make sure your medical providers accept Medicaid. This is true after your Medicaid coverage begins and while you're in the early phase while your medical costs are accruing towards your share-of-cost amount.
As you can see in the example above, Cindy incurred a large bill from the lab on May 4. If the lab didn't accept Medicaid, she'd have been stuck with the lab bill, even though her Medicaid coverage took effect that day because she met her share-of-cost.
Your share-of-cost amount can be from providers that do or don't accept Medicaid. However, the costs on the day your share-of-cost goes over the required amount for Medicaid eligibility will only be covered by Medicaid if the providers you use that day accept Medicaid.
You can use healthcare expenses that would normally be covered by Medicaid if you had Medicaid coverage. You may use expenses from up to 90 days ago.
The amount you paid for health insurance premiums (not counting fixed indemnity plans) can count towards your share of cost, and so can transportation costs (by ambulance, bus, or taxi) incurred for you to get to a medical facility.
The medical expenses don’t necessarily have to be for you. You can use medical expenses for anyone whose income was included in determining your Medicaid eligibility.
In the above example, if Cindy’s husband’s income was included in Cindy’s Medicaid eligibility determination, Cindy could use her husband’s healthcare expenses toward her own share of cost.
However, you can’t use an expense that’s more than 90 days old, and you can’t use an expense that was used to meet a share of cost for an earlier month. Florida Medicaid also notes that you can't count expenses for over-the-counter medications or supplies.
Medicaid eligibility for the aged, blind, disabled, pregnant, and children (ie, traditional Medicaid) is different from Medicaid eligibility under the Affordable Care Act's expansion of Medicaid (which applies to non-elderly adults, and which Florida has not implemented).
The income eligibility guidelines (as a percentage of the poverty level relative to the household's size) for the traditional Medicaid populations vary considerably from one state to another.
Maximizing Benefits
You’ll have to be organized to maximize your Medicaid coverage.
Notify Medicaid of your healthcare expenses, via mail, fax, or in-person.
Time appointments and expenses for early in the month so that you meet your share-of-cost sooner rather than later in the month. This will help you get more days of full Medicaid benefit coverage.
Keep a running total of healthcare expenses until you exceed your share of cost each month.
Be aware of which healthcare expenses have already been used to meet a prior month’s share of cost, which expenses haven’t been used, and which expenses are more than 90 days old and can’t be used to meet your current share of cost.
You’ll need to pay any healthcare expenses that are more than 90 days old, haven’t been used to meet any month’s share of cost, and weren’t received while you had Medicaid coverage.
Does It Work Well?
Medicaid's share-of-cost works especially well for people with high healthcare expenses that recur every month.
For example, if you’re on a medication that costs $3,000 every month, and your share-of-cost is $1,900, you’ll meet your share-of-cost every month when you refill your prescription.
Time your refills to the first day of every month, and you’ll be covered with full Medicaid benefits all month every month.
Problems With Florida Medicaid Share-of-Cost
Florida's Medically Needy program has three significant problems:
Hard to Understand
First, many Florida Medicaid Share of Cost beneficiaries don’t understand the program.
Some people mistakenly believe they have to pay their full share of cost out-of-pocket every month. They struggle to pay their share of cost themselves, thus paying more than was expected of them.
Some people mistakenly believe they won’t have coverage until they pay their share of cost every month, which they can't afford to do. They end up paying too much out-of-pocket and getting very few days of full Medicaid coverage.
Providers Don't Accept It
Depending on the area, it can be hard to find healthcare providers who will accept Florida Medicaid's Share of Cost program beneficiaries. Even providers who accept regular Medicaid sometimes won’t agree to see a patient in the Medically Needy program until the person's share of cost has been met for the month and their coverage is in effect.
If a provider checks your Medicaid eligibility and finds you’re not enrolled because you haven’t met your share of cost for the month, they might request payment in full at the time of service. If you pay, you won’t be reimbursed by Medicaid, even if your Medicaid coverage would have taken effect that day. If you don’t pay, the provider could refuse to provide the service.
Incentive to Use Services
Because eligibility resets every month, the Florida Medicaid Share-of-Cost program encourages you to use as many healthcare services as possible. The more bills you rack up, the more likely you are to have coverage that month.
That means there’s no incentive for you to keep healthcare costs down.
Summary
Florida Medicaid's "Share of Cost" program is the state's Medically Needy eligibility pathway for Medicaid. It allows some people with high medical costs to access Medicaid even if their income is too high to qualify for full Medicaid under the state's normal rules.
Under Florida's Share of Cost program, a person submits their medical costs to the state each month, and Medicaid coverage kicks in once the costs have reached a certain amount. The person then has Medicaid coverage for the rest of the month, but the program resets on the first day of each new month.
Florida Medicaid will pay medical expenses that are incurred on the day that the person's medical expenses reach their share of cost amount, and on any remaining days in the month.
