General eligibility requirements that apply to all Apple Health programs

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Eligibility for hospice as a service

Revised Date: 
February 14, 2018

Programs that cover Hospice as a service?

A client must be eligible for a categorically needy (CN) or medically needy (MN) program to receive hospice care. Examples include but are not limited to the following:

  • CN noninstitutional medicaid in an alternative living facility (G03)
  • Health Care for Workers with Disabilities (HWD) (S08)
  • MAGI based CN with the exception of N21 or N25
  • Home and Community Based (HCB) Waivers (L21, L22)
  • Community First Choice (CFC) (L51, L52)
  • Foster care medicaid (D01, D02, D26)
  • SSI medicaid (S01)
  • SSI related (S02, S95, S99 in active status)

Note: A client who has met their spenddown under MN is eligible for hospice as a service.

  • Clients must meet the hospice diagnostic criteria plus medicaid eligibility criteria in order to receive hospice services.
  • Clients who are in a current base period and have not met their spend-down, do not have to reapply to get hospice but they do have to meet their spenddown before Hospice can be approved.
  • If a client is eligible for a noninstitutional CN program, the hospice provider bills the Medicaid Agency the same as any other service.
  • If the client is residing in a medical institution such as a nursing facility or hospice care center, the case must be coded as hospice on the institutional care screen in ACES 3G in order to set the hospice flag on the program in If income is over the Special Income Limit (SIL), the case will trickle to an MN program.