What's the Role of Medicare & Medicaid in Hospice?


Government health care programs such as Medicare and Medicaid are designed to help shoulder the cost burden of medical expenses for financially vulnerable Americans. These entitlement and insurance programs assist people with all types of care for a wide range of health services, among them hospice care.

While there are current proposals at the state and federal levels that may affect the scope of hospice services covered by these programs, the impact of these changes remains uncertain, and it is helpful to have a grasp on what is and what is not covered right now.

Understanding the Components of Medicare

Medicare is a program run by the federal government that provides health care coverage to individuals over the age of 65, as well as to younger individuals with disabilities and people with end-stage renal diseases. Administered by the Centers for Medicare & Medicaid and securing its funding through a combination of Social Security and Medicare taxes, Medicare premiums and federal budget allowances, Medicare assists individuals financially with a long list of health services, hospice care among them.

There are multiple aspects of Medicare that relate to different areas and options of care, and for people already receiving Social Security benefits, most of their sign up is free and automatic. Medicare Part A is hospital insurance that covers inpatient hospital stays, rehabilitation for a fixed number of days, or hospice house and select aspects of home health care. Medicare Part B, however, refers to medical insurance which covers certain doctors’ services, outpatient care and medical supplies. 

Another element of Medicare that often applies to individuals in hospice care is Part D for prescription drug coverage. In the case of hospice patients, it would usually cover the small copay often required for any prescriptions. Individuals receiving Social Security benefits are not automatically signed up for Part D, however, so they need to sign up separately to be eligible for drug coverage. 

With the diverse and varied range of services that are included in a hospice care plan, it is possible that certain facets of an individual’s care could be addressed by every part – but what aspects of hospice care are covered?

What Does Medicare Cover?

While hospice services are generally covered under Medicare, individuals must meet a list of criteria to be eligible. People with Medicare Part A are eligible for hospice care coverage if: they have received a late-stage illness diagnosis from their doctor with a life expectancy of six months or less, accept palliative care instead of curative care and sign a statement choosing hospice over other Medicare-covered benefits that would attempt to treat the illness, according to Medicare.gov. 

For individuals who qualify, this coverage makes a large impact, as they pay nothing out of pocket for hospice care. Medicare also covers the cost of any medical equipment, oxygen and beds. In addition to coverage for services, any prescription drug copays will most likely never exceed $5 – although these copays would often be covered by Part D for those who are signed up. 

Since Medicare Part B is medical insurance, it is more often than not referring to curative care and is not generally covered under the hospice care umbrella, although there are exceptions when it comes to certain medical supplies that may be needed in hospice care, as well as some palliative care services.

The Role of Medicaid

Where Medicare is a government-run health program intended to primarily benefit senior citizens, Medicaid is a similar program intended to benefit people with limited income and assets. Unlike Medicare, Medicaid is run on a state-to-state basis. This means that although it is run by the Offices of Medicare & Medicaid and funded through a combination of income tax revenue and budgetary allowances, Medicaid programs also receive state funding and may be subject to restrictions on coverage decided at the state level. 

What Does Medicaid Cover?

Although the Medicaid program is managed at the state level, it generally provides much of the same coverage of hospice services that Medicare provides, as well as with similar requirements for eligibility. Individuals who are strictly on Medicaid must have a late-stage illness with a life expectancy of 12 months or less per the New York State Hospice Modernization Law, and waive any other curative Medicaid services before receiving any coverage for hospice care.

In summary, the Medicare and Medicaid benefits cover all of the services provided by Niagara Hospice, including the cost of medications, medical equipment, therapies and supplies that are directly related to the patient’s admitting diagnosis. Niagara Hospice also has contracts with most private insurance companies, such as BlueCross Blue Shield, Independent Health and NOVA to provide similar services to their members.
Hospice Coverage in Public Policy

The question of allocating government funds for health care is never an easy one. There are many medical causes worthy of much more funding than they currently receive, and hospice care is no exception. Yet with so many programs, causes and organizations all vying for allocation of the same funds, policy makers are forced to prioritize certain aspects of medical care over others. 

There are currently lobbying or policy proposals at both the federal and state levels that have the potential to negatively affect coverage of and access to hospice services under both Medicare and Medicaid. 

The National Hospice and Palliative Care Organization (NHPCO) advocates for hospices nationwide in Washington, D.C. to address any concerns regarding legislation that would restrict the access of hospice care to underserved communities already facing limited options for end-of-life care. 

In the event that there are any new legislative developments that emerge this year or news from the NHPCO, Niagara Hospice will share the information on the news or blog sections of NiagaraHospice.org. We believe that every resident of Niagara County should have access to hospice care and the freedom to choose how they want to live their life at the end. 

In addition to policy at the national level, the 2020 New York State proposed budget has many implications for health care spending, with Medicaid clearly in the crosshairs. Gov. Andrew Cuomo has proposed a $2.5 billion spending cut and has organized a Medicaid Redesign Team to oversee the details, which are scant thus far.

Home Health Care News notes significant increases in the cost of home care in recent years – up more than 7 percent from 2018 to 2019 alone. Although Cuomo has said that any cuts must have “zero impact” on Medicaid recipients, some have speculated that these increases in home-care spending may place it on the chopping block. Any changes in funding to home care would most likely affect hospice providers and possibly the options and level of care for Medicaid recipients who need hospice services. 

Fortunately, much of this is largely preliminary and nothing has been decided, but it is good to be aware of potential changes in care coverage that could be coming in the near future. 

Supporting Families at the Toughest Times 

At Niagara Hospice, we are grateful for our community’s continued support of our mission to provide specialized care and personalized support to families faced with the challenges of late-stage illnesses. Whether someone has Medicare, Medicaid or private insurance, we believe that everyone in Niagara County has a right to receive respect, dignity and comfort while maximizing quality of life during hospice care. 

For more information or to make a referral, call 716.439.4417 or visit our Admissions page.

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