Does Medicaid Cover Hospice Care?

According to the National Hospice and Palliative Care Organization, hospice is an optional Medicaid benefit under state Medicaid plans. At this time, benefits are, by law, closely matched with those provided by Medicare. However, due to policy decisions on the national level, many states are now scrutinizing how Medicaid dollars are spent. Thus, Medicaid hospice benefits may or may not be available where you live. Visit this page from the Kaiser Family Foundation to learn more about what’s available in your state. 

Remember, too, that many disabled persons and people over the age of 65 are eligible for both Medicare and Medicaid (“dual-eligible”). When this is the case, and a person on hospice resides in a nursing home, Medicaid typically pays the cost of room and board, while Medicare pays for hospice care. In other situations, Medicaid may pay for some or all of the copayments for medication or respite care. 

If your state offers a Medicaid hospice benefit, the eligibility requirements are the same as those for Medicare. That is, you must sign a statement agreeing to forego curative treatment for your underlying disease or related condition (unless you or the patient are under 21) and a physician must certify that you are terminally ill and have six months or fewer to live. 

Both Medicare and Medicaid cover hospice services at a fixed per-diem rate based on the level of care provided and where it takes place. The designated reimbursement categories are as follows:

• Routine Home Care (RHC) — care provided by members of the hospice team. The reimbursement for RHC is higher for days 1–60 and decreases from day 61 on. 
• Continuous Home Care (CHC) — care provided during a crisis, usually by a nurse
• Inpatient Respite Care (IRC) — care provided in a hospital or nursing home to give family caregivers short-term relief
• General Inpatient Care (GIC) — care in a hospital for relief of pain or other symptoms that cannot be controlled in another setting
• Service Intensity Add-on — a higher level of care provided during the last seven days of life. The care must be provided by a registered nurse or a social worker who visits the patient or family in their home. 

Reimbursement rates for hospice care change annually. They are published by the Centers for Medicare and Medicaid Services in September and go into effect Oct. 1 for the following fiscal year. To learn more about hospice reimbursement rates for 2025, see this document from CMS. 

Sources

“Fiscal Year (FY) 2025 Hospice Payment Rate Update Final Rule (CMS-1810-F)”. Centers for Medicare & Medicaid Services. https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2025-hospice-payment-rate-update-final-rule-cms-1810-f 

“Hospice Benefits”. Centers for Medicare & Medicaid Services. https://www.medicaid.gov/medicaid/benefits/hospice-benefits 

“Medicaid Benefits: Hospice Care”. KFF. https://www.kff.org/medicaid/state-indicator/hospice-care/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22desc%22%7D