Does Medicaid Cover Hospice?
- Get the facts about Medicaid coverage for hospice care for terminal illnesses. Find out what services are included and explore eligibility requirements.
Hospice care allows those who have terminal diseases to live out their remaining days as comfortably as possible and provides support for their caregivers and family members. Teams of medical professionals and social workers develop individualized hospice plans and orchestrate care. Medicaid often pays for the cost of hospice care for individuals who meet certain eligibility requirements.
Does Medicaid Cover Hospice?
Medicaid generally covers hospice care, but the details of coverage vary based on where you live. Although Medicaid is partially funded by the federal government, each state establishes its own regulations for the program. The Kaiser Family Foundation reports that most states cover hospice care to some extent.
To qualify for hospice care, a person must:
- Already be enrolled in Medicaid.
- Have a terminal illness. Some states define a maximum life expectancy that a person may have. For example, in Colorado, a Medicaid enrollee must have no more than 9 months to live to qualify for hospice care.
- Be certified by a doctor to verify they are terminally ill. The certification must also describe the medical condition of the Medicaid recipient.
Once Medicaid receives the physician's certification and approves the need for hospice care, a plan is developed for the hospice recipient. Medicaid won't pay for any hospice services until that plan is finalized. If any expenses were incurred before completion of the plan, you'll usually have to pay for them out of pocket.
Some states require that hospice recipients pay a copay for all hospice care or some specific services received during hospice care. The copayment can also be referred to as a patient liability or patient responsibility share. Under Medicaid programs that follow this rule, the enrollee covers a certain percentage of the cost, usually determined by income.
Other states have no copay requirements or may recoup all or some of the cost of care from the estate of a Medicaid recipient after their death.
What Are the Levels of Hospice Care?
All licensed hospice care providers offer four levels of care:
- Routine home care (RHC) involves administering care on a per-day basis in their home.
- Continuous home care (CHC) includes 24-hour care for pain and symptom management. Most of the care is provided by nurses, though hospice and personal care aides may provide additional support.
- Inpatient respite care (IRC) is a short-term stay in a long-term care facility intended to give family members a break from providing home care so that they can rest and attend to personal matters.
- General inpatient care (GIC) is a short-term stay in a hospital or skilled nursing facility where registered nurses are on duty 24 hours a day. This level is only available when symptoms can't be managed at home.
Hospice providers may also bill Medicaid for service intensity add-ons, which are services that fall outside of the usual guidelines for routine care. To be eligible for coverage, the service must:
- Occur during the last seven days of a person's life
- Occur 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
What Is Included in Hospice Care?
Generally, hospice care includes:
- Emotional and spiritual counseling
- Homemaker services like basic cleaning and cooking
- Medical equipment like a hospital bed or wheelchair
- Medical supplies like catheters and wound care supplies
- Medications for pain and other symptoms
- Nursing and physician care
- Nutritional counseling
- Occupational, physical and speech therapies
- Respite care
- Social worker services
State Medicaid guidelines may exclude some services or include additional services not listed above.
Can You Continue to Receive Treatment for a Disease While Under Hospice Care?
No, under Medicaid, a person can no longer receive treatment for a disease while receiving hospice care. If the enrollee makes an unexpected recovery, they can discontinue hospice care and begin receiving treatment again.
Is Palliative Care the Same as Hospice Care Under Medicaid?
Palliative care and hospice care are not the same under Medicaid. The purpose of palliative care is to ease symptoms of pain related to a medical condition. A Medicaid enrollee can receive palliative care and treatment for a condition simultaneously. Typically, palliative care coverage includes fewer services than hospice care.
How Long Does Medicaid Pay for Hospice?
Most states don't place a limit on the number of days that a person can receive hospice care; however, a doctor may need to periodically recertify that the enrollee still requires hospice care. Some states do limit the number of days a person can receive respite care under hospice.
Does Medicaid Pay for Hospice at Home?
Yes, routine home care and continuous home care are both administered in a home setting. Under Medicaid guidelines, a home setting is wherever a person lives. A private residence, assisted living or nursing home can qualify as a home.