Yes, Medicaid covers hospice care in most states. Hospice is classified as an optional benefit under Medicaid, meaning each state chooses whether to include it in its plan. Nearly all states have opted to offer it. The benefit covers comfort-focused care for people with a terminal illness and a life expectancy of six months or less.
How Medicaid Hospice Coverage Works
To qualify, a physician must certify that you have a terminal illness with a life expectancy of six months or less if the disease follows its normal course. You then file an election statement with a specific hospice provider, formally choosing to begin receiving hospice services. That statement includes your acknowledgment that hospice care is palliative, meaning it focuses on comfort and symptom management rather than curing the illness.
One important trade-off: when an adult elects hospice under Medicaid, they waive coverage for treatments aimed at curing the terminal condition. You can still receive Medicaid coverage for conditions unrelated to the terminal diagnosis, but treatments intended to fight the terminal illness itself are no longer covered. This is a deliberate shift in the goal of care, from cure to comfort.
If your condition improves or stabilizes to the point where a six-month prognosis no longer applies, you may be discharged from hospice. However, if you remain in decline with a reasonable expectation of continued deterioration, you stay eligible even if you’ve been on hospice for longer than six months. There is no hard cutoff that automatically ends coverage.
What Services Are Covered
Medicaid hospice benefits mirror the structure of the Medicare hospice benefit and typically include nursing visits, medical social services, counseling, physical and occupational therapy for symptom management, home health aide services, medical supplies and equipment, and medications for pain and symptom control related to the terminal illness. The exact scope can vary by state since hospice is an optional benefit, so it’s worth confirming with your state’s Medicaid office what’s included in your plan.
Most hospice care is delivered at home, but if you live in a nursing facility, Medicaid also covers room and board. The payment rate is set at 95% of the facility’s standard skilled nursing rate, minus any amount you’re expected to contribute toward the cost of your own care. The hospice provider receives this payment and passes it along to the nursing facility on your behalf.
A Different Rule for Children
Since 2010, children under 21 who are eligible for Medicaid or CHIP do not have to give up curative treatment when they elect hospice. This change came through the Affordable Care Act and was a significant departure from the adult rule. A child can receive active treatment aimed at fighting their illness while simultaneously receiving hospice services for comfort and symptom relief. States are required to continue providing all medically necessary curative services even after a child’s hospice election.
This concurrent care rule recognizes that families facing a child’s terminal illness often want to pursue every available treatment option while also ensuring their child is comfortable. Before 2010, families had to choose one path or the other.
If You Have Both Medicare and Medicaid
Many hospice patients are “dual eligible,” meaning they qualify for both Medicare and Medicaid. In these cases, Medicare serves as the primary payer for hospice services. Medicaid may then cover costs that Medicare doesn’t, such as nursing facility room and board. If you have both programs, you won’t need to choose between them for hospice. They coordinate automatically, with Medicare picking up the core hospice benefit and Medicaid filling in gaps.
Electing and Leaving Hospice
Starting hospice under Medicaid is a formal process. You or your representative signs an election statement that identifies the hospice provider you’ve chosen, names your attending physician, and confirms that you understand the palliative nature of the care. The effective date of your election can be the first day of hospice care or a later date you specify, but it cannot be backdated to before you signed.
Since October 2020, hospice providers must also give you written information about any cost-sharing you might owe, a list of any conditions or medications the hospice considers unrelated to your terminal illness (which matters because those unrelated items stay covered by regular Medicaid), and contact information for a quality improvement organization you can reach out to if you disagree with any of the hospice’s decisions.
Hospice is not a one-way door. You can revoke your election at any time and return to standard Medicaid coverage, including curative treatments for your terminal illness. If your situation changes later, you can re-elect hospice. This flexibility exists because the decision to focus on comfort care is deeply personal, and circumstances shift as an illness progresses.
State Variations to Watch For
Because hospice is an optional Medicaid benefit rather than a mandatory one, coverage details can differ from state to state. Most states cover the full range of hospice services, but the reimbursement rates, provider networks, and specific covered items may not be identical everywhere. If you’re exploring hospice for yourself or a family member, contact your state Medicaid agency or the hospice provider directly to confirm exactly what your plan covers. The hospice intake team handles these questions routinely and can walk you through what to expect financially before you sign anything.