The state Medicaid program determines your eligibility, which is limited to individuals who fall into certain categories. Medicaid is a state-administered program and each state sets its own guidelines regarding eligibility. The hospice service benefit is an optional benefit, which states may choose to make available under the Medicaid program. The purpose of the hospice benefit is to provide for the palliation or management of the terminal illness and related conditions. Under federal guidelines, the hospice benefit is available to individuals who have been certified terminally ill by a physician. A hospice must meet the Medicare Conditions of Participation in order to receive payment under Medicaid.
St. Croix Hospice will provide services for care of the patient’s life-limiting illness directly through contracted services. During the patient’s hospice benefit period, St. Croix Hospice, through Medicare or eligible Medicaid programs, will cover the patient’s full financial responsibility for these services, except under any of the following circumstances:
- If the patient decides to pursue a curative, non-palliative course of treatment.
- If the patient enters an inpatient facility without prior authorization from St. Croix Hospice.
- If the patient enters an inpatient facility for a condition unrelated to his/her primary hospice diagnosis.
- If the patient enters an inpatient facility that does not have a contract with St. Croix Hospice to provide care to St. Croix Hospice patients.
- If the patient receives the same type of care from a different provider, unless you change your provider.
The Medicare and Medicaid hospice benefit provides for four levels of care: Routine Home Care, General Inpatient, Respite Care and Continuous Care. Any changes in a patient’s level of care must be approved by St. Croix Hospice.