Yes. Medicaid does pay for hospice care in nearly every state, covering nursing visits, medications for pain and symptom control, counseling, home health aides, medical equipment, and short-term inpatient stays for a beneficiary whose physician certifies a terminal illness.1Medicaid.gov. Hospice Benefits Hospice is technically an optional Medicaid benefit that each state chooses to include, but virtually all states offer it, and for those who qualify the care usually comes at little or no cost.
What Medicaid Hospice Covers
The benefit is built around a full care team, not a single visiting nurse. Under a plan of care tailored to the patient, Medicaid hospice pays for:1Medicaid.gov. Hospice Benefits
- Nursing care
- Physician services
- Medical social services
- Counseling for the patient and family caregivers
- Home health aide and homemaker services
- Physical, occupational, and speech-language therapy
- Medical appliances and supplies
- Medications for pain relief and symptom control
- Short-term inpatient care for pain management or respite
Bereavement support for the family is part of the hospice model as well, though states have some flexibility in how they structure that piece.
Care is delivered at one of four levels, and the hospice team and physician choose the level based on what the patient needs at the moment. Routine home care is the most common: the patient stays at home and the hospice team visits regularly. Continuous home care is provided during a medical crisis when mostly nursing care is needed on a continuous basis to keep the patient at home.2eCFR. 42 CFR 418.302 – Payment Procedures for Hospice Care Inpatient respite care is a short stay in an approved facility so a family caregiver can rest, capped at five consecutive days per stay. General inpatient care is short-term care in a hospital or inpatient facility for pain or symptoms that can’t be managed at home.
Who Qualifies
Two standards have to be met. Medically, a physician must certify that the patient has a terminal illness with a life expectancy of six months or less if the disease follows its expected course.3Centers for Medicare & Medicaid Services. Hospice Care for Children in Medicaid and CHIP That six-month figure is not a cutoff. If the patient is still living when the period ends, a physician can recertify and hospice continues.
Financially, the patient has to qualify for Medicaid under the state’s income and asset rules. Because each state runs its own program, the thresholds differ, and some states have separate eligibility pathways for people in nursing facilities or receiving home and community-based services.
What It Costs You
Very little, in most cases. Federal rules exempt hospice beneficiaries from most Medicaid cost sharing, so copays and coinsurance generally do not apply to hospice services.4Medicaid and CHIP Payment and Access Commission. Cost Sharing and Premiums Medications, equipment, nursing, and counseling under the benefit are covered without the small charges that accumulate elsewhere in Medicaid.
If the patient lives in a skilled nursing facility or intermediate care facility and elects hospice, Medicaid keeps paying for room and board at 95 percent of the facility’s daily rate, minus any amount the patient is required to contribute from their own income.5Medicaid.gov. Hospice Payments The hospice provider receives that payment and passes it through to the facility, while hospice-specific services are billed separately under the hospice benefit. A nursing home resident does not face a coverage gap when moving onto hospice.
Many hospice patients on Medicaid also have Medicare, and for these dual-eligible beneficiaries Medicare pays first for hospice.6Centers for Medicare & Medicaid Services. Beneficiaries Dually Eligible for Medicare and Medicaid Medicare hospice may charge up to $5 per prescription for outpatient drugs related to pain and symptom management; Medicaid can pick up that copay so the patient pays nothing. Medicaid may also cover services outside Medicare’s hospice benefit, such as personal care or certain home and community-based supports.
Choosing Hospice and the Curative-Care Trade-Off
Hospice does not start automatically. The patient, or a representative if the patient cannot act, files an election statement with the chosen hospice provider that names the provider and attending physician, sets an effective date, and carries the patient’s signature.7eCFR. 42 CFR 418.24 – Election of Hospice Care
The election also acknowledges a trade-off. In choosing hospice, the patient agrees to focus on comfort care for the terminal illness rather than treatment aimed at curing it, and Medicaid will no longer pay for curative treatment of that condition.1Medicaid.gov. Hospice Benefits The rest of Medicaid coverage stays in place. Care for conditions unrelated to the terminal illness continues as before, so a patient who elects hospice for cancer still has Medicaid coverage for diabetes care, for example.
Changing Your Mind
The election is not permanent. A patient can revoke hospice at any time by giving a signed, written statement to the hospice provider, and regular Medicaid coverage, including curative treatment for the terminal condition, resumes.1Medicaid.gov. Hospice Benefits If the patient later wants to return to hospice, they can re-elect the benefit as long as they still meet the eligibility criteria.7eCFR. 42 CFR 418.24 – Election of Hospice Care
Concurrent Care for Children Under 21
The curative-care trade-off does not apply to children. Since 2010, the Affordable Care Act has required state Medicaid programs, including Medicaid-expansion CHIP programs, to let Medicaid-eligible children under 21 receive hospice care and curative treatment at the same time.1Medicaid.gov. Hospice Benefits3Centers for Medicare & Medicaid Services. Hospice Care for Children in Medicaid and CHIP A child with a terminal diagnosis can continue chemotherapy, surgery, or other aggressive treatment while also getting hospice support for pain, comfort, and family counseling.