Hospice
Check Medi-Cal Eligibility
Medi-Cal, California’s version of Medicaid, is a state and federal program that covers hospice care costs for those who have low incomes or whose resources have been depleted by health care costs.
After Medicare, Medi-Cal is the second most common source of payment for hospice care in the state.
Who Is Eligible
An individual must first meet the basics of qualifying for hospice coverage by:
- Having a doctor certify that he or she has a terminal illness and probably has less than six months to live, and
- Signing a statement choosing hospice care, instead of coverage for other benefits that may be available.
In general, an individual who is over age 65 can then qualify for Medi-Cal coverage of hospice care if he or she has either:
- A low income and little savings or few other assets, as described below under “Income and Asset Levels,” or
- Personal resources that are reduced because of paying for health care expenses, as described below under “Higher Limits for High Medical Expenses.”
In addition, those who are enrolled in the following programs can automatically qualify for Medi-Cal:
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Supplemental Security Income (SSI) or State Supplementary Payment (SSP) — federal and state programs providing income to those who are 65 and over, blind, or disabled who meet income and resource limits. Both programs are administered by the Social Security Administration. For a quick analysis of whether you qualify, use the SSI Benefit Eligibility Screening Tool.
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In-Home Supportive Services (IHSS) — providing services to those over 65, disabled or blind who want to remain living at home, administered through county offices. Learn more .
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California Work Opportunity and Responsibility to Kids (CalWORKs) — a welfare program providing money and services to some families with special needs. This program is administered through the county welfare departments. Learn more.
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Refugee Programs — operated by the state’s Refugee Program’s Bureau. Learn more.
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Foster Care or Adoption Assistance Program — operated by the state’s Children and Family Services Division. Learn more.
Income and Asset Levels
Not all income and assets are counted when determining eligibility (income limits change frequently; for current information contact the local Medi-Cal office). Those that are not counted include:
- A home, if the patient or his or her spouse is living there;
- A cash reserve of $2,000 for single people, more for married couples;
- One car and household and personal belongings including clothing, heirlooms and wedding and engagement rings;
- Burial plots and any money in a designated burial plan fund; and
- Life insurance policies and the balance of pension funds, IRAs, and certain annuities.
Individuals with income and assets above Medi-Cal limits who are not in immediate need of long term care may be able to become eligible by some of their assets. For example, Medi-Cal rules allow reducing assets by paying off medical bills or a mortgage or other debts, paying for home care, replacing an old vehicle, updating home furnishings, or prepaying funeral expenses. Some people may also qualify for Medi-Cal by transferring their property to others, with the important limitation that anything transferred during the 60 months before applying for coverage will be taken into account in determining eligibility.
Higher limits for high medical expenses. Some people with relatively high incomes may qualify for Medi-Cal if a stated share goes exclusively to paying medical costs. This is called paying a "share of cost." The amount may change with an individual's monthly income.
When only one spouse remains at home. A couple does not need to sell their home to qualify for Medi-Cal when one of the spouses enters a nursing facility. And the spouse who remains at home is also allowed to receive a certain amount of income each month, and to retain some of the couple's combined assets.
For more information on each of these Medi-Cal eligibility requirements, see the Medi-Cal Web site.
What Is Covered
Medi-Cal will pay for hospice care provided by a Medicare-certified agency that is authorized to participate in the Medi-Cal program. To be covered, hospice care must be approved in advance by the Medi-Cal office.
Medi-Cal pays a fixed amount for most hospice services, including:
- Doctor services and nursing care;
- Physical therapy, occupational therapy, and speech-language pathology services;
- Medical social services, hospice aide services, and homemaker services;
- Medical equipment, such as wheelchairs and walkers and medical supplies, such as bandages and catheters;
- Drugs for symptom control or pain relief; a copayment is sometimes required;
- Counseling, including dietary counseling, counseling about care of the terminally ill patient, and bereavement counseling; and
- Short-term inpatient care for pain control and symptom management and for respite.
Medi-Cal may also pay room and board charges for patients who receive Medicare-certified hospice care in a hospital or nursing facility.
How to Apply
Individuals must apply for coverage at the local Medi-Cal office. If a person is homebound or already in a nursing facility, the individual or family can request that a Medi-Cal representative assist them in completing the application in a personal visit.
Within 45 days after the paperwork is completed, the Medi-Cal office will send a written notice about eligibility. Individuals have 90 days to appeal a denial of coverage and request an informal hearing for reconsideration.
Dual Coverage with Medicare
People who qualify for both Medi-Cal and Medicare benefits are known as “dual eligibles” or “Medi-Medis.” For them, Medicare will be the primary payer, with Medi-Cal providing secondary coverage to take up some of the slack. Medi-Cal may also cover deductibles and copayments. It will also pay for Medicare Part A and Part B deductibles and copayments and for Part B premiums as well as some types of drugs, vitamins, and minerals that Medicare does not cover.
For information about hospice services, including Medi-Cal coverage, visit the California Hospice Foundation.
