Can Patient on Hospice Care Also Receive Medicaid Coverage?

 In Long-Term Care Planning

Question:

My 86-year-old sister has been in a nursing home since November of 2017. The paperwork is still “working” to qualify her for Medicaid (New Mexico). However, just recently, the doctor has requested hospice for her, because she has been declining. I understand that hospice is under Medicare . My question is if she continues to decline, would it be possible to take her home and still qualify for any of the Medicaid benefits?

Response:

That is correct. Medicaid pays for nursing home care and Medicare for hospice care. To receive the hospice care, the doctor must certify that you are unlikely to live more than six months and you have to agree to receive only comfort care (often called “palliative” care), not medical care aiming to cure what ails you. The reality is that some patients actually do better with palliative care and end up living longer than six months, sometimes even being deemed to be no longer terminally ill and going back to regular Medicare. On the other hand, in many cases patients opt into hospice care only at the very end of life and receive only a few days or weeks of hospice care.

Hospice care can be provided anywhere, in special hospice facilities, at home, in a nursing home or in assisted living. It can be combined with Medicaid, which pays for the basic costs with the hospice care supplementing what Medicaid covers.

In terms of your question, there are really two issues: First, can your sister qualify for Medicaid benefits at home. The answer to this question is probably yes. In most cases, people receiving Medicaid in a nursing home can also qualify for Medicaid coverage at home. However, the second inquiry has to be what does Medicaid cover outside of the nursing home? This is more difficult and varies tremendously from state to state, with some states being much more generous in terms of covering home care than others. To know about New Mexico in particular (or any other state for that matter), you will need to consult with a local care provider or elder law attorney.

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