New York Medicaid covers hospice for people with a medical prognosis of six months or less if the terminal illness runs its normal course. Hospice means coordinated home and inpatient non-curative medical and support care focused on easing symptoms. Referrals can come from any source, but a physician must certify the terminal illness. For a family facing advanced dementia, this means you can ask for hospice directly and the doctor decides if the prognosis fits.
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 Ny — Use this primary source to verify the official guidance.
- Read the official guidance from Ny — Use this primary source to verify the official guidance.
Table of Contents
- Who qualifies and who can refer?
- What care and support are included?
- What happens to curative treatment?
- Where can hospice be given?
- How do you start or stop hospice?
Who qualifies and who can refer?
The NYS Department of Health says eligibility turns on prognosis, not diagnosis alone. A physician must certify terminal illness with six months or less if the illness runs its normal course, as described in the hospice program page.
Anyone can start the referral. Family, friends, clergy, a nursing facility, a doctor, or a hospital can contact hospice.
- Ask your Medicaid plan, doctor, or a local hospice for a referral.
- Get physician certification of terminal illness.
- Choose a hospice willing to accept care.
What care and support are included?
The NYS Department of Health lists hospice core services as nursing and physician services, medical social services, nutrition counseling, and spiritual and bereavement counseling in its hospice coverage details. Coverage also includes aide and homemaker help, medical supplies, physical and occupational and speech therapy, and short-term inpatient care. This package fits common dementia needs. Nursing manages pain, breathing trouble, and agitation.
Aides help with bathing and bed care. Social workers and counselors support decisions and grief. Therapy and inpatient stays are short-term and symptom-focused. They do not aim to cure the terminal illness itself.
What happens to curative treatment?
Electing hospice means the patient or representative waives standard Medicaid and Medicare payment for treatment of the terminal illness and related conditions. Families can rescind that election and return to standard coverage. Children under age 21 have a special rule.
The NYS Department of Health guidance in its managed-care hospice transition rules says they stay covered for medically necessary curative services alongside palliative hospice care. For adults with dementia, this is the key trade-off. Comfort care for the terminal condition replaces disease-directed treatment for that condition. Care for unrelated problems continues.
Where can hospice be given?
New York defines four levels: routine home care, respite, continuous home care, and general inpatient care. Most days are routine home care, with higher levels used for crises or caregiver needs. If your family member lives in a nursing facility and elects hospice, New York pays the hospice a daily room-and-board amount equal to 95% of the facility rate otherwise payable, according to Cornell LII citing the state regulation in the room-and-board rule.
The hospice then coordinates comfort care with facility staff. Respite gives the regular caregiver a break. The Centers for Medicare & Medicaid Services says hospice inpatient respite allows up to 5 consecutive days in an approved inpatient facility to rest the regular caregiver.
How do you start or stop hospice?
You file an election statement with the chosen hospice. It stays in effect while the person remains in hospice care.
You can revoke at any time. Cornell LII cites state regulation 10 NYCRR 793.2 in the election and revocation rule, which requires a signed, dated statement that names the effective date. Keep a copy and tell the Medicaid plan the same day.
