Hospice care in New York is available to anyone with a terminal illness and a life expectancy of under twelve months, a wider window than Medicare’s six-month standard. Medicare pays for the care itself with no cost to the patient except a small drug copay, and New York Medicaid picks up room and board in a nursing facility or hospice residence. Starting hospice requires a physician’s certification and a signed election statement, and you can revoke that election at any time.
Who Qualifies
New York’s Medicaid program and the state Department of Health define a hospice-eligible patient as someone with a terminal illness whose life expectancy is under twelve months if the illness runs its normal course.1New York State Department of Health. Hospice Medicare uses a stricter threshold: a prognosis of six months or less.2Medicare.gov. Hospice Care Coverage Most providers in New York work off the Medicare standard because federal reimbursement follows it, but the state rule means Medicaid-funded hospice can begin earlier in an illness.
Two physicians must certify the terminal diagnosis for the first benefit period: the hospice medical director (or a physician designee) and the patient’s attending physician, if the patient has one.3eCFR. 42 CFR 418.22 – Certification of Terminal Illness After that, the hospice medical director’s certification alone is enough. A referral can come from anyone — family, a hospital discharge planner, the patient themselves — but a physician has to certify before services begin.
Children Can Keep Curative Treatment
The adult rule generally requires patients to give up curative treatment for the terminal condition when they elect hospice. That does not apply to children. Section 2302 of the Affordable Care Act allows children eligible for Medicaid or the Children’s Health Insurance Program to receive curative treatment and hospice comfort care at the same time.4Department of Health & Human Services. Hospice Care for Children in Medicaid and CHIP
Electing Hospice and How Long It Lasts
Starting hospice is a formal step. The patient or their representative signs an election statement with the hospice provider. The statement must acknowledge that hospice care is palliative rather than curative, that certain Medicare benefits are waived during the election, and it must name the attending physician who will participate in the patient’s care.5eCFR. 42 CFR 418.24 – Election of Hospice Care The hospice also has to give the patient information about cost-sharing and the right to contact the Beneficiary and Family Centered Care Quality Improvement Organization with concerns.
The election statement is not an advance directive. Signing it does not replace a health care proxy or living will, and the hospice must still ask about any existing directive and add it to the clinical record.6eCFR. 42 CFR Part 418 – Hospice Care
Medicare structures the coverage as benefit periods: two initial 90-day periods followed by an unlimited number of 60-day periods.2Medicare.gov. Hospice Care Coverage The hospice medical director must recertify terminal illness at the start of each new period. After six months on hospice, recertification requires a face-to-face encounter with the hospice physician or nurse practitioner. There is no cap on the number of 60-day periods, so a patient who remains eligible can stay on hospice indefinitely.
What Hospice Covers and What You Pay
Federal rules recognize four levels of hospice care, and Medicare pays a different daily rate for each. The FY 2026 base rates are:
- Routine home care, days 1–60: $230.83 per day
- Routine home care, days 61 and after: $181.94 per day
- Continuous home care: $69.76 per hour, up to $1,674.29 for a full 24-hour day
- Inpatient respite care: $532.48 per day
- General inpatient care: $1,199.86 per day
These are national base rates; New York payments are adjusted upward for local wages.7Federal Register. Medicare Program; FY 2026 Hospice Wage Index and Payment Rate Update Most patients receive routine home care, which covers nursing visits, pain and symptom medications, medical equipment, and support from social workers and chaplains. Continuous home care is for crises and requires at least eight hours of care in a 24-hour period, more than half of it provided by a nurse.8CMS Medicare Benefit Policy Manual. 40.2.1 – Continuous Home Care General inpatient care covers short facility stays when symptoms cannot be managed at home. Respite care places the patient in a facility for up to five consecutive days so family caregivers can rest.
Out-of-Pocket Costs
Under Medicare, patients pay nothing for hospice services themselves. The one exception is a copay of up to $5 per prescription for outpatient drugs used for pain and symptom management.2Medicare.gov. Hospice Care Coverage Medicare will not pay for treatments aimed at curing the terminal illness once hospice is elected.