A Word From Verywell
If you're eligible for this program, be sure you understand all the conditions so you can maximize your health care while minimizing the expenses you have to cover yourself. If you have questions, call the Florida Medicaid office and ask them to explain the details. And remember that you can ask a friend or loved one to be part of that conversation, to help ensure that you understand everything that's explained. Especially when you're dealing with significant medical needs, it can be challenging to figure out all the administrative details on your own.
A beneficiary's share of cost amount is equal to the difference between the individual's net nonexempt income and the applicable state-determined “maintenance need level.”
“Share of Cost” is the amount you agree to pay for health care before Medi-Cal starts to pay. This is called “meeting your share of cost.” Your Share of Cost is a set amount based on how much money you make. You only need to meet your Share of Cost in the months that you get health care services.
A Share of Cost (also referred to as a SOC) is the amount of money an individual is responsible to pay towards their medical related services, supplies, or equip- ment before Medi-Cal will begin to pay. The Share of Cost amount applies to all immediate household members who do not qualify for a free Medi-Cal program.
Countable Assets in Florida. A single person over 65 or disabled who needs Medicaid benefits for health assistance at home, assisted living, or nursing care cannot have more than $2,000 in assets that are countable for Medicaid.
Under Florida's Share of Cost program, a person submits their medical costs to the state each month, and Medicaid coverage kicks in once the costs have reached a certain amount. The person then has Medicaid coverage for the rest of the month, but the program resets on the first day of each new month.
Individuals enrolled in the Medically Needy Program have income or assets that exceed the limits for regular Medicaid. A certain amount of medical bills must be incurred each month before Medicaid is approved. This is your “share of cost.”
Buy health insurance each month to get rid of the monthly Medi-Cal Share of Cost. reduce your income so that you meet the Medi-Cal monthly income limits of $1468 for a single person or $1983 for a married couple. policy that costs $50 a month.
You might not be eligible for expensive surgical procedures or care because Medi-Share is technically NOT insurance. Many health care institutions and hospitals might not treat you, especially for the more costly procedures if Medi-Share is your only health insurance policy.
Cost sharing lowers costs for everyone. There are three basic types of cost sharing everyone needs to understand: deductibles, copayments and coinsurance.
A term used to describe the practice of dividing the cost of healthcare services between the patient and the insurance plan. For example, if a plan pays 80% of the cost of a service, then the patient pays the remaining 20% of the cost.
Who is eligible for the cost sharing reduction? People who are eligible to receive a premium tax credit and have household incomes from 100% to 250% of poverty are eligible for cost sharing reductions.
In 2022, the medically needy income limit in FL is $180 / month for a single applicant and $241 / month for a married couple. The “spend-down” amount is the difference between one's monthly income and the medically needy income limit.
While Medicaid agencies do not have independent access to a Medicaid recipient's financial statements, Medicaid does an annual update to make sure a Medicaid recipient still meets the financial eligibility requirements. Furthermore, a Medicaid agency can ask for bank statements at any time, not just on an annual basis.
Florida is an “Income Cap State,” which means that if an individual's gross income is more than $2,523 per month, that person is not eligible for Medicaid assistance.
In order to qualify for long-term Medicaid in Florida, such as nursing home or assisted living care, the applicant must not have given away (i.e., made "uncompensated transfers") assets within five years of applying for Medicaid benefits. This is generally known as the Medicaid “look-back” period.
Cost-sharing reduces premiums (because it saves your health insurance company money) in two ways. First, you're paying part of the bill; since you're sharing the cost with your insurance company, they pay less.
When you use medical services, you also usually have to pay a part of the charges. The part you pay for is called “cost-‐sharing.”The amount of money you pay each time you get a service – called the “co-‐ payment” or “co-‐insurance.”
This is the maximum amount that an enrollee is required to pay for all cost-sharing charges (including the deductible, copayments and/or coinsurance) during the course of a year.
Medicaid extends medical coverage to several groups of low-income persons. This includes children, pregnant women, adults under 65, people with disabilities, and the elderly (65+).
An irrevocable asset protection trust may hold your Florida homestead property and protect it in the event you need to go onto Medicaid. Even if you do not have a great deal of assets other than your home (such as in the example above), then it may be helpful to place your homestead property into an irrevocable trust.
Yes, you should pay your medical bills from your settlement. However there are many different circ*mstances regarding your medical bills to be paid out of your settlement.
A discount that lowers the amount you have to pay for deductibles, copayments, and coinsurance. In the Health Insurance Marketplace ®, cost-sharing reductions are often called “extra savings.” If you qualify, you must enroll in a plan in the Silver category to get the extra savings.
This type of income relates to interest on savings and retirement accounts, pensions, annuities, veteran's benefits, etc. Social Security counts as unearned income as well.
The Medi-Cal program must seek repayment from the estates of certain deceased Medi-Cal beneficiaries. Repayment only applies to benefits received by these beneficiaries on or after their 55th birthday and who own assets at the time of death. If a deceased beneficiary owns nothing when they die, nothing will be owed.
So, Is Medi-Share Legit? Here's our conclusion: Medi-Share is legitimate, and there's a strong membership base to support it and similar programs. But it's likely not the most affordable health care option for most people.
