Can patients who receive Medicaid home care get Medicare hospice care? Even professionals disagree on the answer.
Last fall I read an article in the New York Times that discussed the difficulty of getting adequate home care for an aging parent, particularly for patients on Medicaid. Medicaid is the government’s health care program for lower-income individuals. The article discussed the problem of getting sufficient care hours, finding competent home attendants, and obtaining professional oversight. The article went on to criticize the government for not permitting elderly patients with Medicaid home care to receive Medicare home hospice as well.
Could this be possible? Medicare covers home hospice care for people 65 years of age or older. People who receive Medicaid but who are not 65+ are not eligible to receive Medicare hospice care; they receive hospice care through Medicaid. However people, 65 years + (these people are called dual eligible in eldercare lexicon) are entitled to both. Why then is an elderly Medicaid recipient unable to receive Medicare hospice care as well? I had not encounter this issue in my role as a senior care advisor and advocate, but I could not understand why a person must choose between these services. I decided to investigate.
Is it possible to receive Medicare Hospice Care while receiving Medicaid Home Care?
My first call was to the Medicare Rights Center a national, nonprofit organization dedicated to educating the public on their rights under Medicare and to advocate for Medicare recipients. The organization offers educational programs on Medicare entitlements to individuals and professionals. One of their services is a national telephone helpline that answers Medicare questions to recipients and their families. The Helpline assists thousand of callers every year with their questions. They should have the answer.
I spoke with a Helpline representative. Surprisingly she was unable to give me an immediate answer. She admitted this was an unclear area. She took my phone number and agreed to investigate and get back to me with an answer.
Some patients have been refused hospice care while receiving Medicaid Home Care
While waiting I emailed a contact at New York State Office of the Aging’s Health Insurance Information Counseling and Assistance Program(HIICAP). HIICAP counsels seniors on Medicare rights in New York State. My contact responded immediately; she was not sure of the answer either but told me would look into it and get back to me.
Courts have disagreed on Medicare/Medicaid benefits
I made one final call to Disability Rights New York (DRNY) in Albany and asked to speak with Simeon Goldman, Esq. one of their senior staff attorneys. Disability Rights New York is a not-for-profit advocacy organization for people with disabilities, which can include many elderly people as well. I had read a letter to the editor in the New York Times by Mr. Goldman on a similar topic and wanted to learn if he knew the answer.
Sim acknowledged that the issue was confusing. Last year DRNY represented two clients who were grappling with this same issue. Each person had lost his Medicaid home care when he enrolled in Medicare hospice. DRNY brought the cases to court. In both instances, the law judge could not find evidence why the patients could not receive both Medicare and Medicaid services. He determined these were arbitrary decisions and had each overturned.
Sim admitted that he empathizes with people who found this confusing. “It is not surprising that other people should had problems understanding these regulations” he confessed, “I’ve been working in this area for years and even I find it confusing.”
Our government health care system is complicated and hard to understand, particularly with issues dealing with our seniors. It is not surprising that there are misunderstandings. The public is fortunate to have organizations such as the Medicare Rights Center, State Offices for the Aging, and Disabilities Right New York that keep on top of these issues and can offer informed answers.
P.S. both the Medicare Rights Center and HIICAP came up with the same answer.