Understanding the Hospice Medicaid Benefit

Document created by kbass on Dec 30, 2016Last modified by alawson on Mar 27, 2017
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Medicaid covers hospice services for eligible recipients. The individual, having been certified as terminally ill, may elect Hospice Medicaid and receive services covered under the Hospice Medicaid Benefit.


Who is eligible to apply?

  • A patient who does not have another payer source and has applied for Social Security Disability (if under the age of 65).
  • A patient who may need nursing home placement
  • A patient who already receives Medicaid by qualifying for Supplemental Security Income (SSI)
  • A patient who may qualify for Spend Down. A Spend Down card could help a patient pay for medical bills he/she accumulated before becoming a Hospice patient.


What does Hospice Medicaid cover?

  • Nursing, social work, chaplain and home care aide visits
  • All drugs related to the terminal illness including non-prescription
  • All related supplies
  • All related durable medical equipment
  • Labs, X-rays related to terminal illness
  • Hospital stays, inpatient care related to terminal illness
  • Respite Care
  • If patient is eligible for both Medicare and Medicaid, non-related drugs are covered
  • Nursing home room and board


How to apply

The application for Medicaid can be made at your local Medicaid office. Your social worker can accompany you and will help you with the Medicaid forms that you will need. You will need to take the following information with you to the appointment:

  • Social Security card
  • Spouse’s date of birth and Social Security card
  • Medicare card
  • Other health insurance cards
  • Proof of secondary health insurance premium amounts/payments
  • Birth certificate or passport
  • Life insurance policy (or policies): policy number, account number, face value, cash surrender value
  • Prepaid burial contract
  • Checking account statements (current and three months prior)
  • Savings account statements (current and four months prior)
  • Vehicle(s) -- year, make and model
  • Verification of any stocks, bonds and/or certificates of deposit
  • Current tax statement for non-home property
  • Award letter for Social Security benefits
  • Verification of pension(s) income
  • Proof of any other income
  • Verification of cost of utilities
  • Verification of cost of rent/mortgage
  • Copy of Power of Attorney or guardianship


Hospice Medicaid in the nursing home

When a patient needs to live in a nursing home, there must be a payer source for the nursing home to provide daily care. Hospice Medicaid will pay for nursing home room and board when the patient does not have the funds available for such care. The patient and/or family will still be responsible for paying the liability to the nursing home. Liability is considered any income the patient receives from Social Security, pensions or retirement and is considered supplemental payment to the nursing facility. The patient will be allowed $40 a month for personal items. The patient can have $2,000 in resources.


If a patient’s income exceeds $1,656 per month, a Qualifying (Miller) Income Trust (QIT) will need to be established. The income placed in a QIT will be disregarded in determining Medicaid eligibility but will be considered when determining how much the individual has available to contribute to his/her cost of care. No resources can be placed in this irrevocable trust and the trust must be a separate account. An attorney must be contacted to set up a QIT, and then be approved by Kentucky Medicaid.


In regard to the Homestead Act, after a patient lives in a nursing home for six months, the nursing home is considered the patient’s residence. If the patient owns a home it will have to be sold and the money used to pay for nursing home care. The family must show an attempt to sell the property. A hospice patient may be exempt from Estate Recovery, in which the state attempts to recover funds from the estate of the patient to offset the costs of long-term care. 

It is important for the hospice social worker to review any letters you receive from the Medicaid office. The Medicaid office will inform the recipient when the re-certification application is scheduled, usually a year after approval. Your hospice social worker can assist you in completing the re-certification process.


Kentucky Medicaid Website: http://chfs.ky.gov/



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