Find Respite Care Near You:

Medicaid and Medicare Respite Care Coverage

When you or a loved one become seriously ill and require someone to help provide care for you when caregivers take a break, respite care possibly arises as a consideration that requires discussion.

Discover whether Medicare or Medicaid provides respite care coverage.

Learn about potential alternative options for payment of respite care.

Does Medicare Cover Respite Care?

Understanding the description of respite care is an important aspect of learning about respite care coverage. The National Hospice and Palliative Care Organization describes respite care as, “Short-term inpatient care provided to the individual only when necessary to relieve family members or other individuals caring for the individual at home.”

An issue with receiving respite care coverage through Medicare comes with program guidelines. Respite care coverage through Medicare is limited to individuals receiving hospice care coverage through their Original Medicare.

Unless an individual meets requirements for Medicare-covered hospice care, the person will most likely not qualify for respite care under Original Medicare.

If you do receive hospice benefits, there are still limitations on respite care coverage. Respite care coverage allows only five consecutive days of benefits, beginning the first day of admission. The last day does not count in the allotted five days coverage.

Medicare strictly enforces the five-day limit on each respite care admission. A 2014 Centers for Medicare & Medicaid Services (CMS) article addressed to providers of respite care under Medicare’s hospice coverage reminded providers of the five-day limit. It stated that any claims beyond five consecutive days would be returned to the provider. The CMS did explain in detail that providers were not to count the day of discharge within the five days.

Additional Medicare guidelines include the fact that respite care must be provided in a Medicare-certified inpatient hospice facility.

You likely have to pay five percent of the Medicare-approved inpatient respite care costs.

What Are My Alternative Options To Pay For Respite Care?

If an individual needs respite care and does not receive Medicare-covered hospice care coverage, needs respite care beyond the allotted five consecutive days or for other circumstances, there are other possible options available.

If you are a U.S. Military Veteran, the Veteran’s Health Administration (VHA) indicates that VA medical centers potentially take over care for you or your loved one for a short period of time, for “Respite care” purposes.

The VHA provides up to 30 days respite care coverage within each calendar year. There are possible exceptions to this rule if you meet the qualifications. The VHA understands that unforeseen difficulties periodically arise and allows for applying for an extension.

The VHA allows respite care benefits for all U.S. Veterans enrolled in the VA health care system. If you or your family member is not yet enrolled in the VA health care system, there is still a possibility of receiving VA-covered respite care.

Another option is to check with senior care agencies to learn more about respite care coverage.

Yet another alternative option to Medicare coverage for respite care is Medicaid.

Does Medicaid Cover Respite Care?

Medicaid, although a federal program, provides states considerable liberties with designing and implementing their own coverage options. Medicaid considers hospice care as short-term care intended to relieve family members or others caring for the individual.

Respite care is one Medicaid-provided benefit often administered by the individual states. Medicaid-eligible recipients potentially receive their covered respite care through waivers provided under Medicaid’s Home & Community-Based Care Services (HCBS) waiver program.

HCBS 1915(c) allows states to offer a variety of services, including respite care. It also allows states to target certain populations, such as the elderly, to receive services and help protect the health and welfare of recipients.

HCBS 1915(I) allows individual states the opportunity to provide services to eligible individuals in need of certain services, including respite care. States have options such as targeting specific populations, including seniors, those in need of respite care or who would otherwise only receive eligible care and services in an institutional setting.

If you or your loved one is homeless, you still potentially qualify for Medicaid-covered respite care.

Once an individual enters into the Medicaid-covered hospice benefits service plan, the person also becomes eligible for respite care if recommended by the hospice care team.

Where Can I Find Medicaid And Medicare Respite Care Near Me?

A senior care and senior living agency often have information and resources beyond the information you are aware of regarding respite care and other Medicare and Medicaid covered benefits.

Check with Medicare to learn if you or your loved one is eligible for the limited respite care benefits of the program.

Remember that although Medicaid is a federal program, your local state Medicaid office has the information and application you need for Medicaid-eligible respite care coverage.

If you have not yet signed up for hospice care service coverage through Medicare or Medicaid, do not assume you are not eligible for respite care. With leeway provided to states, you possibly still have respite care coverage through Medicaid. Medicare may potentially provide respite services for terminally ill patients once you apply for hospice.

Learn more by contacting Medicare, Medicaid, and your senior care agencies.

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Since graduating from Harvard with an honors degree in Statistics, Jeff has been creating content in print, online, and on television. Much of his work has been dedicated to informing seniors on how to live better lives. As Editor-in-Chief of the personal… Learn More About Jeff Hoyt

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