Hospice Under Medicaid

Hospice is care for people with a terminal illness that focuses on comfort, dignity and quality of life rather than cure. It includes pain and symptom management, emotional and spiritual support, and help for the family. Medicare pays for most hospice care for older adults, but Medicaid plays an important role, especially for nursing home residents. This guide explains how hospice works, how Medicare and Medicaid share the costs, and what families should know.

Figures change periodically. Double-check current amounts before relying on them.

The short version

Hospice is for people whose doctor and the hospice medical director certify a life expectancy of six months or less if the illness runs its normal course.
Medicaid hospice is technically an optional benefit, but all states cover it.
For people with both Medicare and Medicaid, Medicare pays for hospice care. If the person lives in a nursing home, Medicaid continues to pay room and board.
Electing hospice generally means giving up curative treatment for the terminal illness (but not other care). Children under 21 on Medicaid can receive both.
Hospice can be provided at home, in a nursing home, in assisted living or in an inpatient hospice facility.

What hospice covers

Hospice provides a team approach, typically including:

a doctor and nurses focused on comfort care;
home health aides;
social workers;
chaplains or spiritual counselors;
volunteers;
medications for pain and symptom control related to the terminal illness;
medical equipment, such as a hospital bed or wheelchair;
medical supplies;
physical, occupational and speech therapy for comfort;
dietary counseling;
short-term inpatient care for symptoms that cannot be managed at home;
respite care for family caregivers;
grief and bereavement support for the family for up to a year after the death.

Levels of hospice care

Hospice is paid at four levels:

Routine home care, the most common, wherever the patient lives.
Continuous home care, for short periods of crisis, with nursing care at home for at least eight hours a day.
General inpatient care, in a hospital, hospice facility or nursing home, for symptoms that cannot be managed elsewhere.
Inpatient respite care, up to five days at a time, to give caregivers a break.

Eligibility and election

To receive hospice:

a doctor (and the hospice medical director) certifies that the person is terminally ill with a life expectancy of six months or less if the illness runs its normal course;
the person, or their representative, signs an election statement choosing hospice;
for adults, the election means giving up curative treatment for the terminal illness. Care for unrelated conditions continues to be covered.

Hospice is given in benefit periods: two 90-day periods, followed by an unlimited number of 60-day periods, with recertification each time. People who live longer than six months can keep receiving hospice if they remain eligible. A person can stop hospice at any time and return to regular coverage.

Under the Affordable Care Act (section 2302), children under 21 on Medicaid or CHIP can receive hospice and curative treatment at the same time.

People with Medicare only

Medicare Part A pays for hospice, with very small copayments for drugs and inpatient respite.

People with both Medicare and Medicaid (dual eligible)

Medicare pays for hospice care.
Medicaid may pay small Medicare copayments and covers services Medicare does not.
If the person lives in a nursing home on Medicaid, Medicaid pays the hospice an amount for room and board, and the hospice pays the nursing home. Federal law sets this payment at no less than 95 percent of the state’s nursing home rate for that facility (Social Security Act section 1902(a)(13)(B)).

People with Medicaid only

Medicaid pays for hospice under its own benefit, following rules similar to Medicare’s.

Hospice in a nursing home

Many hospice patients live in nursing homes. Hospice staff visit the resident and work with nursing home staff. The nursing home provides room, board and personal care; the hospice manages the terminal illness, provides comfort medications, equipment and supplies, and offers extra support. The resident’s patient liability still goes to the nursing home (or to the hospice, depending on the state’s billing arrangements).

Hospice in assisted living or at home

Hospice can be provided in assisted living or at home. At home, family members usually provide most day-to-day care, with hospice staff visiting regularly and on call 24 hours a day. Hospice does not usually provide round-the-clock aides at home, except during crisis periods. Medicaid waiver services, such as personal care, may continue alongside hospice in some states, as long as services are not duplicated.

Choosing a hospice

Ask the doctor or hospital for recommendations.
Check quality information on Medicare’s Care Compare tool, which includes hospice providers.
Ask how quickly the hospice can start, how often staff visit, and how after-hours calls are handled.
Ask whether the hospice works with the person’s nursing home or assisted living facility.
Ask about volunteer and bereavement programs.

Hospice and Medicaid eligibility

Hospice does not change Medicaid financial eligibility rules. A person who needs Long-Term Care Medicaid for nursing home room and board still must meet the asset, income and look-back rules. Families sometimes rush to apply when a loved one enters hospice; the right timing can protect assets for a spouse, so it helps to understand the rules. A Certified Medicaid Planner can help with urgent applications.

A simple example

Harold, 90, lives in a nursing home on Medicaid and also has Medicare. He has advanced heart failure, and his doctor certifies a life expectancy of six months or less. Harold’s daughter, his health care agent, elects hospice for him. Medicare now pays the hospice for his care. Medicaid pays the hospice for his room and board, and the hospice pays the nursing home. Hospice nurses manage his symptoms, a chaplain visits weekly, and his daughter receives counseling and bereavement support after he dies.

Frequently asked questions

Does choosing hospice mean giving up all treatment? No. Adults give up curative treatment for the terminal illness, but comfort care and treatment for other conditions continue.

Can someone leave hospice? Yes, at any time. They can return later if still eligible.

Does hospice pay for a nursing home? Medicare hospice does not pay room and board. For a resident on Medicaid, Medicaid pays room and board.

What if the person lives longer than six months? Hospice can continue as long as the person remains eligible and is recertified.

Key terms

Terminal illness: a prognosis of six months or less if the illness runs its normal course.
Election statement: the form a patient or representative signs to choose hospice.
Benefit period: a span of hospice coverage; two 90-day periods, then unlimited 60-day periods.
Recertification: a doctor’s confirmation, at each new period, that the patient is still eligible.
Room and board (in hospice): the nursing home’s charge for housing and meals, which Medicaid pays for eligible residents.

A second example: hospice at home

Marian, 82, has advanced lung disease and wants to die at home. She has Medicare and Medicaid and lives with her son. She elects hospice. A hospice nurse visits twice a week, an aide helps with bathing three times a week, and the hospice provides a hospital bed, oxygen and comfort medications. The hospice is on call around the clock; when Marian has a breathing crisis one night, a nurse comes to the home and adjusts her medications. Her state’s waiver continues to provide some personal care hours that do not duplicate hospice services. When her son needs a break, hospice arranges a five-day inpatient respite stay. Marian dies at home, and the hospice offers her son bereavement counseling for the following year.

Common mistakes

Waiting until the last few days of life to start hospice, which limits the benefit to the patient and family.
Assuming hospice will provide round-the-clock aides at home.
Assuming hospice pays nursing home room and board.
Not asking how hospice and existing waiver services will work together.
Not completing a health care power of attorney and advance directive, so decisions are clear.

Questions to ask a hospice provider

How often will nurses and aides visit?
How quickly does a nurse respond to an after-hours call?
Which medications and equipment will you provide?
Do you work with this nursing home or assisted living facility?
What respite and bereavement services do you offer?

Hospice and the Medicaid application

When a nursing home resident starts hospice before Medicaid is approved, the family may still need to file a Long-Term Care Medicaid application for room and board. Hospice staff and the nursing home business office can help coordinate. Filing promptly protects the months Medicaid can cover.

Families can also ask the hospice social worker for help with practical matters, such as funeral planning and paperwork.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.