"Hospice says Mom no longer qualifies": discharge from hospice, explained

Why would a hospice discharge someone?

A hospice must discharge a person who no longer meets Medicare's standard for hospice: a life expectancy of six months or less if the illness runs its usual course. Some people stabilize or improve with good comfort care, steady meals and fewer hospital trips.

The hospice doctor and team decide when a person no longer meets that standard. The everyday word is "graduating", and it can feel like good news and like being abandoned at the same time.

Federal rules allow a hospice to discharge a patient for only three reasons (42 CFR 418.26):

How is the decision made?

The hospice team reviews the person's condition at least every 15 days, and before each new benefit period the doctor decides whether to certify again. A discharge needs a written order from the hospice medical director, a physician designee, or a physician member of the hospice team (42 CFR 418.26(b), as amended from October 1, 2026). If the person has their own attending doctor, the hospice should consult that doctor first.

The hospice must also plan for a discharge before it happens, including family counseling, teaching and arranging other services (42 CFR 418.26(d)). At Beta Hospice the team reviews the case together, the medical director writes the order after talking with the attending doctor, and the social worker writes the discharge plan with the family.

Your notice and your right to a fast appeal

These are the Medicare rules for a discharge you disagree with. Act quickly: the deadline is noon on the day after you get the notice.

1. Step 1

   You get written notice

   Before Medicare-covered hospice care ends, the hospice must give you a standard form called the Notice of Medicare Non-Coverage, at least 2 calendar days before the last covered day (42 CFR 405.1200). It shows the date coverage ends and how to appeal. Signing it means you received it, not that you agree.

2. Step 2

   Call the quality organization

   If you disagree, call the Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) by noon of the day after you receive the notice. For California it is Commence Health (formerly Livanta), 1-877-588-1123. The number is also printed on the notice. You can ask by phone or in writing (42 CFR 405.1202).

3. Step 3

   The hospice explains in detail

   Once the QIO calls the hospice, the hospice must give you a detailed written explanation by the end of that day: why it believes hospice care is no longer covered, and the rules it relied on. The hospice has to prove its case. You can add your own information, such as notes on weight loss, falls or new symptoms.

4. Step 4

   The QIO decides

   The QIO, which is independent of the hospice, reviews the records and asks for your views and the hospice's. The QIO must tell you its decision no later than 72 hours after your request. Hospice coverage continues until the date on the notice while the review is under way. If the QIO agrees with you, hospice care continues.

5. Step 5

   If you lose, you can ask again

   The QIO's decision letter explains how to ask for a reconsideration and the deadline. If you missed the noon deadline, the QIO still reviews the case as soon as it can, but without the protection from paying for care after the end date.

What happens to equipment and medicines?

On the discharge date, hospice coverage ends and regular Medicare coverage starts again (42 CFR 418.26(c)). The hospice picks up the equipment it provided, such as the hospital bed, oxygen and wheelchair, and the hospice stops supplying medicines.

Ask for the discharge plan in writing before that day. It should say who will manage symptoms, which prescriptions go to the person's own doctor, and how equipment the person still needs will be replaced.

Medicare Part B covers medically necessary equipment such as a hospital bed or home oxygen when a doctor orders it, usually with 20% coinsurance after the Part B deductible. Medicines go back to the Part D plan or other drug coverage. Make sure the new prescriptions are filled before the comfort kit is removed.

Questions to ask before the discharge date

• What changed, in the hospice doctor's view, and what would make the person eligible again?
• Has the hospice talked with the person's own doctor, and who takes over symptom care?
• Which medicines continue, who writes the new prescriptions, and when do they need to be filled?
• When will the equipment be picked up, and has the doctor ordered replacements we still need?
• Can the social worker help arrange palliative care, home health or help at home?
• Who do we call if things get worse?

Can you go back on hospice later?

Yes. A discharge does not count against a later election. If the illness progresses, the person can be referred again, and if a doctor certifies once more that life expectancy is six months or less, they can elect hospice again at any time (42 CFR 418.26(c)(3)). The next benefit period begins, not the first one again. Read how long Medicare pays for hospice.

Call the person's doctor, or a hospice, if you see new weight loss, more time in bed, more falls, new trouble eating or swallowing, more hospital visits, or symptoms that are harder to control. You can ask for a new hospice evaluation yourself, from Beta Hospice at (877) 258-7129 or from any other hospice that serves your area. Read is it time for hospice?.

What care is there in the meantime?

Palliative care gives specialist help with symptoms and stress at any stage, without a six-month prognosis, and treatment can continue alongside it. Read palliative care.

Home health can send nurses and therapists for a time if the person is homebound and needs skilled care. Read hospice or home health?.

Help at home through In-Home Supportive Services, for people with Medi-Cal, does not depend on hospice and can continue. Read IHSS and hospice.

Common questions about hospice discharge

Related guides

For clinicians and facility staff: discharge, revocation and transfer rules. For families: your rights as a hospice patient, switching hospice providers and caring for someone on hospice at home.