Medi-Cal and hospice

What does Medi-Cal hospice cover?

Medi-Cal hospice covers the same kinds of care as Medicare hospice: nursing, doctor services, hospice aide visits, social work, counseling, medicines for symptoms, medical equipment and supplies, short-term inpatient care and respite care, and grief support for the family. Medi-Cal hospice is for people with a terminal illness when a doctor certifies that life expectancy is six months or less if the illness runs its usual course.

Adults who choose hospice agree to comfort-focused care for the terminal illness in place of treatment meant to cure it. Children and young people under 21 on Medi-Cal are different: they can receive hospice and keep treatment for their illness at the same time.

Choosing hospice is your decision. You can stop hospice at any time and return to your regular Medi-Cal coverage.

Who pays for hospice with your kind of Medi-Cal coverage?

With Medi-Cal only, your Medi-Cal managed care plan or Medi-Cal directly pays for hospice. With both Medicare and Medi-Cal, Medicare pays for hospice first and Medi-Cal acts as the second payer. With a share of cost, Medi-Cal pays after the monthly share of cost is met.

We check your benefits and tell you your costs before care starts. See paying for care.

How do Medi-Cal managed care plans cover hospice?

Hospice is a covered benefit in every Medi-Cal managed care plan, and most people with Medi-Cal are in a managed care plan. The plan is chosen by county, and the choices differ between San Bernardino, Riverside, Los Angeles and Orange counties. A plan may require the hospice to be in its network or to ask for authorization, and federal and state rules expect plans to act on hospice requests quickly.

You still have a say in which hospice you use. If the hospice you want is not in your plan's network, ask the plan what your options are.

Which hospice can IEHP and Molina members use?

In San Bernardino and Riverside counties, most Medi-Cal members belong to Inland Empire Health Plan (IEHP) or Molina Healthcare, and under DHCS All Plan Letter 25-008 the plan may ask members to use a hospice in its network unless no in-network hospice is available. Ask your plan which hospices are in its network, or ask us to check. Whether we are contracted with your plan is checked for each patient. Call us with your plan card.

If you have both Medicare and Medi-Cal, Medicare pays for hospice first, and the plan's rules about hospice networks do not limit that choice. If the person lives in a nursing facility, the plan pays the room and board through the hospice. See who pays for the nursing home when you are on hospice.

Does Medi-Cal pay nursing facility room and board on hospice?

Yes. When a person with Medi-Cal lives in a nursing facility and chooses hospice, Medi-Cal continues to cover the nursing facility room and board. This is an important Medi-Cal exception, because hospice coverage pays for hospice care and does not pay for a place to live. The payment is routed through the hospice, which passes it to the facility. The family should not see a new bill because of this change, apart from any share of cost the resident already pays the facility.

This applies to nursing facilities. Regular Medi-Cal does not pay room and board in assisted living or board and care homes. See hospice in assisted living.

Does Medi-Cal cover palliative care?

Yes. Under a California law known as SB 1004, Medi-Cal managed care plans must offer palliative care to members who meet the plan's criteria. These generally cover advanced stages of cancer, heart failure, chronic obstructive pulmonary disease (COPD) and liver disease, and plans may include other conditions. Not everyone with a serious illness is ready for hospice or eligible for it.

Medi-Cal palliative care can be given along with treatment aimed at the illness. It usually includes advance care planning, help with pain and symptoms, a care team, care coordination and a number to call. It is arranged through your plan, not through the hospice benefit.

To ask about it, call your plan's member services number and ask for a palliative care referral under SB 1004, or ask your doctor to request one. For how palliative care differs from hospice, see hospice and palliative care compared and palliative care.

How do you check hospice coverage with your Medi-Cal plan?

To check hospice coverage with your Medi-Cal plan, find your plan card, call member services, ask four questions, and tell the hospice what you learned.

1. Step 1

   Find your plan's name and member number

   They are on your plan ID card. Your white and blue Medi-Cal Benefits Identification Card (BIC) is separate. Have both.

2. Step 2

   Call member services

   The number is on the back of the plan card. Say the person's doctor is recommending hospice, or that you want to ask about hospice or palliative care.

3. Step 3

   Ask four questions

   Which hospices near me are in your network? Do you need to approve hospice before it starts, and how long does that take? Will I have a care manager? What stays the same with my other benefits?

4. Step 4

   Tell the hospice what you learned

   The hospice confirms benefits on its side and requests any authorization. You should be told about any cost before care begins.

5. Step 5

   If you hit a wall

   Ask the plan how to file an urgent grievance. You can also contact the Medi-Cal Managed Care Office of the Ombudsman at DHCS, or ask a hospice social worker for help.

Related guides

Does Medicare pay 100% of hospice? and health plans and IPAs.

Common questions about Medi-Cal and hospice