Advocating for Patients' Access to Hospice Care


As an aging population increases the demand for healthcare services, the Missouri Hospice & Palliative Care Association used data to ensure state residents will have access to hospice benefits in the future.

The Challenge

According to the U.S. Department of Health and Human Services, 64.5 million Americans were covered by Medicaid in 2019. State-administered Medicaid programs ensure that vulnerable populations, including elderly, disabled and low-income adults, have access to healthcare services. However, many states are eager to reassess spending on Medicaid to improve overall state budgets, with hospice benefits being a primary target. Alabama, Illinois, Louisiana, Missouri, North Carolina, South Carolina and Washington have each considered reducing or eliminating hospice benefits within their Medicaid programs.

This reassessment comes at a bad time—the demand for senior healthcare services is anticipated to grow by 75 percent in the next decade due to the aging population of baby boomers. Hospice, in particular, is an essential service for individuals and families who face the daunting need for end-of-life services. Without access to hospice, Medicaid participants tally high medical bills for the state, and ultimately receive a lower quality of care. To preserve access to this critical service, the Missouri Hospice & Palliative Care Association undertook a first-of-its-kind study to demonstrate the cost implications associated with hospice and end-of-life services.


The Approach

Partnerships were key. MHPCA worked with the Missouri Department of Social Services to receive approval for the study and access necessary Missouri Medicaid data for 2011 and 2012. MHPCA engaged national experts Dr. Donald H. Taylor, Jr., Associate Professor of Public Policy, Duke University, and Dr. Cordt T. Kassner, Principal, Hospice Analytics, to support high-level conversations with the state. The study replicated similar methods used in the 2007 Hospice Cost Savings Study by Dr. Taylor from his work at Duke University.

The process was also outcome-driven. MHPCA set specific goals for the study, including a clear financial understanding of the benefits and costs associated with maintaining hospice as part of Missouri’s Medicaid package.

The first phase of the research referenced data from the 2011 Missouri Medicaid program. The study evaluated data by service provider, including general hospitals, nursing homes, hospice facilities, rural health clinics and home health agencies as the primary providers for Medicaid services in the state. The major finding: Patients who received hospice care as an end-of-life service instead of hospital care cost the state 42 percent less. When MHCPA completed the analysis of the 2012 Missouri Medicaid data, they found that hospice saved the state 41 percent compared to hospital care that year. The study further determined that making hospice care available as early as possible to patients with advanced, life-limiting illnesses and disabilities resulted in additional cost savings of 40 percent to Missouri’s Medicaid program.


The Missouri Hospice & Palliative Care Association was able to demonstrate to state legislators in Missouri that keeping hospice services available for Medicaid receipients resulted in cost savings to the state program. This research convinced Missouri state legislators to reconsider their planned budget cuts and maintain hospice services through the state’s program.

MHPCA released the findings to national hospices to assist in the support of advocating for Medicaid Hospice Benefits in states across the nation. Louisiana and Oklahoma have referenced this research to inform budget conversations on Medicaid Hospice Benefits with state legislators.

In 2014, the Missouri Society of Association Executives awarded MHPCA an Award of Excellent in Association Management for External Affairs.


According to the Missouri Hospice & Palliative Care Association, “Hospice is considered to be the model for quality, compassionate care for people facing life-limiting illness or injury” that provides “a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient’s needs and wishes.” Hospice expands access to services patients typically cannot receive through the traditional healthcare model. Though many assume hospices only serve the elderly; in reality people of all ages benefit from hospice care.

For many lawmakers, the benefits patients received from hospice care weren’t enough to earn their supportl—the economic and fiscal benefits needed to be clear as well. Through this research, MHPCA and their partners were able to empirically prove these benefits. Due to MHPCA’s research and and advocacy, Missouri State Medicaid continued to provide access to hospice care, thus improving the quality of life for patients who are approaching death.

“This study is the primary reason the Medicaid Hospice Benefit has been preserved in Missouri since 2015—providing valuable end-of-life care services to Missouri Medicaid recipients for several years.” —Dr. Cordt T. Kassner, Principal, Hospice Analytics

“There’s evidence that people live longer on hospice than without. Sometimes people go off to hospice with complex terminal illnesses, but they’ve had poor healthcare up until that point. In hospice, they get multidisciplinary attention and start receiving all the things that have been missing in their healthcare, and actually improve.” —Jane Moore, CEO Missouri Hospice & Palliative Care Organization


MedPAC Report to Congress, Medicare Payment Policy, March 2019,

The Missouri Hospice Medicaid Project, “Trending Report”, 2013
Population Reference Bureau, “Aging Baby Boomers to Face Caregiving, Obesity, Inequality Challenges,” January 13, 2016,