Does Medicaid Cover Hospice Care?

Hospice care is usually covered under Medicaid.
Hospice care is designed to manage the symptoms of individuals who are terminally ill.
Article Details
  • Originally Written By: Mary McMahon
  • Revised By: Rachel Catherine Allen
  • Edited By: O. Wallace
  • Last Modified Date: 18 September 2014
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Most US states do provide hospice care under Medicaid, though the territories do not. It is considered an optional service, however, and may not get as much funding as mandatory services, though this varies by state. Each state has different eligibility criteria and the services offered vary, but all are required to offer a certain time period of care. Since the rules and services are so region-specific, the best way to get reliable information about up-to-date Medicaid coverage is through a social worker or individual state websites.

Eligibility Criteria

To be eligible for hospice care under Medicaid, a person must qualify for Medicaid and demonstrate that he or she is terminally ill, usually by getting certification from a healthcare provider. The person must also opt for hospice care rather than other types of hospitalization, and he or she must use the services of a hospice that has been approved as a provider by Medicaid.

Benefits are allocated during set time periods: all states are required to provide patients with at least 210 days of care, but most states start with a period of 90 days, and then allow patients to renew for 30, 60, or 90 day periods. Though some states allow people to renew their stays indefinitely, or until the service is no longer needed, others have time limits. Some states have additional eligibility requirements as well, such as having certain high-priority conditions or enrollment in state-specific programs.

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Services Offered

Hospice care is not intended to treat a condition, but rather, it is designed to manage the symptoms of those who are terminally ill and help them and their families prepare for death. Though the specific services offered vary by state, they typically include pain management; therapeutic treatments, like discussions with a psychologist; massage; special nutrition; and other supportive measures to keep the person as comfortable as possible. Some places also offer respite care, during which a person who normally lives at home moves into a care facility for a short time to give his or her family a break.

Payment

Payment for hospice care under Medicaid is done in a few ways. As with Medicare, each state groups the services it provides into four levels of care, each of which comes with different reimbursement rates. In addition to this, in some areas, almost all services are paid for totally by the state, with patients only having to pay for things that are unrelated to their illness. Other states have a co-payment structure for some types of services, like room and board in nursing homes or respite care stays. Generally speaking, the payment structure in most places is based on the Medicare payment structure, with the state reimbursing medical facilities for the majority of the cost, and the person receiving the service paying a small percentage of the fee.

Medicaid vs. Medicare

The hospice care offered by Medicaid is often compared to that offered by Medicare, which is a federal social insurance for certain elderly or disabled people. Medicaid is a welfare program managed at the state level for certain groups of people with a low income. Though hospice care is optional for states, if they do opt in, their programs have to meet most of the same criteria as Medicare. States that offer hospice care can't have co-payments that are lower than those in Medicare, and most match their co-payments pretty closely with those of the other program. Additionally, most states require people who are eligible for both Medicaid and Medicare to use the latter.

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