Does Medicaid Cover Hospice? What You Need To Know

Does Medicaid Cover Hospice?

Explore the details of Medicaid coverage for hospice care, understanding the eligibility criteria, certification process, and copayment requirements.

Learn about the levels of hospice care and additional services covered under Medicaid.

Medicaid often covers hospice care, but coverage specifics depend on your state.

With each state having its own regulations, this article delves into the common eligibility criteria, certification process, and copayment structures associated with Medicaid’s hospice care coverage.

Hospice care offers comfort and support to individuals with terminal illnesses.

This aims to enhance their quality of life during their final days.

Expert teams, including medical professionals and social workers, create personalized hospice plans.

In certain cases, Medicaid covers the expenses associated with hospice care for eligible individuals.

Does Medicaid Cover Hospice?

To be eligible for hospice care, an individual must:

1.Already be enrolled in Medicaid.

2. Have a terminal illness, with certain states defining a maximum life expectancy.

In Colorado, for instance, Medicaid enrollees must have no more than a 9-month life expectancy to qualify for hospice care.

3. Obtain certification from a doctor, confirming the terminal illness and describing the medical condition of the Medicaid recipient.

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Once Medicaid receives the physician’s certification and approves the need for hospice care, a personalized plan is developed for the recipient.

Medicaid does not cover any hospice services until the plan is finalized. If any expenses were incurred before the plan’s completion, these are typically out-of-pocket expenses.

Some states may require hospice recipients to pay a copay for all or specific services during hospice care.

This copayment, also known as patient liability or patient responsibility share, involves the enrollee covering a certain percentage of the cost, often determined by income.

Conversely, other states may have no copay requirements or may recoup some or all of the care costs from the estate of a Medicaid recipient after their death.

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Levels Of Hospice Care

Hospice care comprises four levels provided by licensed hospice care providers:

Routine Home Care (RHC): Administered on a per-day basis in the patient’s home.

Continuous Home Care (CHC):

Involves 24-hour care for pain and symptom management, primarily provided by nurses, with additional support from hospice and personal care aides.

Inpatient Respite Care (IRC):

A short-term stay in a long-term care facility to offer family members a break from providing home care.

General Inpatient Care (GIC):

A short-term stay in a hospital or skilled nursing facility with 24-hour nursing care, available when symptoms cannot be managed at home.

Hospice providers can bill Medicaid for service intensity add-ons, which are non-routine services.

To be eligible for coverage, these services must:

• Occur during the last seven days of a person’s life
• Take place during routine home care hospice
• Be provided by a registered nurse or social worker
• Last a minimum of 15 minutes and a maximum of 4 hours

Included in hospice care are services like emotional and spiritual counseling, homemaker services, medical equipment;

Supplies, medications, nursing and physician care, nutritional counseling, therapies, respite care, and social worker services.

However, specific inclusions or exclusions may vary based on state Medicaid guidelines.

Can You Receive Disease Treatment While Under Hospice Care?

No, Medicaid prohibits receiving disease treatment concurrently with hospice care.

If unexpected recovery occurs, the enrollee can discontinue hospice care and resume treatment.

Is Palliative Care the Same as Hospice Care in Medicaid?

No, palliative care and hospice care differ under Medicaid.

Palliative care aims to alleviate pain symptoms related to a medical condition.

Medicaid enrollees can simultaneously receive palliative care and treatment.

But palliative care usually covers fewer services than hospice care.

How Long Will Medicaid Cover Hospice?

In most states, there’s no specified limit on hospice care duration, but periodic doctor recertification may be required.

Some states limit respite care days within the hospice program.

Does Medicaid Cover Hospice Home Care?

Yes, Medicaid covers both routine and continuous home care;

And a home setting, as defined by Medicaid, includes any place of residence like a private home, assisted living, or nursing home.