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 May 2, 2011



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)
  • Disability Lifeline for Aged, Blind or Disabled,  who have a NGMA determination from DDDS (GA-A, GA-D, GA-B)
  • Disability Lifeline – 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 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 the Medicaid Agency 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 coded as hospice on the INST screen in order to set the hospice flag on the STAT screen. If income is over the SIL, the case will trickle to a MN program. 
Modification Date: May 2, 2011