In California, a Medi-Cal beneficiary with income above the standard eligibility threshold may still qualify under a 'share of cost' arrangement, which requires the beneficiary to:

Why A is correct

The Medi-Cal share of cost applies to beneficiaries, such as many aged, blind, or disabled individuals, whose income exceeds the Medi-Cal eligibility limit. The beneficiary agrees to pay medical expenses up to a specified monthly share-of-cost amount; once that amount is met in a month, Medi-Cal pays for covered services for the rest of the month. The arrangement is a bridge between partial eligibility and full benefits, letting higher-income applicants participate by contributing toward their own care. D-SNPs that serve dual-eligible members interact directly with this Medi-Cal cost-sharing structure, which is why the concept appears in the senior products material.

Why the other options are wrong

• B) Share of cost is a monthly amount based on income and incurred medical expenses, not a one-time enrollment fee paid to the county. There is no enrollment fee for Medi-Cal.
• C) Share of cost does not require surrendering Medicare Part B. Dual-eligible members keep their Medicare benefits alongside Medi-Cal, which helps pay their Medicare cost-sharing.
• D) Beneficiaries with income above the threshold must meet the monthly share of cost before Medi-Cal pays. Coverage is not free at that income level.

Memory hook

Medi-Cal share of cost = spend down to your monthly amount, then Medi-Cal picks up the rest.

Why A is correct

For individuals whose income exceeds Medi-Cal's eligibility thresholds, California provides a 'medically needy' option with a monthly share of cost. The person must incur qualifying medical expenses each month equal to the share of cost; once those expenses are met, Medi-Cal pays for covered services for the remainder of that month. This mechanism extends coverage to people who have too much income for regular Medi-Cal but face heavy medical costs.

Why the other options are wrong

• B) There is no requirement to buy private insurance for a year before reapplying; the share-of-cost mechanism handles the income excess.
• C) Medicare Part B is a federal program for people 65 or older or with qualifying disabilities, unrelated to Medi-Cal's medically needy eligibility.
• D) The share of cost is a monthly spend-down of incurred expenses, not a flat copay per visit.

Memory hook

Share of cost: spend your monthly amount on medical bills, then Medi-Cal takes over.