Change in the Share of Cost (SOC)
Changes Which Decrease the SOC
When a change in income, family composition, or other circumstances results in a decreased SOC, the client is entitled to an adjustment.
Change Reported Timely
Timely reporting means that the client reports changes within 10 calendar days following the date the change occurred or is known, whichever occurs first.
ExampleExampleThe client is told on January 12 that his employment will be terminated on January 23. He must report the change no later than January 22 in order to meet timely reporting requirements. Determine what the correct SOC should have been during the months in which the decrease occurred.
Example Example A decrease in income occurred on April 29. The client reported this change on May 3. The EW must determine the correct SOC for April and May.
Change Not Reported Timely
Change the ongoing SOC by the first of the month following the month in which the change was reported.
Example Example Decrease in income occurred on January 10. Change reported on February 3. SOC change is effective March 1. No recomputation of SOC for January and February is done, unless good cause exists. Note: Make no adjustment for the excess cost the client may have paid or obligated before the ongoing SOC was changed, unless there was a good cause for failure to report in a timely manner.
Changes Which Increase the SOC
When a change in income or other circumstances is reported and results in an increased SOC, an adequate and timely NOA must be given.
Change Reported Timely
Reevaluate the budget for the first of the month following the month in which the change is reported, if a 10-day notice can be given.
Example Example Change reported timely on January 8. SOC must be changed for February. Reevaluate for the first of the second month following the month in which the change is reported, if the SOC cannot be increased for the first of the following month because a 10-day notice cannot be given.
Example Example Change reported timely on January 25. Ten-day notice cannot be given for February. Reevaluate SOC for March.
Note: When it is too late for a 10-day notice to increase the SOC and the change is made in the second month, there is no Medi-Cal overpayment.
Reminder: Notices of Actions issued to decrease the SOC do not require a 10-day notification period.
Change Not Reported Timely
Revise the budget for the first of the month following the month in which the change is reported, if a 10-day notice can be given.
Example Example Change occurred on January 8 and reported on February 5. SOC must be reevaluated for March. Revise the budget for the first of the second month following the month in which the change is reported, if the SOC cannot be increased for the first of the following month because a 10-day notice cannot be given.
Example Example Change occurred on January 8 and reported on February 25. Ten-day notice cannot be given for March. SOC must be reevaluated for April.
Important: Complete a potential overpayment referral if the client:
- Received zero SOC MC but should have had a SOC, or
- Met a SOC which was less than the correct SOC.
Excess income received or other changes that are reported AFTER the EW should have taken action is NOT a potential overpayment.
Example Example Change occurred on January 15 and is reported on January 30. Even if the client had reported the change within ten days (January 25), the EW cannot increase the SOC for February because a 10-day notice cannot be given for February. The change must be effective March 1. There is no potential overpayment for February.
Related Topics
Share of Cost