Yes. For adults on Medicaid, electing hospice changes home-care use because Medicaid payment for cure or treatment of the terminal condition pauses while the election is active.
Home-care help can often continue, but it must fit around the hospice plan without duplicating hospice work. Hospice means comfort-focused care for a terminal condition, not treatment to cure it. A Medicaid home and community-based services waiver pays for longer-term help at home, such as personal care and nursing supports tied to daily needs.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Official resources:
- Read the official guidance from Medicaid — Use this primary source to verify the official guidance.
- Read the official guidance from Medicaid — Use this primary source to verify the official guidance.
Table of Contents
- What hospice brings into the home
- Can waiver services continue during hospice
- Where duplicate help is not allowed
- What dementia families should clarify now
What hospice brings into the home
Medicaid.gov explains that the hospice package includes nursing, physician, medical social, counseling, short-term inpatient, supplies, home health aide and homemaker help, plus physical, occupational and speech therapy through the Medicaid hospice benefit page. Those services follow a hospice plan aimed at comfort, symptom control and family support.
Most home days do not bring many hours of hands-on help. The Centers for Medicare & Medicaid Services defines four hospice payment levels, including routine home care, continuous home care, inpatient respite up to five consecutive days and general inpatient care, so most home days remain routine visits as described on the federal hospice payment page. For dementia, that can mean brief nurse or aide visits for symptoms and counseling, not all-day supervision.
Can waiver services continue during hospice
Often yes, when the state allows both at once and the teams coordinate. The Alabama Medicaid Agency updated policy on Jan. 14, 2025 to allow hospice and a waiver to operate concurrently, with hospice and waiver care-manager coordination required, according to the Alabama concurrent-services alert.
Ohio takes a similar approach for its PASSPORT waiver, letting waiver nursing and personal care continue under the approved service plan while hospice keeps responsibility for hospice-plan nursing and aide services. The main exception involves children: under a Sept. 9, 2010 CMS State Medicaid Director letter, children under 21 may receive curative treatment for the terminal condition at the same time as hospice.
Where duplicate help is not allowed
The line is duplication. Alabama bars duplicate billing such as a hospice aide and waiver personal-care aide at the same time.
Only one program can bill for the same kind of hands-on help during the same period. Mississippi applies a use-hospice-first rule where overlap is possible, including aide and homemaker help versus personal-care attendant, therapies and nursing visits, according to the current Mississippi hospice-waiver rule. In practice, the family may keep waiver hours for unrelated daily needs, meals, supervision or home support, while hospice covers comfort care tied to the terminal condition.
What dementia families should clarify now
Ask which tasks belong to hospice and which remain with the waiver before schedules change. Get the hospice plan and waiver service plan in writing, with visit times, aide duties, nursing tasks and after-hours contacts. Bring both plans to every update meeting and ask for same-day correction when an aide visit, therapy or nursing visit appears on both schedules.
- Which aide hours stay, change time or stop during hospice
- Who handles bathing, meals, medications, night supervision and behavior support
- How the hospice nurse and waiver care manager will share updates
- What to call when symptoms change or coverage overlaps
