Hospice facility and Medicaid. Any information on the Medicaid 5 year lookback in the hospice facility?

Ask the business and accounting department of the hospice facility. I'm definitely not an expert but I've been on the forum a long time - I think you are right to have concerns, the room will have to be paid for and if there is no money and no reasonable hope for medicaid assistance things could get very complicated.

I’m sorry I don’t have any advice to offer you. I just wanted to comment on how dramatically different things are depending on where you are and what agency you have.

My mom just died on home hospice, and I really wanted her to go to a hospice facility at the end. Not only could I not find one nearby or affiliated with my agency, the couple that I DID find, many miles away (or in another state) were inaccessible or unresponsive.

Also, my hospice agency was against mom moving. She died at home, alone with me. I found an end of life kit with medications that I didn’t even know what they were for, and other supplies, like mouth swabs, that we ended up buying ourselves, after she died. Hospice sent that stuff over 6 months ago, never said anything about it and I set it aside and forgot about it.

I hope you have a better experience.

I would wonder why this is being suggested. It comes down to Dad can't afford the facility. Your "in home" Medicaid is not the same as LTC. You need to talk to Moms Medicaid caseworker.

As we are not privy to what he "did 2 years ago with his money" that precludes our having any answers. You may need to consult an elder law attorney if things are that complicated.
As to what is covered, usually Hospice care is covered by MediCARE , not Medicaid, and it isn't clear what this person saying he must move is talking about.

Hospice has access to Social Workers.
Use them first to track down the details given you information about what dad "did" with his finances.
If necessary then, try an elder law attorney with your details in hand.

Find out if the facility they are wanting your Dad to move to is a LTACH aka a Long Term Acute Care Hospital. LTACH not a regular hospital although it might be a LTACH floor or wing within a big hospital and will have limited access. That the “long term” is LTACH and not LTC custodial care in a NH.

If it’s an LTACH, I’m pretty certain it is considered a “hospitalization” and so it’s covered benefits under Medicare Part A. And hospice itself is a Medicare Part A benefit, so between the 2 that stay is covered except maybe for some medications as sometimes meds fall into Part D of Medicare. There would be no LTC Medicaid involved as it is NOT custodial care that is happening but hospital care.

LTACH for admissions are run totally different than a hospital as a hospital will have an ER / ED and takes in folks “off the street”.
LTACH tends to quietly exist next to a big teaching hospital and connected by a enclosed bridge OR are a free standing hospital located within a big Health Science center OR are their own floor or wing within a hospital that they “rent” as an LTACH with their own nursing staff and it has limited access for entry. What you have in your area will be imho kinda interdependent on how big your city is. For admissions, LTACH it is done by a referral only with specialized continuity of care type of paperwork submitted to insurance.

I have had 2 direct experiences with LTACHs:
- for my Aunt in her 90’s she fell in her IL apt & found unconscious at the tiered facility (IL, AL, NH on one campus) and went via EMS to hospital where she was stabilized and it was determined little could be done by an admission so she instead went to the LTACH that was a free standing building that was pretty much all elderly hospice in last stages of life but needed more involved care & meds that could be done at home by hospice coming by even in a SNF. It was run by VITAS. In its past life the building had previously been a Women’s and Children’s Hospital.
My Aunt as she was living in IL & had Medicare and a secondary supplemental health insurance (I think it was Humana) was not faced with anything LTC Medicaid program or Medicaid as health insurance.

- my MiL in her 80’s was in a NH, got pneumonia and hospitalized for it. It was her second go round on this happening. Few days in she started to get septic and obvious she was never getting better. & MiL returning to the NH wasn’t going to happen as her care was way involved. She got moved to the LTACH next door which was connected by a bridge btw them. She was on serious black box drugs, had bad sepsis and was doing cascading organ failure. This LTACH was different than my Aunts as most there were way waaaaay younger and there dealing with end stage cancer care. MIL had filed for LTC Medicaid to pay for her custodial care costs for her NH stay (which was still not approved at the time of her death which is a whole other drama) but was on Original Medicare and low income Medicaid at the tie so she had those 2 for health insurance. This LTACH is now a Kindred Hospital; and Kindred is the big national chain that does LTACH type of health care, & it tends to be end stage cancer care.

