Updated August 27, 2026. Quick answer: California calls it share of cost, and the current instruction to counties is a withdrawal. ACWDL 24-10 revokes a planned increase: “Due to budgetary restrictions in the 2024-2025 fiscal year, the Medi-Cal Share of Cost (SOC) reform outlined in ACWDL No. 23-31 is hereby revoked.” The reform “The reform was intended to increase the maintenance need level to 138% of the federal poverty level (FPL), effective January 1, 2025, contingent upon fiscal capacity and federal approval.” Instead, “Counties are to adhere to existing SOC guidelines located in ACWDL 89-58 and the Medi-Cal maintenance need will continue to be based on the Aid to Families with Dependent Children (AFDC) program payment levels.”
What California requires
| What the state sets out | What it says |
|---|---|
| California’s name for it | share of cost (SOC) |
| The letter | ACWDL 24-10, September 18, 2024 — “OBSOLESCENCE OF SHARE OF COST (SOC) REFORM POLICY” |
| What it superseded | This letter supersedes the policy guidance outlined in All County Welfare Director Letter (ACWDL) 23-31, dated December 22, 2023, concerning the changes to the “maintenance need” used to calculate the share of cost (SOC) for Medically Needy (MN) program enrollees not in long-term care. |
| The revocation | “Due to budgetary restrictions in the 2024-2025 fiscal year, the Medi-Cal Share of Cost (SOC) reform outlined in ACWDL No. 23-31 is hereby revoked.” |
| What the reform would have done | “The reform was intended to increase the maintenance need level to 138% of the federal poverty level (FPL), effective January 1, 2025, contingent upon fiscal capacity and federal approval.” |
| What counties apply now | “Counties are to adhere to existing SOC guidelines located in ACWDL 89-58 and the Medi-Cal maintenance need will continue to be based on the Aid to Families with Dependent Children (AFDC) program payment levels.” |
How it works in practice
- The reason this page exists is that the internet is full of the reform. A great deal of material written in 2024 describes a maintenance need level rising to 138% of the federal poverty level from January 1, 2025. The department revoked it, and the revocation is the current instruction.
- The maintenance need is the number your share of cost is measured against, and it is not indexed to poverty guidelines. It “will continue to be based on the Aid to Families with Dependent Children (AFDC) program payment levels” — a programme that no longer exists federally.
- The stated reason was money: “Due to budgetary restrictions in the 2024-2025 fiscal year”. That is a description of why it was revoked, not a forecast about whether it returns; nothing in the letter promises either.
The mechanism itself — why an income cap exists and what the trust must contain — is explained on the income-cap and Miller trust page. This page is the record for California.
What this page does not settle
- ACWDL 89-58 is where counties are pointed for the operative guidelines. This page does not reproduce that letter, and it does not state a maintenance-need dollar figure, because the document read for this page does not publish one.
- This page reads one source: California DHCS, All County Welfare Director Letter 24-10 (September 18, 2024). It is the state’s own publication on this rule, but no state puts its whole treatment of excess income in a single document, and a detail that decides your case may sit in one this page did not read.
- A spend-down fixes an income problem and nothing else. The resource test, the level-of-care test and the transfer-of-assets look-back are separate hurdles, each decided on your own file, and meeting this rule does not clear any of them.
- Every quotation here was read against the source on August 27, 2026. States revise these rules, and a figure or a section number can move without the page around it changing. Open the source before you rely on a detail.
Eligibility is decided by the state agency on the whole file, not by one rule on one page. Nothing here is legal advice, and no one should move, retitle or assign income on the strength of a web page.
Sources
The source above was retrieved and read against the state text on August 27, 2026. Every quotation on this page was checked against those bytes.
Spending down to the income limit is only half of what California Medicaid can do for a household that is already providing the care itself, and getting paid as a family caregiver in California names the California program that pays one and answers the family-member and the spouse question separately.
This page covers what happens to income above the eligibility standard. What California actually uses as that standard, and the state document it comes from, is on Medicaid nursing home income limit in California (No Income Cap).
Related: California’s Medicaid home equity limit for a single applicant with no spouse or dependent child at home.
Related: California’s Medicaid Personal Needs Allowance; the amount a nursing-facility resident keeps from their own income each month.