Medicaid Share of Cost—What Is It?

Middle aged man getting IV therapy may have Medicaid Share-of-Cost.
Medicaid Share-of-Cost helps people whose incomes are too high to qualify for regular Medicaid, but too low to pay for the health care they need.. Purestock/Getty Images


Medicaid Share-of-Cost is a special kind of Medicaid health insurance coverage used only in a few states. A type of Medically Needy program, a Medicaid Share-of-Cost program is for people who don’t meet the income requirements for Medicaid, but meet all of the other requirements. Each state that has a Medicaid Share-of-Cost program administers it in its own way, so the program works differently from state to state.

Medicaid Share-of-Cost programs might help you if you make too much money to qualify for regular Medicaid, but not enough money to pay for your medical needs. These programs only provide Medicaid health insurance benefits after certain conditions have been met. For example, you might be required to pay something toward your healthcare expenses each month before your Medicaid coverage kicks in. Or, you might only get Medicaid coverage after you’ve racked-up a certain amount of healthcare expenses, whether or not you’ve actually paid those expenses.

Not surprisingly given that Medicaid is a government-run program, Medicaid Share-of-Cost programs can be complicated, full of complex rules, and notoriously difficult to navigate for both consumers and providers. In fact, sometimes it's hard to find a provider willing to accept Medicaid Share-of-Cost. However, if you're a Medicaid Share-of-Cost recipient, it can be an extremely valuable asset once you know how to use it and establish relationships with providers willing to accept it.

Take the extra time that it requires to fully understand how to access and use your benefits correctly.

Read more about Florida’s Medicaid Share-of-Cost program, and Nebraska’s Share-of-Cost program.

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