But for both it was a hospital stay as far as health insurance was concerned for billing. An hospital stay is a MediCARE Part A benefit which if you kept Original Medicare covers hospital costs. And both had affiliation with a hospice group which still came by to see them at the LTACH but way less than an In-Home hospice or at the Nh hospice visit would. And hospice too is a Medicare Part A benefit.
If yiur dad is on Medicare Advantage Plan those will be a crapshoot as to the LtACH being “in network”, so good luck on that.

I will say the nursing staff for both was stellar; it’s not easy or simple working with end stage patients and dealing with their families. They were very much “the Pros from Dover”.

If you are not sure about your dad's need to go to a facility, do some more checking. I, too, would question that recommendation, especially for you, since you already experienced your mother's death at home. Do you know why your father prefers to go to a facility?

I believe you are thinking that if he were still alive after 5-7 days in a facility, he might have to return home for financial reasons? I agree that that would be very disruptive. However, while nothing's certain, if he is definitely "near death", it is probably unlikely that he would live that long. In the situations with which I'm familiar, people who moved to a hospice facility near death died within a very few days. I realize that is not a certainty, though.

I do not know whether the 5-year lookback would apply if he needed to transition to long-term care after 7 days. However, pragmatically it doesn't make sense to me, because completing the lookback could not usually be done in the amount of time available before the patient dies. I don't know how difficult it is to contact Medicaid, but my first thought would be to contact Medicaid directly via phone to be certain you have an answer. As someone else suggested, if he has a Medicaid caseworker, he/she should know also.

Not sure why it would matter. If dad is dying, what will there be to look back on once he’s gone?

Talk with a Medicaid expert and social worker in your area.

"The Hospice care manager said she thought it was simply transitioned to long term care without a lookback, but I don't think so."

You may want to look for another care manager if she can not provide the answers. It is frustrating dealing with someone who is supposed to be experienced and uses the words "thought, thinks, possibly, etc." without offering to find the information for you from someone who KNOWS. This is not a time you should have to look for the answers on your own and risking the wrong answer.

You may also have her define her word "disaster" since you have already gone through it one time. Of course no two experiences will be exactly the same.

You also have the right to use any Hospice company you desire and change as many times as it takes to find one that is a comfortable fit. That said, as long as your dad is mentally capable you are limited by his desires which makes it harder for you to advocate for him. Hoping you can get a better understanding soon.

Hospice in a facility when someone is considered short term is covered under Medicare .

it sounds like you think you Dad does not really qualify to be receiving Medicaid and you dont' want medicaid to find that out. That's a good reason not to abuse the system in the first place.

jolobo: No logical answer can be given as we aren't privy to what "dad did with his money two years ago."

Many hospice medicate with liquid morphine and Ativan to speed the process! I would let him stay home. Hospice is covered by medicare

In our state, they did the 5 year look back and any other review they wanted BEFORE they accepted my mil for medicaid.
The hospice was covered by medicare and once she went in, she was inpatient until she died.
My bil just went on hospice and they took him for a respite while our other two men were sick in the hospital. That is different from inpatient hospice.
Important to know is that all hospice units are not the same.
If you have a choice, ask around and also talk to several hospice houses.
Also know that some hospice houses do not have inpatient facilities at all….. in our town.

In NJ the 5 year look back in only for when you first apply to get medicaid or are in a renewal process.

You may want to see an elder law attorney. They deal with Medicaid a lot. Medicaid rules vary from state to state and should be able to bring clarity to your situation.

What I read has to do with people already receiving Medicaid in some way when it comes to Hospice. If your Dad is receiving Medicaid, talk to his caseworker about sending them to a Hospice facility. I think Medicare only pays when actually dying. Hospice admitting should also be able to answer questions concerning who pays what.

What I read has to do with people already receiving Medicaid in some way when it comes to Hospice. If your Dad is receiving Medicaid, talk to his caseworker about sending him to a Hospice facility. I think Medicare only pays when actually dying. Hospice admitting should also be able to answer questions concerning who pays what.