General eligibility requirements that apply to all Apple Health programs

Hospice changes or death reported

Revised Date: 
February 14, 2018

For active CN or ABP medicaid programs, hospice at home is a covered service, so a program change is not required.

  • The hospice election should be updated on the institutional care screen for aged, blind, or disabled (ABD) medicaid programs; under home and Community Based Services, code hospice with the hospice service start date and Health Care Authority (MA) as approval source. The correct ProviderOne ID number should be used; this will send approval, change, and termination letters to the hospice provider.

For a client that is active on S95 or S99 (including spend-down in M status), an ACES program change may be needed if the client is requesting hospice coverage if elected in a facility for more than 30 days.

  • Add an L32 program to the existing active medical assistance unit.
  • Determine eligibility for the L32 hospice program following instructions under the hospice applications section.
  • If the client is found financially eligible for L32, the certification end date should match the certification end date of the original medical assistance unit.
  • If the client is found financially eligible, the Approval for Hospice Services award letter (00002-18) should generate and is also sent to the hospice provider based on the institutional care screen.

See the special circumstances section for instruction on active MN Medicaid client entering a nursing facility.

Hospice short stay

A client may elect hospice for less than 30 days

The hospice election should be updated using the short stay screen instead of the institutional screen when stays are 29 days or less.

See short stays for additional information.

Reporting hospice revocation

Hospice revocation is reported on the Hospice Notification form 13-746 by the hospice provider. 

  • The hospice revocation should be updated in the month of revocation and ongoing months, if applicable.
  • If the client’s L32 Medicaid terminates due to no services, the client should be reconsidered for other Medicaid programs for the remainder of their certification period.
  • If the hospice services were received in a nursing facility or medical institution and the client will remain in the institution after revocation, the client’s eligibility should be reviewed due to the dissimilar financial eligibility factors for institutional Medicaid programs (for example, transfers would potentially apply without a hospice election). This would also apply to clients discharging home on home and community based waiver services.

Reporting date of death for a hospice client 

Date of death is reported on the Hospice Notification form 13-746 by the hospice provider.

  • If the client was a recipient of CN A/B/D medical or was receiving MN coverage because their spenddown had already been met, the FSS does not need to do a program change. Hospice services at home are covered.

 If the hospice services were received in a nursing facility, medical institution, or hospice care center, a short stay award letter can be provided if needed for billing. 

  • If the client is deceased and a pending application is on file, follow the  application  instructions on the Hospice Applications manual page for either the L32 hospice program or noninstitutional Medicaid CNP.  An eligibility determination is still required and the hospice agencies must still be notified timely of the approval or denial. 
  • If the client is deceased and there is no application prior to the date of death, a representative may apply on the client’s behalf.