Medicare also does not pay for room and board when a patient lives in a nursing facility or hospice residence, except during short-term inpatient stays. New York Medicaid does cover that room and board.9eMedNY. New York State Medicaid Program Hospice Manual Policy Section For patients without Medicaid who need residential hospice, this can be a substantial expense.
Unreimbursed hospice costs, including nursing care and medical supplies you pay for yourself, may be deductible as medical expenses on a federal tax return. The deduction applies only to the portion of total medical expenses that exceeds 7.5 percent of adjusted gross income, and you have to itemize to claim it.10Internal Revenue Service. Medical, Nursing Home, Special Care Expenses
Health Care Proxy, Advance Directive, and MOLST
New York’s Health Care Proxy Law lets you appoint someone to make medical decisions for you if you lose the ability to decide.11New York State Department of Health. Health Care Proxy – Appointing Your Health Care Agent in New York State Your agent can consent to, choose among, or decline treatments on your behalf, consistent with your wishes. You keep the right to decide for yourself as long as you are able. Hospices must ask about and document any existing proxy or advance directive at enrollment.
New York also uses a form called MOLST — Medical Orders for Life-Sustaining Treatment — which turns a patient’s treatment preferences into actual medical orders. A health care proxy names a decision-maker; a MOLST issues instructions that emergency responders and other health care providers are required to follow. Completing one begins with a conversation between the patient (or their agent) and a qualified health professional, and a physician, nurse practitioner, or physician assistant must sign the orders.12New York State Department of Health. Medical Orders for Life-Sustaining Treatment (MOLST)
The distinction matters in an emergency. If paramedics come to a hospice patient’s home, they generally cannot honor a health care proxy or living will on the spot. They can follow the medical orders on a MOLST, including a do-not-resuscitate order. For hospice patients who have decided against aggressive interventions, a completed MOLST kept somewhere obvious prevents unwanted treatment during a crisis.
Patient Rights and Bereavement Support
Article 40 of the New York Public Health Law requires hospice providers to give patients a written statement of their rights at admission, in a language and format they can understand.13Justia. New York Public Health Law Article 40 – Hospice Those rights include participating in care decisions, accepting or refusing any treatment, seeing your medical records, and getting clear explanations of the care plan. Hospice programs must also have written policies against abuse, neglect, and exploitation, along with procedures for reporting and investigating misconduct.
Bereavement services are part of the hospice benefit, not an optional extra. Federal rules require every hospice to run an organized bereavement program supervised by a qualified professional and to make services available to the patient’s family for up to one year after the death, with a plan of care describing the type and frequency of support.6eCFR. 42 CFR Part 418 – Hospice Care Families sometimes assume support ends when the patient dies. If your hospice has not reached out, ask what is available.
Leaving Hospice or Being Discharged
You can leave hospice at any time. Revoking the election requires a signed written statement filed with the hospice, and the effective date cannot be earlier than the day you submit it.14eCFR. 42 CFR 418.28 – Revoking the Election of Hospice Care Once revocation takes effect, you get back the regular Medicare coverage you had waived, including curative treatment for your terminal illness. Revoking ends the current benefit period; if you later come back to hospice, you start a new one. Transferring between hospice providers is different and does not require revocation.
A hospice can discharge a patient in only three situations: the patient moves out of the service area or transfers to another hospice, the patient is no longer terminally ill, or the patient’s behavior seriously impairs the hospice’s ability to deliver care.15eCFR. 42 CFR 418.26 – Discharge From Hospice Care Discharge for cause has procedural safeguards. The hospice must notify the patient that discharge is being considered, try to resolve the problem, confirm the discharge is not just because the patient is using needed services, and document all of it. A written discharge order signed by the hospice medical director is required, and the attending physician should be consulted.
When a patient’s condition stabilizes and they no longer qualify, the hospice’s discharge planning process should arrange counseling, patient education, and a transition to other services. A patient who later declines again can re-elect hospice. If you believe a discharge was improper, you can file a complaint with the New York State Department of Health.