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GEORGE DEUKMEJIAN. GovernorSTATE OF CALIFORNIAHEALTH AND WELFARE AGENCYDEPARTMENT OF HEALTH SERVICES 714/744 P STREET SACRAMENTO, CATO:95814All County Welfare Directors All County Administrative OfficersSUBJECT:June

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How to fill out share of cost forms

01

Gather all necessary financial documentation such as pay stubs, bank statements, and tax returns.

02

Contact your healthcare provider or insurance company to obtain the necessary share of cost forms.

03

Carefully review the forms and fill out all required information accurately.

04

Include any additional documentation required by the share of cost forms such as proof of income or medical expenses.

05

Submit the completed forms and all necessary documentation to the appropriate office or department.

Who needs share of cost forms?

01

Individuals who are enrolled in Medicaid and have income above the Medicaid eligibility threshold but below the share of cost threshold.

02

People with high medical expenses who need assistance paying for healthcare services.

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What is share of cost forms?

Share of cost forms are documents used to report and determine the portion of costs that individuals or families are required to share when receiving certain services or benefits, particularly in healthcare programs.

Who is required to file share of cost forms?

Individuals or families receiving specific benefits or services, such as those enrolled in Medicaid or other financial assistance programs, are typically required to file share of cost forms.

How to fill out share of cost forms?

To fill out share of cost forms, individuals need to provide personal and financial information, including income, expenses, and other relevant details, and ensure that all requested fields are completed accurately.

What is the purpose of share of cost forms?

The purpose of share of cost forms is to assess an individual's financial situation to determine their share of the costs for services provided, ensuring equitable distribution of expenses.

What information must be reported on share of cost forms?

Information that must be reported includes income sources, monthly expenses, family size, and any other financial obligations that may impact the individual's ability to share costs.

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