Hospice services now available to those on Medicaid

Patients with terminal illnesses who are covered by Medicaid can now have hospice services for end-of-life care paid for by the government insurance program, thanks to a new state law that took effect Jan. 1.

Maureen Collins, director of clinical services at Hospice Southeastern Connecticut, said Monday that the change will be most significant for nursing home patients with Medicaid, the health insurance program for the poor.

Half of the program's funding comes from the federal government and the other half from states. While most nursing home patients are elderly and covered by Medicare, which already covered hospice services, the new regulation specifically affects the small portion of the nursing home population that is younger and covered only by Medicaid.

"This benefit will affect a younger and smaller part of the nursing home population, but it's an important change," said Matthew Barrett, executive vice president of the Connecticut Association of Health Care Facilities, the statewide nursing home organization. "It's an excellent expansion of this benefit."

An estimate of the numbers of patients that would be affected by the change was not available.

Previously, patients with most types of private insurance and Medicare, which covers the elderly, were eligible to have hospice services covered, said Ronny J. Knight, senior vice president of planning and reimbursement for Connecticut Hospice. But in Connecticut and just one other state, Medicaid patients were ineligible for the end-of-life medical and support services. These include the care of hospice nurses, social workers, aides, clergy, volunteers and bereavement counselors to terminally ill patients and their families. Hospice care can be provided in a patient's home or in a skilled nursing facility.

"We have the expertise" in end-of-life medical care, social and emotional issues, said Knight of Connecticut Hospice.

Collins said Medicaid patients who were not in nursing homes could usually receive some - but not all - hospice end-of-life services through grants, donations and other funding means, but that was not the case with those in nursing homes. Now Medicaid patients both in and out of nursing homes can receive the full range of hospice care, she said.

The change came about due to a law passed by the state legislature in 2008 that did not take effect until this year as the state Department of Social Services, which administers Medicaid, set the specific guidelines for eligible hospice care. The benefit is available to Medicaid patients determined to have a life expectancy of six months or less by their doctor and a hospice medical director.

Barrett said that although Medicaid patients in nursing homes could not receive services from an official hospice organization, most nursing homes did provide dying patients with "hospice-type" counseling, nursing and other medical services.

Collins, of the Norwich-based Hospice Southeastern Connecticut, said the organization has been meeting with area nursing homes to let them know about the new benefit and how to access it for their Medicaid patients.

Administration and paperwork requirements of the program may provide some challenges for both the nursing homes and hospice organizations, Knight added.