Does Medicaid cover hospice?
Usually covered
Hospice is an optional Medicaid benefit that almost every state provides, covering comfort-focused care for members with a terminal illness who choose it in place of curative treatment.
- Covered when A physician certifies a terminal illness, the member elects hospice, and the state offers the benefit — which nearly all states do.
- Covered when The patient is under 21 and can receive hospice and curative care concurrently.
- Not when An adult wants to keep pursuing a cure for the terminal condition, which electing hospice generally waives.
What flips the answer
- Covered when
A physician certifies a terminal illness, the member elects hospice, and the state offers the benefit — which nearly all states do.
- Covered when
The patient is under 21 and can receive hospice and curative care concurrently.
- Not covered when
An adult wants to keep pursuing a cure for the terminal condition, which electing hospice generally waives.
Key facts
- Verdict
- Usually covered
- Applies to
- hospice · Medicaid
- Covered when
- A physician certifies a terminal illness, the member elects hospice, and the state offers the benefit — which nearly all states do.
- Not covered when
- An adult wants to keep pursuing a cure for the terminal condition, which electing hospice generally waives.
- Verified
- 2026-07-03 · 2 primary sources
Medicaid classifies hospice as an optional benefit, and nearly all states elect to cover it. The benefit bundles the services a terminally ill member needs to stay comfortable — nursing, physician oversight, symptom-relief medications, medical equipment, and counseling and bereavement support for the family.
Eligibility runs through certification and election: a physician certifies a terminal illness (generally six months or less to live if the disease runs its usual course), and the member signs a statement electing hospice comfort care and waiving Medicaid coverage of curative treatment for that terminal condition.
Children under 21 get a broader deal — the concurrent-care rule lets a child receive hospice and continue curative treatment at the same time. As with all Medicaid, the specific providers and administrative steps are handled by your state program.
What people typically pay
With Medicaid hospice elected, members typically pay little to nothing out of pocket for the covered services — nursing, physician services, symptom-relief medications and supplies, medical equipment, and counseling for the individual and family are bundled into the benefit. Room and board in a nursing facility is handled separately under state rules.
Paid privately, hospice costs vary widely by level of care and setting — routine home care, continuous home care during a crisis, inpatient respite care, and general inpatient care are billed differently, and individual services like nursing visits, medications, and equipment add up when billed separately.
Costs vary widely by state, by whether care is at home or in a facility, and by the level of care needed on a given day.
How to actually get it covered
Talk with your treating physician about whether your condition meets the terminal-illness criteria (the base entry describes this as generally six months or less to live if the disease runs its usual course).
Have a hospice provider obtain physician certification that you are terminally ill — this certification is required for Medicaid hospice.
Choose a hospice provider; ask your state Medicaid office or managed-care plan for a list of enrolled providers.
File the hospice election statement with a particular hospice, acknowledging that (for adults) other Medicaid services for the cure or treatment of the terminal condition are waived.
Confirm room-and-board arrangements with your state or plan if you live in or will move to a nursing facility, since that piece is handled separately.
A hospice plan of care must be established before services are provided; follow your state's re-certification process so coverage continues if you live beyond the initial estimate.
Common questions
Does Medicaid charge me anything for hospice care?
Medicaid hospice comes with little to no cost sharing for the member — the benefit is designed to cover the full package of comfort care described in the state plan. If you're in a nursing facility and elect hospice, room-and-board charges are typically handled separately under your state's rules and may involve some responsibility depending on your state and income. There is no separate deductible for the hospice services themselves.
How does a doctor certify me for the six-month terminal prognosis?
A hospice provider must obtain a physician certification that you are terminally ill, and the hospice services must be reasonable and necessary for the palliation or management of the terminal illness and related conditions. The base entry describes the terminal-illness standard as generally six months or less to live if the disease runs its usual course. This is a clinical judgment, not a guarantee — certification is generally renewed periodically rather than being a one-time approval. Check your state program for the specific re-certification schedule.
Can I leave hospice and go back to curative treatment if I change my mind?
Yes. Medicaid.gov states that individuals may revoke the election of hospice at any time and resume receipt of the Medicaid-covered benefits that were waived when hospice was elected. Choosing hospice is not permanent or irreversible.
My state offers hospice — do I have to use a specific agency?
You elect the hospice benefit by filing an election statement with a particular hospice. Your state program determines which providers are enrolled, so it's best to ask your state Medicaid office or managed-care plan for a list of participating hospices. Specific rules about switching providers vary by state.
Why can a child get both hospice and curative care when an adult can't?
Since March 23, 2010, under the Affordable Care Act, Medicaid and CHIP-eligible individuals under age 21 who elect the hospice benefit no longer have to waive services for the cure or treatment of the terminal condition and can receive both curative care and hospice care. Adults electing hospice must acknowledge that other Medicaid services for the cure or treatment of the terminal condition are waived. The concurrent-care rule for children exists so families aren't forced to choose between comfort and cure for a seriously ill child.
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