Medicaid does not cover palliative care as a standalone federal benefit. Unlike hospice, which is a defined optional benefit states can add to their Medicaid plans, palliative care lacks its own billing category in most states. That said, many of the services that make up palliative care, such as pain management, counseling, and care coordination, can be covered under other Medicaid benefits. And a growing number of states are building dedicated palliative care programs into their Medicaid systems.
Why Palliative Care Falls Through the Gaps
The core issue is structural. Medicaid’s hospice benefit is well defined: it covers nursing, counseling, medical social services, physician visits, therapy, home health aides, and medical supplies for people who are terminally ill. But to qualify, a physician must certify that the patient has a life expectancy of six months or less, and the patient traditionally agrees to stop curative treatment for their terminal condition.
Palliative care is different. It focuses on managing pain, symptoms, and quality of life for anyone with a serious illness, whether terminal or not. You can receive palliative care while still pursuing treatment to cure or slow your disease. That flexibility is exactly what makes it valuable, but it also means palliative care doesn’t fit neatly into the hospice box that Medicaid already recognizes. The Urban Institute has identified this lack of explicit Medicaid coverage for palliative care as a major funding problem.
In practice, individual members of a palliative care team (physicians, for example) can often bill Medicaid for their services under existing codes. But other team members, like social workers or chaplains, frequently cannot. And key palliative care activities like care coordination often happen outside of a face-to-face visit, making them difficult to bill under traditional Medicaid rules.
What Medicaid Will Cover Right Now
Even without a dedicated palliative care benefit, Medicaid can pay for many of the same services under different labels. If you’re enrolled in Medicaid and living with a serious illness, your coverage likely includes doctor visits for symptom and pain management, mental health counseling, physical and occupational therapy, home health services, and medical supplies. These are all core components of palliative care. The key difference is that they’re billed individually rather than as part of a coordinated palliative care program.
The practical effect: you may receive palliative-style care, but it can feel fragmented. There’s no single team overseeing your comfort, emotional needs, and treatment goals unless your state or managed care plan has set up a specific palliative care program.
States Building Their Own Programs
A handful of states have moved ahead on their own, creating Medicaid palliative care benefits through legislation, state plan amendments, or managed care requirements. The landscape is changing quickly.
Hawaii became the first state in the country to receive federal approval for a state plan amendment covering community-based palliative care, with CMS approving it in 2024. As of April 2025, the state released guidance for health plans to begin comprehensively covering these services for Medicaid enrollees with serious illnesses.
California requires all Medi-Cal managed care plans to offer palliative care programs. Starting in January 2024, the state extended this requirement to Medicare dual eligible special needs plans as well. California also covers palliative care for children as a screening and treatment service, and has been doing so since 2008.
Maine is legislatively mandated to reimburse palliative care through its Medicaid program, MaineCare. New Jersey passed legislation in 2023 to cover community-based palliative care under Medicaid and is exploring a state plan amendment similar to Hawaii’s. Ohio added community-based palliative care as a required service in its MyCare Ohio program for people enrolled in both Medicare and Medicaid. New York included a proposal to expand Medicaid palliative care access in its Master Plan for Aging. Texas has recommended pursuing a palliative care Medicaid benefit based on actuarial analysis. And Washington currently pays for pediatric palliative care through Medicaid and has been mandated to design a broader palliative care benefit for health plans.
If your state isn’t on this list, that doesn’t mean you have zero access. It means your path to coverage is less direct, and you’ll likely need to work with your provider to bill palliative services under existing Medicaid categories.
Special Rules for Children
Children on Medicaid have a significant advantage when it comes to palliative care access. Section 2302 of the Affordable Care Act requires all state Medicaid plans to allow children under 21 to receive hospice care and curative treatment at the same time. This “concurrent care” rule went into effect immediately when the ACA was signed.
This matters because it removes the biggest barrier adults face: the traditional requirement to give up curative treatment in order to receive hospice and its palliative services. A child with cancer, for example, can continue chemotherapy while also receiving the full range of hospice services, including pain management, counseling, and home health support. Several states, including California, Washington, and Massachusetts, have built additional pediatric palliative care programs on top of this federal requirement. Massachusetts operates a Pediatric Palliative Care Network through its Department of Public Health, contracting with community organizations within licensed hospice agencies to deliver care to children at no cost to the family when their health plan doesn’t cover it.
Managed Care Plans May Offer More
If you’re enrolled in a Medicaid managed care plan rather than traditional fee-for-service Medicaid, you may have better access to palliative care. Managed care organizations have more flexibility to design benefits and pay for services like care coordination that don’t fit into standard billing. California’s approach of requiring palliative care programs within its managed care plans is the clearest example, but other states are following suit through similar managed care contracts.
It’s worth calling your plan directly and asking whether they cover palliative care services or have a palliative care program. Some plans offer these benefits even when the state hasn’t formally mandated them, because coordinated palliative care tends to reduce emergency visits and hospitalizations.
How to Access Palliative Care on Medicaid
Your starting point is a conversation with your doctor. Ask for a referral to a palliative care specialist or team. Many hospitals have palliative care consultants on staff, and community-based palliative care programs are expanding in several states. Your doctor can bill Medicaid for palliative consultations and symptom management visits even if your state doesn’t have a formal palliative care benefit.
If you’re told palliative care isn’t covered, ask specifically which services you need. Pain management visits, mental health counseling, home health aide services, and therapy are all individually billable under Medicaid in most states. The label “palliative care” may not appear on your benefits, but the component services often do. Contact your state Medicaid agency to confirm what’s available in your area, since benefits vary significantly from state to state.