Hospice-When am I Eligible for Hospice as a service?

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Hospice-When am I Eligible for Hospice as a service?

Revised October 28, 2008

When am I Eligible for Hospice as a service?
A person must be eligible for a categorically needy (CN) or medically needy (MN) program* to receive hospice care. Examples include but are not limited to the following:

CNP non institutional Medicaid in an alternative living facility (G03)

General assistance for Aged, Blind or Disabled, who have a NGMA determination from DDDS (GA-A, GA-D, GA-B)

General assistance – disability determination pending (GA-X)

Temporary Assistance for needy families

Healthcare for Workers with Disabilities (HWD)

Children’s Health

SCHIP

Foster Care/Adoption Support

Refugee Assistance

*For clients determined eligible under the MN program, see additional instructions in ’When am I eligible for the C01 hospice program following institutional Medicaid rules?’ (a client who has met their spenddown under MN is eligible for Hospice as a service).

Clients must meet the Hospice diagnostic criteria plus Medicaid eligibility criteria in order to receive Hospice.

Clients who are in a current base period and have not met their spend-down don't have to reapply to get Hospice but they do have to meet their spenddown before Hospice can be approved.

If a client is eligible for a non institutional CNP Program, the Hospice provider bills Health and Recovery Services Administration (H.R.S.A) the same as any other service.

If the client is residing in a medical facility such as a nursing home or hospice care center, the case must be changed to a C01 institutional hospice case. C01 is CN. If income is over the SIL, the case will trickle to a MN program.

Hospice-When am I Eligible for Hospice as a service?
Revised October 28, 2008

When am I Eligible for Hospice as a service? A person must be eligible for a categorically needy (CN) or medically needy (MN) program* to receive hospice care. Examples include but are not limited to the following: CNP non institutional Medicaid in an alternative living facility (G03) General assistance for Aged, Blind or Disabled, who have a NGMA determination from DDDS (GA-A, GA-D, GA-B) General assistance – disability determination pending (GA-X) Temporary Assistance for needy families Healthcare for Workers with Disabilities (HWD) Children’s Health SCHIP Foster Care/Adoption Support Refugee Assistance *For clients determined eligible under the MN program, see additional instructions in ’When am I eligible for the C01 hospice program following institutional Medicaid rules?’ (a client who has met their spenddown under MN is eligible for Hospice as a service). Clients must meet the Hospice diagnostic criteria plus Medicaid eligibility criteria in order to receive Hospice. Clients who are in a current base period and have not met their spend-down don't have to reapply to get Hospice but they do have to meet their spenddown before Hospice can be approved. If a client is eligible for a non institutional CNP Program, the Hospice provider bills Health and Recovery Services Administration (H.R.S.A) the same as any other service. If the client is residing in a medical facility such as a nursing home or hospice care center, the case must be changed to a C01 institutional hospice case. C01 is CN. If income is over the SIL, the case will trickle to a MN program.

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