Can You Get Home Health Care While Also on Hospice?

Medicaid Planning
Jason Neufeld
April 27, 2022

Hospice helps those who are terminally ill (defined as having a life expectancy of 6-months or less) to live as peacefully and comfortably as possible – generally referred to as “palliative care”.  First, a quick background summary of Hospice:

What does Hospice Cover in Florida?

The Hospice benefit covers a range of services that are intended to provide physical, emotional and spiritual assistance related to that terminal illness, including: medication management, supplies, morphine administration, social worker counseling, CNA limited assistance with bathing and toileting, nurses and doctors. 

Hospice also provides respite care (for up to five days at a time), bereavement counseling for family (access to books, support groups, etc... sometimes up to 1 year after death). Importantly, hospice can also  connect with community resources (e.g. food delivery, Medicaid waiver).   

This care is usually provided in the home, but it can also be provided in a long-term care facility. 

Finally, and contrary to popular belief, Hospice will provide some physical therapy, occupational therapy, and speech therapy. However, this benefit is limited. Remember, hospice is supposed to help improve the quality of one’s life while dealing with a terminal illness - not cure the disease. As a simple example, if physical therapy would be useful to help a hospice patient better, and more safely, ambulate to the bathroom – that is more likely to be approved and provided. If you are seeking physical therapy so you can go for a jog, that is less likely to be approved.  

In addition to your hospice doctor or nurse (who are on call 24 hours a day), you can choose to include your regular doctor as part of the team as well.  

Who Pays for Hospice? 

Hospice is 100% paid for by Medicare Part A. If you are on a Medicare Advantage Plan before starting hospice, you can stay in that plan by continuing to pay premiums. If you need an out-of-network hospice provider you may revert back to Original Medicare (also called “Traditional Medicare Parts A& B”). Generally those on Medicare Advantage Plans are encouraged to revert back to Traditional Medicare.  

For those who do not have Medicare, Medicaid also pays for full hospice care. But there is no additional hospice benefit for those with Medicare and Medicaid (however, Medicaid may cover some additional benefits through the Florida Medicaid Waiver program). 

Can You Be On Hospice and Long Term Care Medicaid?  

A very common fear that people have is that if they go on Hospice, that they will have to give up their other services – or no longer be entitled to apply for different government assistance programs such as Medicaid Waiver or VA Aid and Attendance. This is not true. 

As a quick background, Florida's Medicaid Waiver Program will pay for home-health care services (averaging between 15 - 40 hours per week) or about $1,300 - $1,500 towards an Assisted Living Facility (the Florida Medicaid ICP program will pay for almost all of a skilled nursing facility or nursing home).

Yes, you can be on hospice and receive services through different government programs - such as Home and Community Based Medicaid

You, in fact, may be on both Hospice and Florida’s Medicaid Waiver programs at the same time.

I think the origin of the misconception - that if you are on hospice you are essentially giving up access to other services - is the fact that if you are solely relying on Medicare, and are on hospice, then any home therapies you received on Medicare will be quite limited while receiving Medicare’s hospice benefit. But, this does not prevent you from utilizing the services and benefits available through other non-Medicare programs.

In short: you do not have to give up Medicaid Waiver, or other program benefits, if you go on Hospice. This is particularly useful because, while hospice provides an extremely valuable and important service, it has a very limited home health care benefit.

Our goal, as experienced elder law attorneys, is to help you to apply for every program that will provide you or your family with the resources needed to improve the quality of your life. The Florida Medicaid Waiver program may provide an additional 15 –40 hours of home health care per week (or more) on top of what Medicare’s hospice benefit provides. It can also help pay family caregivers who are providing you that additional care.

To learn more about how to protect your assets and qualify for Florida Medicaid without having to wait five years or spenddown everything, please schedule a consultation today. We assist clients throughout the State of Florida.

Jason Neufeld
Jason is committed to assisting and protecting the most vulnerable members of society, through his substantial legal work with the elderly.