What, When & Where Does Medicaid Long Term Care Provide for Hospice Coverage

Hospice care uses a variety of medical services to alleviate pain and suffering for terminally ill people. It focuses on easing symptoms and providing comfort rather than trying to cure the terminal condition. Coverage varies by state, but Medicaid Long Term Care does cover at least a portion of some hospice care services in all 50 states and Washington, D.C.


What is Hospice Care?

Hospice care helps terminally ill people live out their final days in as much comfort as possible using a team of medical professionals, usually including social workers or mental health counselors. The team, often directed by the patient’s physician, creates a hospice plan and then works together to carry out that plan. Hospice care plans can also provide support for the family and caregivers of the terminally ill individual. Medicaid Long Term Care recipients can receive hospice care services in their home or in an institutionalized setting like a nursing home or assisted living facility.


Hospice Care Services Covered by Medicaid

Hospice care coverage varies by state, but in general Medicaid Long Term Care will cover the following services for about six months:
• Emotional, spiritual and grievance counseling
• Medical care from doctors and nurses
• Prescription medications for pain relief and management
• Short-term inpatient stays and services
• Medical equipment and supplies
• Occupational, physical and speech therapies
• Home health aides
• Homemaker services


Service Intensity Add-On

Medicaid will also cover the extra care a terminally ill person may need during the last seven days of their life. This extra coverage, introduced as part of the Medicaid program in 2016, is called a Service Intensity Add-On (SIA). Medicaid will pay for a SIA as long as it occurs during routine hospice care, is provided by a registered nurse or social worker, lasts a minimum of 15 minutes and a maximum of four hours, and occurs during the last seven days of the terminally ill person’s life.


Levels of Hospice Care

Licensed hospice care providers offer four levels of care:
1) Routine Home Care (RHC) – Daily care received in the home.
2) Continuous Home Care (CHC) – 24-hour care received in the home in the case of extreme symptoms or pain. Nurses usually provide most of this care, but some support and care may come from hospice care aides.
3) Inpatient Respite Care (IRC) – This is a short stay in a long-term care facility designed to give family members a short break, or respite, from their hospice care duties so they can recuperate and take care of other personal matters.
4) General Inpatient Care (GIC) – When the terminally ill individual has symptoms that can’t be managed at home they can receive this General Inpatient Care at a hospital or skilled nursing home facility that has registered nurses on duty 24 hours a day.


Requirements to Receive Medicaid-Covered Hospice Care

In order to receive hospice care services covered by Medicaid Long Term Care, a person must:

• Be enrolled in one of the three Medicaid Long Term Care programs – Nursing Home Medicaid; Home and Community Based Service Waivers; Aged, Blind or Disabled Medicaid
• Have a physician certify that they are terminally ill. The definition of “terminally ill” varies by state. In some states, it means a patient is only expected to live another six months, while that number can change (to nine months, for example) in other states.
• Choose to receive hospice benefits by completing an election statement.
• Waive all Medicaid services that are trying to cure their terminal condition.
• Have a hospice plan of care in place that has been created by a medical professional.
All of these requirements must be met before Medicaid will pay for any hospice services. If the terminally ill person receives hospice care before all the requirements are completed, they will have to pay for that care out of pocket.


Locations in Which One Can Receive Medicaid-Covered Hospice Care

Medicaid Long Term Care will cover hospice care in a variety of locations, including your home. If a terminally ill person has a Home and Community Based Service (HCBS) Waiver or Aged, Blind or Disabled (ABD) Medicaid, they are likely already living at home and can stay there to receive hospice care.

If a terminally ill person has Nursing Home Medicaid and is living in a nursing home facility, Medicaid can consider the facility to be the home and provide hospice care there. However, if the terminally ill Medicaid patient wishes to leave the nursing home and return to their home (perhaps their spouse still lives there) or somewhere else in the community (with a family member, for example) and this relocation is part of the physician-approved hospice care plan, the state Medicaid office may decide to pay for hospice care in the home. Many individuals would be more comfortable spending their final days at home, and making the terminally ill individual comfortable is the purpose of hospice care. Plus, it may be more cost-effective for Medicaid to have the terminally patient at home rather than paying for room and board at the nursing home.