Medicaid Share of Cost

October 4, 2021

Share of Cost (SOC) or Patient Liability (PL) is the amount a Medicaid recipient must pay towards the cost of his / her nursing home care.   In Arizona, this amount is called something different when the member lives in an Assisted Living (HCBS) but the premise is the same. It is called a “Room and Board Payment”.  Each member is assessed a part of their monthly income to pay for care.

Medicaid is always payer of last resort, which means the member must pay “what they can” towards their cost of care.  In most situations, this is the member’s gross monthly income minus the allowed personal needs allowance ($119.10-2021).  It is important to note that there are rules that allow the well spouse to keep some of the ill spouse’s income, called Community Spouse Monthly, Income Allowance, which we discussed in a previous Benefit Blast.

Management and collection of the Share of Cost can be difficult. What does your facility do if you find that the resident is not paying their assessed Share of Cost? What is your action if you feel the Share of Cost is assessed incorrectly? How long do you wait to ask WHY the resident isn’t paying? What strategies do you have in place to investigate and fix these non-payment issues?

Benefit Results encourages a very proactive approach to these issues to avoid unnecssary revenue loss.

Click HERE for a worksheet that can help estimate Share of Cost.