Hospice and Medicaid in Florida: Who Pays for What

To qualify for Medicare hospice, you need Part A and a certification that you are terminally ill (42 CFR 418.20). The hospice doctor and your regular doctor, if you have one, certify a life expectancy of six months or less if the illness runs its normal course. You accept comfort care in place of treatment aimed at a cure, and you sign a statement choosing hospice (Medicare.gov).

Some details matter in practice:

The election statement. It names the hospice and your attending doctor. It confirms that you understand hospice care is palliative, not curative. A representative can sign it if you are physically or mentally incapacitated (42 CFR 418.24). This is one reason a health care surrogate designation matters. What you give up. For the terminal illness and related conditions, you waive regular Medicare payment for care other than what the hospice provides or arranges. Your own attending doctor's services are an exception (42 CFR 418.24(g)). Medicare still pays for unrelated health problems, with the usual deductibles and coinsurance (Medicare.gov). Recertification. A doctor must recertify the prognosis for each period. Before the third period, and before every period after that, a hospice doctor or nurse practitioner must see the patient face to face (42 CFR 418.22). Changing your mind. You can revoke hospice at any time and go back to standard Medicare. You can also elect hospice again later (42 CFR 418.28). You can change hospice providers once in each benefit period (Medicare.gov).

The hospice team provides or arranges nursing, physician services, medical social work, counseling, aide visits, medical equipment and supplies, drugs for symptoms, and therapies (AHCA Hospice Coverage Policy). Under Medicare, you pay up to $5 per prescription for pain and symptom drugs and 5% of the approved amount for inpatient respite care (Medicare.gov). Respite stays give a caregiver a break and can last up to five days in a row (42 CFR 418.204(b)).

The big gap is room and board. Medicare doesn't pay it when you get hospice care at home, in a nursing home or in a hospice residence (Medicare.gov). For someone living in a nursing home, that daily rate is usually the largest bill.

Florida Medicaid covers hospice for recipients who are certified as terminally ill and who elect hospice under the federal rules (AHCA). Hospice is a covered service in every Managed Medical Assistance and Long-Term Care plan (AHCA). For recipients 21 and older, curative treatment isn't covered once hospice is elected (AHCA Hospice Coverage Policy).

On the eligibility side, DCF requires a person who isn't already on Medicaid to meet the SSI-related rules and the income and asset limits for ICP, MEDS-AD or Medically Needy (ESS Policy Manual 2040.0814.01). The person must also have a physician-certified prognosis of six months or less, sign an election choosing hospice over other regular Medicaid services, and use a qualified hospice (ESS Policy Manual 2040.0814.02).

In 2026 the institutional income limit is $2,982 a month. The asset limit for hospice is $2,000 for one person, or $5,000 if income is within the MEDS-AD limit (DCF Appendix A-9; ESS Policy Manual 1640.0200). People with income above $2,982 usually need a qualified income trust. Medically Needy hospice is another option when the share of cost is met (ESS Policy Manual 2040.0814.04).

This is where the two programs fit together. For a resident who has both Medicare and Medicaid, Medicare pays the hospice for its care, and Medicaid pays room and board. Medicaid pays that money to the hospice, which then pays the nursing home (AHCA Hospice Coverage Policy). Federal law requires the room and board payment to be at least 95% of what Medicaid would have paid the facility (42 U.S.C. 1396a(a)(13)(B)), and Florida pays at 95% of the facility's rate on file (AHCA Hospice Coverage Policy).

The hospice and the nursing home must have a written agreement. The facility provides 24-hour room and board, and the hospice manages the hospice care (42 CFR 418.112).

The resident still pays a share. Institutional hospice uses the same patient responsibility calculation as ICP. The resident keeps a $160 personal needs allowance, and most of the rest of their income goes toward the cost of care (ESS Policy Manual 2640.0117–2640.0118). If a spouse lives at home, the spousal impoverishment rules apply (ESS Policy Manual 2040.0814.03). In 2026 those rules let the spouse keep up to $162,660 in assets and receive an income allowance based on a minimum of $2,705 a month (DCF Appendix A-9).

In the Boynton Beach example, if the wife qualifies, Medicaid takes over the room and board through the hospice. Her husband stops paying privately, and her income, minus the allowances, goes to the facility.

Medicaid "community hospice" keeps more income at home. The personal needs allowance equals the federal poverty level, which is $1,330 in 2026 (ESS Policy Manual 2640.0118; DCF Appendix A-9). If there is a spouse and no dependents, the spouse can receive the SSI federal benefit rate minus the spouse's own income (ESS Policy Manual 2640.0121).

Assisted living works differently. Florida's Long-Term Care program doesn't pay room and board to an ALF (AHCA LTC Coverage Policy). A resident on hospice in an ALF usually keeps paying rent from income or family help. Our assisted living Medicaid guide covers that budget.

Palliative care focuses on comfort and quality of life. It can begin at diagnosis and continue alongside treatment aimed at a cure. In hospice, efforts to cure the illness stop, though other helpful care can continue (National Institute on Aging). Medicare, Medicaid and private insurance may cover palliative care, depending on the benefits and the treatment plan (National Institute on Aging).

Florida's hospice licensing law defines palliative care as non-curative care that reduces pain and suffering. For licensing purposes, it defines "terminally ill" as a prognosis of one year or less (Fla. Stat. 400.601). Medicare and Medicaid payment, however, still requires the six-month certification (ESS Policy Manual 2040.0814.02).