Medicaid Hospice Benefits Explained
Medicaid is a jointly funded, federal and state program that provides free or low-cost health insurance coverage to low- income families, pregnant women, the disabled and the elderly.
For those facing a terminal illness, Medicaid helps ensure access to compassionate, end-of-life care focused on comfort, dignity, and quality of life.
Medicaid coverage can be used alongside the patient’s existing Medicare coverage. If the patient elects to use the Medicaid hospice benefit, this does not eliminate Medicaid coverage for other symptoms or conditions not associated with their terminal diagnosis.
Who qualifies for Medicaid hospice benefits?
In most states, Medicaid participants are eligible to receive hospice care when they have been diagnosed with a terminal illness with a medical prognosis of less than six months to live if the illness runs its normal course.
While each state’s Medicaid program may have slight differences in hospice eligibility requirements, most states require the following:
- Certification of terminal illness by the patient’s physician
- Patient must agree they are accepting hospice care by completing an election form
- Patient must agree to discontinue curative treatment, unless they are under 21 years old
- The patient’s physician must state that they have a reduced life expectancy as defined by their state each time they certify eligibility
Not sure if your loved one qualifies? We can help verify Medicaid hospice eligibility. Call us today at 855-788-1896.
How long does Medicaid pay for hospice?
Medicaid typically follows the Medicare hospice benefit structure, which includes two initial 90-day benefit periods followed by an unlimited number of 60-day benefit periods. As long as a physician certifies that the patient continues to meet hospice eligibility requirements, Medicaid hospice coverage can continue beyond six months.
What hospice services does Medicaid cover?
Medicaid hospice coverage includes a wide range of services designed to support patients with terminal illnesses and improve quality of life. These services are provided by a skilled hospice team to meet your physical, psychosocial, emotional, and spiritual needs.
Services covered by Medicaid include:
- Hospice physician services
- Hospice nursing care
- Hospice aide services
- Medication for symptom control and pain relief
- Medical equipment and supplies
- Short-term inpatient care for pain control and symptom management
- Social worker services
- Chaplain support
- Respite care
- Bereavement counseling
- Physical, speech, occupational, dietary and other therapies
The patient’s hospice team works alongside their family and physicians to provide the care and comfort they need for the highest possible quality of life.
In addition to these core services, Crossroads offers specialized programs to enhance the patient’s life including our Gift of a Day program, Life Journals, and Veterans Recognition services. These programs are available to all patients.
Does Medicaid hospice coverage vary by state?
Yes, Medicaid hospice coverage can vary by state because Medicaid is a state-administered program. While all states are required to offer hospice benefits, the specific details of coverage, eligibility requirements, and costs may differ.
Most states model their coverage on the federal Medicare model, However, there can still be differences in how services are covered and what limitations apply.
Common Medicaid coverage guidelines and limitations
- Curative treatment: The Medicaid hospice benefit requires patients discontinue curative treatment to begin hospice care. The one exception to this is for patients under the age of 21 who may be able to continue curative treatment while receiving comfort care.
- Care coordination: Once a patient begins receiving hospice services, all care for their terminal illness will be coordinated by the hospice organization.
- Room and board: The Medicaid hospice benefit does not cover room and board fees if the patient resides at a nursing home or other facility.
- Skilled nursing care timing: If a patient has received skilled nursing care for their terminal illness, the Medicaid hospice benefit will not cover hospice services until the following day.
- Inpatient respite care costs: Patients may be responsible for paying 5% of the Medicaid-approved amount for short-term in-patient respite care.
How to apply for hospice services under Medicaid.
Once a patient meets the criteria listed above, they are eligible to begin hospice service. Our hospice team will meet with patients and their families to admit the patient and begin care.
Our admissions nurse will be happy to answer any questions the family has about hospice services and the admissions paperwork. We are able to begin delivering hospice services, equipment, and supplies as soon as the patient is admitted, ensuring a smooth transition into hospice care for the patient and their family.
Medicaid & hospice frequently asked questions.
What is the cost of hospice care for patients using Medicaid?
Hospice services are typically 100% covered with no out-of-pocket costs for patients and their families. They typically see no bills for hospice services as the hospice care reimbursement is handled between the hospice care organization and Medicaid.
Where are hospice services provided?
Hospice services can be provided wherever the patient currently resides including their home, a hospital, a nursing home or assisted living facilities. Crossroads will provide hospice services wherever the patient calls home.
What if I want to discontinue hospice services?
If a patient wishes to discontinue hospice services, they may sign out any time. If the patient begins to improve under hospice care and no longer meets the hospice eligibility criteria, they may be discharged from hospice care. The patient may return to hospice care if their illness progresses and they are once again certified with a terminal illness with a prognosis of six month of less to live if the disease follows its typical course.
When should a patient begin hospice care?
The one thing we hear most from patients and families is that they wish they had known they could start hospice services earlier in their terminal diagnosis and taken advantage of the added support available to them. Experts agree that hospice patients receive the greatest benefit when they utilized hospice services for at least two to three months. In fact, studies show that patients receiving the support of hospice care live an average of 29 days longer than those who do not elect to use their hospice benefit.
Learn more about Medicaid hospice benefits.
The Medicaid hospice benefit allows low-income individuals, individuals with a disability and the elderly to receive quality end-of-life care from a team of skilled hospice professionals.
Crossroads is available 24 hours a day, 7 days a week, 365 days a year to admit patients and provide care. Our admissions team can meet patients and their families in the location that works best for them including their home, the nursing home, a hospital, a workplace or a nearby library, coffee shop or café.
If you have any questions about Medicaid and hospice, please contact us using the blue Help Center bar above.
Get the care you need now.
Crossroads Hospice & Palliative Care will come to you or your loved one's home, nursing home, hospital room or anywhere else.
Our team is available 24/7 to answer your questions, verify Medicaid hospice coverage, and begin care as soon as you’re ready.