The bottom line. Medical cost-sharing plans can offer lower monthly costs than regular health insurance. However, members are also taking a risk, as these plans don't guarantee coverage or even partial coverage. Also, the plans can't be sued for nonpayment.
Medi-Share is a healthcare sharing ministry program administered by Christian Care Ministry, Inc. (“Christian Care Ministry” or “CCM”). Christian Care Ministry is a Florida not for profit corporation that is recognized as tax exempt under Internal Revenue Code 501(c)(3).
Identify shared facilities or support services. Identify the costs to be allocated. Determine the allocation factors/methodology to distribute the costs equitably. Allocate the costs.
The three general categories of costs included in manufacturing processes are direct materials, direct labor, and overhead. Note that there are a few exceptions, since some service industries do not have direct material costs, and some automated manufacturing companies do not have direct labor costs.
There are primarily three types of cost sharing that may occur on sponsored projects: mandatory cost sharing; voluntary committed cost sharing; and voluntary uncommitted cost sharing.
Both the sub's royalty payments to the parent (under the transfer pricing agreement) and the sub's cost-sharing payment to the parent (under the cost-sharing agreement) constitute taxable income to the parent, and are tax deductible for the sub.
“Cost sharing” means a portion of total project of program costs related to a sponsored agreement that is contributed by someone other than the sponsor.
If a person with income below 250 percent of the poverty line enrolls in a bronze plan instead of a silver plan, they would not be eligible for cost-sharing reductions. They would have to pay whatever out-of-pocket charges are required under the bronze plan.
Cost-share exemption is available to clients whose taxable income (line 26000 of the most recent income tax return) is: $20,970 or less for a single person,$33,240 or less for a family with no children, or. $39,250 or less for a family with children.
Cost-Sharing Exclusion (Improvements) You can exclude from your income part or all of a payment you receive under certain federal or state costsharing conservation, reclamation, and restoration programs. A payment is any economic benefit you get as a result of an improvement.
Parents of Dependent Children: Eligibility levels for parents are presented as a percentage of the 2022 FPL for a family of three, which is $23,030. Other Adults: Eligibility limits for other adults are presented as a percentage of the 2022 FPL for an individual, which is $13,590.
Documentation of income might include any of the following: Most current pay stubs, award letter for Social Security, SSI, Railroad Retirement, or VA, pension statement, alimony checks, dividend checks, a written statement from one's employer or from a family member who is providing support, or an income tax return.
The applicant income limit is equivalent to 300% of the Federal Benefit Rate (FBR), which increases on an annual basis in January. In 2021, an applicant, regardless of marital status, can have a monthly income up to $2,382.00.
First, understand that, per Florida Medicaid rules, the applicant's primary residence is considered a non-countable asset. If the applicant or spouse resides there—or if the applicant intends to return after treatment—Medicaid does not regard the home as a countable asset.
In Florida, Medicaid eligibility for long-term nursing home care is based on the assets and income of the Medicaid applicant, as well as the assets and income of the Medicaid applicant's spouse.
Yes, it is possible to meet the eligibility requirements for Medicaid while owning a house in Florida. If the Medicaid recipient's primary residence is protected by Florida homestead laws, it is not considered a “countable asset” towards Medicaid asset limit requirements.
Countable Assets in Florida. A single person over 65 or disabled who needs Medicaid benefits for health assistance at home, assisted living, or nursing care cannot have more than $2,000 in assets that are countable for Medicaid.
For a household of one person, the maximum net income is $1,074, or 100% of poverty level. For a family of four, the maximum net income limit in Florida is $2,209. A family of four in Florida would receive a maximum of $835 per month in 2022 in SNAP benefits.
My answer to him was that he was correct - Florida Medicaid does have a pay back provision, just like all states. During your lifetime, if you receive Medicaid benefits, if you die after age 55, the State of Florida is a creditor in your estate.
Most states — 38 and Washington, D.C. — have the same income limit of $2,523 per month for a single person for most types of Medicaid services. For a married couple, the limit increases to $5,046 in most cases.
Family-Related Medicaid is a benefit for children, parents and other caretakers, pregnant women, and individuals up to age 26 previously who aged out of foster care.
To figure out your cost base per share, you will need to divide the original value of the investment ($5,000) by the new number of shares you hold post-split (1,000) to get a value of $5, compared to your previous cost base per share of $10.
Cost-sharing reduces premiums (because it saves your health insurance company money) in two ways. First, you're paying part of the bill; since you're sharing the cost with your insurance company, they pay less.
The costs actually incurred in acquiring or creating an asset. For example, these costs could include the cost of purchasing an asset or the cost of erecting a building. The expenditure should not have been claimed against income.
Choosing the best cost basis method depends on your specific financial situation and needs. If you have modest holdings and don't want to keep close track of when you bought and sold shares, using the average cost method with mutual fund sales and the FIFO method for your other investments is probably fine.
Introduction: My name is Velia Krajcik, I am a handsome, clean, lucky, gleaming, magnificent, proud, glorious person who loves writing and wants to share my knowledge and understanding with you.
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