Medicaid covers hospice care, but the scope and rules depend on your state and which Medicaid program you are in
Medicaid pays for hospice services when a doctor certifies that you have a terminal illness and six months or less to live. The federal government sets the basic framework, but each state runs its own Medicaid program and can set different rules about which hospice providers it will pay, what services it covers beyond the federal minimum, and whether it covers hospice for people in nursing homes or other settings.
Hospice is covered under both traditional Medicaid (the program for people with low income) and Medicare (the program for people 65 and older, regardless of income). If you are on both — called "dual may be able to access" — Medicare is usually the primary payer, and Medicaid fills in gaps. If you are on Medicaid alone, your state's Medicaid program pays the hospice provider directly.
The hospice provider must be certified by Medicare to receive payment from any Medicaid program, even if you are not on Medicare yourself. This means your state will not pay an uncertified hospice, so your choice of provider is limited to those on your state's approved list.
Key Takeaways
- Medicaid covers hospice care when a doctor certifies a terminal diagnosis with six months or less to live, but your state Medicaid program sets which providers it will pay.
- The hospice provider must be Medicare-certified to receive Medicaid payment, even if you are not on Medicare yourself.
- Medicaid covers pain medication, nursing visits, counseling, and equipment like hospital beds and wheelchairs, but coverage rules vary by state.
- If you are in a nursing home, your state Medicaid program decides whether it will pay for hospice services there, and some states do not cover both simultaneously.
- You should contact your state Medicaid office or your hospice provider to confirm what your specific state covers before you enroll in hospice.
What Medicaid hospice services include
Medicaid covers the core hospice services that Medicare covers: nursing care, doctor visits, pain medication and other drugs, counseling (including spiritual care if you want it), and medical equipment like hospital beds, oxygen, and wheelchairs. It also covers short-term inpatient care if you need symptom management that cannot happen at home.
Medicaid also covers homemaker and aide services — someone to help with bathing, dressing, and household tasks — which is often the service families need most. The number of hours per week varies by state and by your individual care plan, but most states cover this as part of the hospice benefit.
Bereavement counseling for your family after you die is covered for a set period, usually 12 months. Some states cover more services than the federal minimum, such as respite care (temporary care so a family caregiver can take a break), but you need to check with your state Medicaid program to know what is available where you live.
How to find out what your state Medicaid program covers
Contact your state Medicaid office directly — not a hospice provider, not a hospital social worker, but your state's Medicaid program. You can find the phone number on your Medicaid card or by searching "[your state] Medicaid" online. Tell them you want to know about hospice coverage in your state: which providers are approved, what services are covered, and whether there are any limits based on where you receive care.
Write down the name of the person you speak with and the date, because Medicaid rules change and you may need to refer back to what you were told. Ask specifically whether your state covers hospice in a nursing home, assisted living facility, or only at home — this varies significantly.
If you are already working with a hospice provider, ask them to contact your state Medicaid program on your behalf and confirm coverage before you enroll. Hospice providers do this regularly and can often get answers faster than you can.
Medicaid hospice coverage in nursing homes and other facilities
This is where state rules differ most sharply. Some states cover hospice services for people living in nursing homes under Medicaid. Others do not — they require the nursing home itself to provide end-of-life care using its own staff and budget. A few states cover hospice in assisted living but not in nursing homes, or vice versa.
If you or a family member is in a nursing home and approaching end of life, ask the nursing home social worker or administrator whether your state Medicaid program will pay for hospice services there. If the answer is no, the nursing home is still required to provide comfort care and pain management, but it will not be called "hospice" and will not include the same level of specialized end-of-life support.
If your state does not cover hospice in the facility where you are, you have the option to leave the facility and move to home-based hospice if that is possible for you. Some families make this choice to access the full range of hospice services.
Dual may be able to access: when you have both Medicaid and Medicare
If you are 65 or older and have both Medicare and Medicaid, Medicare is the primary payer for hospice. Medicare has its own hospice benefit with specific rules about what it covers and how much it pays providers. Medicaid steps in to cover costs Medicare does not pay, such as copayments or services that Medicare limits but your state Medicaid program covers more generously.
You do not have to choose between them — both programs work together automatically once you enroll in hospice. The hospice provider bills Medicare first, then bills Medicaid for anything remaining. You should not receive a bill for hospice services if you are dual may be able to access, because one program or the other will cover the cost.
If you are unsure whether you are on both programs, call the number on your insurance card or contact your state Medicaid office and ask. They can tell you in one call.
What happens if your state Medicaid program does not cover a service you need
If your state does not cover a service that your hospice provider recommends — for example, some states do not cover respite care — you have a few options. You can ask your hospice provider whether they offer the service at no charge or at a reduced cost; many do for patients who cannot pay. You can ask whether a family member or volunteer can provide the service instead. Or you can contact your state Medicaid office and ask whether there is a waiver or exception process for your situation.
Some states have Medicaid waivers that allow them to cover services outside the standard benefit package for people with specific needs. These are not common and not may provide, but it is worth asking if you have a documented medical need that your state's standard hospice benefit does not cover.
Income and resource limits for Medicaid hospice
To be on Medicaid, you must meet your state's income and resource limits. These limits vary widely — some states are more generous than others. If you are already on Medicaid, you do not need to requalify to receive hospice; your existing Medicaid coverage extends to hospice services.
If you are not on Medicaid but think you might be, contact your state Medicaid office or a local social worker to find out whether you meet the limits in your state. Some states have special programs for people with terminal illnesses that have higher income limits than regular Medicaid, so it is worth asking even if you think you earn too much.
Frequently Asked Questions
Does Medicaid cover hospice at home?
Yes, Medicaid covers home-based hospice in all states. Coverage includes nursing visits, medication, equipment, and aide services. Your state Medicaid program determines how often nurses can visit and how many hours of aide care you receive per week, but home hospice is a standard covered service everywhere.
What if I want to switch hospice providers after I enroll?
You can switch to a different Medicare-certified hospice provider at any time. Tell your current provider you are leaving, and contact the new provider to enroll. Medicaid will pay the new provider from the date you switch. There is no penalty or waiting period.
Does Medicaid cover hospice for children?
Yes, Medicaid covers hospice for children with terminal illnesses. The rules are the same as for adults — a doctor must certify the terminal diagnosis and prognosis of six months or less. Some states have pediatric hospice programs with additional services tailored to children and families.
Will I lose my Medicaid if I enroll in hospice?
No. Enrolling in hospice does not change your Medicaid status. You remain on Medicaid, and your coverage continues for all services, not just hospice. If you recover and no longer need hospice, you can unenroll and keep your Medicaid.
Can I be on hospice and still receive other medical treatment?
Hospice and curative treatment are generally not covered at the same time by Medicaid. When you enroll in hospice, you are choosing comfort care as your primary goal. However, you can unenroll from hospice if you want to pursue other treatment, and you can re-enroll later if you choose hospice again.