Despite Indiana’s advancements in home hospice care, including our prominent Abbie Hunt Bryce Home, state-level Medicaid issues still cause many individuals to fall through the cracks. (Getty Images)
My neighborhood is full of wonderful places. Lovely places where people go to worship, to meet for meals, to do their errands, and, a lovely place to die. Let me explain.
Tucked behind the busy near-north Keystone corridor is the Abbie Hunt Bryce Home, a no-cost home for terminally ill individuals who are low-income or homeless and would have no other home to go to during their last days or months of life. Operated by Morning Light, LLC, Abbie Hunt Bryce Home offers critical and compassionate services to Hoosiers in their final days.
As the second largest residential hospice in the nation, our state is positioned to be a leader in providing compassionate end-of-life care. Not only is the Home a leader in size and scope, but all hospice residents stay free of charge, with no payment or insurance required. The Home is supported solely by community support and qualifies for Medicaid Waiver.
Recently, Morning Light’s operators proudly hosted a national conference dedicated to advancing person-centered and affordable hospice care practices, showcasing their commitment to excellence in this vital area. However, despite these significant achievements and community investments, barriers within the Medicaid system continue to prevent many individuals from accessing the care they deserve. Addressing these issues is crucial not only to uphold Indiana’s reputation as a leader in hospice care but also to ensure that every resident receives the dignified end-of-life support they need.
The Case of Mark
Mark, a cherished resident of the Abbie Hunt Bryce Home for nearly a year and a half, loved his home. He wanted to do everything he could to support them and was often physically and financially unable to do so. That would have been a great legacy for him, to obtain the funds he was eligible for to free up resources to support the friends and family he made at the home.
Mark enjoys a Christmas visit from Santa at the home. (Courtesy photo)
Unfortunately, while Mark was eligible for Medicaid waiver services, he faced significant obstacles. Mark’s intern encountered difficulty with the local Area Agency on Aging (AAA) during the intake process. The AAA interviewer refused assistance, leading Mark to incorrectly answer several level of care questions and disqualify him for waiver services.
Then, after a prolonged period, the Director of Social Services (DSS) attempted to correct the situation. Despite explaining that Mark was heavily medicated and on hospice, the process was delayed. DSS was contacted only four months later for the interview, and Mark’s application remained on a waitlist until he died this summer. If a team of professionals can’t navigate the complicated and long Medicaid system, what hope do our families have?
Systemic challenges in Indiana
Mark’s story highlights broader systemic issues, such as the ticking clock under which patients and caregivers operate. Hospice care is characterized as an estimated timeline of six months or less before passing. With a current wait list of six months or more for benefits, that math simply doesn’t work. Retroactive payments only occur if the individual is alive when their case is approved. Financial relief from caregiving never comes if the patient dies before their approval.
Dilemmas are also far too common in the discharge process. Patients with terminal illnesses often need to transition from hospital care to home hospice or a care facility. However, too many facilities are reluctant to accept Medicaid-pending patients due to concerns about payment if the patient passes before Medicaid is fully activated. Again, the wait list is long, and patients often just don’t have the time. This reluctance leaves patients in discharge limbo, causing strain on hospitals, limiting placement options, and costing the state more overall.
Despite Indiana’s advancements in home hospice care, including our prominent Abbie Hunt Bryce Home, state-level Medicaid issues still cause many individuals to fall through the cracks.
To address these challenges and break down barriers to hospice care, policymakers should strongly consider measures to streamline the intake process and expedite the Medicaid waiver intake processes, primarily for hospice patients who don’t have the time to wait. Communication and coordination between social workers, healthcare providers, and the AAA should be enhanced to address patients’ needs accurately and efficiently. We must also implement policies to alleviate care facilities’ concerns about accepting Medicaid-pending patients, ensuring fair compensation, and preventing discharge limbo. And finally, the state must adequately fund Medicaid Waiver programs to avoid delays and gaps in service.
Morning Light’s Executive Director, Madison Wood-Gonzalez, routinely says,”Just as it takes a village to bring a new life into the world, it takes a village to ensure a dignified transition at the end of life.”
Indiana’s leadership in hospice care is commendable, but we must continue to refine our policies to prevent tragedies like Mark’s from recurring. By making targeted reforms, we can uphold the quality of life for our neighbors and demonstrate our commitment to compassionate end-of-life care.
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