Medicaid is a jointly funded, federal and state program that provides free or low-lost health insurance coverage to low- income families, pregnant women, the disabled and the elderly. 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.
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.
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
What hospice services does Medicaid cover?
States are required to offer hospice benefits divided up into set review periods. At the end of each time period, hospice care eligibility must be recertified by a physician.
The Medicaid hospice benefit covers services provided by a skilled hospice team to meet your physical, psychosocial, emotional, and spiritual needs. These 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, Crossroads Hospice & Palliative Care 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 Crossroads Hospice & Palliative Care patients.
Hospice and Medicaid restrictions.
The Medicaid hospice benefit is a provision of the state, and each state may cover different end-of-life care services. Most states model their coverage on the federal Medicare model, which restricts certain treatments and services including:
- 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 not provided or arranged by the selected hospice organization: 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: 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: Patients may be responsible for paying 5% of the Medicaid-approved amount for short-term in-patient respite care.
Applying for hospice services.
Once a patient meets the criteria listed above, they are eligible to begin hospice service. Crossroads Hospice & Palliative Care will meet with patients and their families to admit the patient and begin care.
The Crossroads Hospice & Palliative Care 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 Hospice & Palliative Care 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 Hospice & Palliative Care 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.
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