ICWP and Hospice at the same time????

[AtlantaRN, RN]

I had to look up "independent care waver program," as i had never heard of it. it's like source in that it is a medicaid program that pays for case management, supplies, respite in the patients home, home health, and other resources. It was developed to keep persons under age 64 in their home. I have a patient who sustained a traumatic brain injury in the 1990s.

I didn't think medicare would pay us when medicaid is paying for other services including cnas for 12 hrs/day 7 days a week in the home. Our director says we will be paid by medicare as long as we don't "duplicate services."

We are told to visualize the patients wounds and document their size, but we are not to do wound care.....????? That just seems "off" to me.

Has anyone else encountered a person being on a medicaid service program and then hospice begins and medicare is paying for the hospice portion? It just seems wrong to me.

thank you for your input.

[curiousauntie]

Yes, I have had patients in hospice who had what we here in Jersey call "waver programs". They are Medicaid programs that the patient who has a little too much income or property for Medicaid, but are still considered "poor" and have no other insurance. It may pay for care, supplies and case management by the county medicaid office. We also are told not to duplicate services. Which in Jersey means the home health aide, as the "case manager" for Medicaid would be a social worker, not a nurse. And it seems the waver programs only pay for about 4 hours of an aide, so if they come in the morning, ours goes in the afternoon. We also have patients who qualify for traditional Medicaid due to their income being below the minimum who have programs that we have to coordinate with. I feel it is no different that the person who has hospice paid for by Medicare and has a secondary insurance policy that pays for home care as some long term care policies do. There just has to be a coordination of benefits and no duplication of benefits.