Nearly two-and-a-half years ago, the eligibility regulations for hospice care for strictly Medicaid recipients underwent a dramatic change that has gone under the radar not only in the public eye, but also in the hospice community.
Without much public acknowledgment, New York state amended the Public Health Law in August 2016 by re-defining “terminal illness” for patients on Medicaid from the traditional six-month prognosis to a 12-month prognosis. The revised regulation, known as the “Hospice Modernization Bill,” demonstrated our State’s commitment to expanding the level of service Medicaid recipients should be able to access. New York also stands out as one of the only states to define “terminal illness” for Medicaid recipients with this adopted 12-month timeline.
Now what does this change mean? Medicaid-only recipients in New York State who have been diagnosed with a terminal illness now have the option of choosing hospice care much sooner in their illness. Instead of waiting for a prognosis of six months or less, patients who receive exclusively Medicaid coverage can be admitted into hospice care when they have a prognosis of 12 months or less should their illness run its natural course.
Once hospice care is elected, this longer-term commitment to a managed treatment plan ensures that patients will be provided expert pain and symptom management, social work support, durable medical equipment, coverage of medications related to their terminal conditions, aides, massage therapy and other services that they are entitled to receive. With these essential support services, patients and their families will benefit as they are all focused on maintaining quality of life.
The Medicaid 12-month extension has prompted hospice leaders to guide their clinical staff in shifting the mindset of the traditional timeline of a six-month prognosis to the broader 12-month prognosis. Efforts are underway to enhance the prognostication process to better identify patients who meet this criteria and will benefit from an earlier hospice admission.
Ultimately, the intention of the law is very noble in its design to help alleviate suffering for Medicaid-only recipients who are struggling with a terminal disease.
Patients and families are always encouraged to call hospice at any time. This can be done even before one’s medical condition worsens to obtain more information about the hospice program. The goal is to admit people sooner to help not only with the physical symptoms associated with terminal illness, but also to alleviate social, emotional and spiritual suffering.
Many people do not realize that with the added support services from hospice, people will often live longer. Although the goal of hospice is not to hasten death or prolong life, care providers strive to deliver the best care so that patients can make the most of whatever time they have left.
If you or a loved one have been diagnosed with a life-limiting disease, you may want to consult with your primary care physician or call 439-4417 (or 716-HOSPICE) to learn more about eligibility, health insurance coverage and options for entering hospice care.
Dr. Sarina E. Bax DeBiaso, M.D. is the assistant medical director at Niagara Hospice. For more information on hospice services, visit niagarahospice.org.