The best states to open a hospice, judged by what Medicaid pays for routine home care, are New York, Massachusetts and Maine. New York ranks 1st of the 21 states compared at $317.60 a day, 70.1% above the national median of $186.66. Massachusetts ranks 2nd at $231.13 a day and Maine 3rd at $223.84.
Hospice rates are unusually tight. Outside New York at the top and Arkansas at the bottom, every ranked state pays between 6.8% below and 23.8% above the national median for a routine home care day, so the choice of state turns less on the rate and more on staffing, managed-care rules and local competition. This guide ranks states on the daily rate, explains how plans in each state treat it, and points to the other hospice services worth comparing. Reimbursement is one input to a location decision; licensing, staffing, payer mix and competition need local research.
The table ranks the ten states that pay the most for a day of hospice routine home care. We do not show a margin for hospice: a daily rate pays for a whole team of nurses, aides, social workers and chaplains, so no single wage comparison fits. The last column shows how far each rate sits above the national median.
| State | Daily rate | Rank | Above national median |
|---|---|---|---|
| New York | $317.60 | 1 of 21 | 70.1% |
| Massachusetts | $231.13 | 2 of 21 | 23.8% |
| Maine | $223.84 | 3 of 21 | 19.9% |
| Rhode Island | $222.38 | 4 of 21 | 19.1% |
| New Jersey | $219.21 | 5 of 21 | 17.4% |
| Oregon | $215.11 | 6 of 21 | 15.2% |
| Kansas | $202.68 | 7 of 21 | 8.6% |
| Wisconsin | $192.39 | 8 of 21 | 3.1% |
| Arizona | $190.02 | 9 of 21 | 1.8% |
| Iowa | $187.01 | 10 of 21 | 0.2% |
The pattern is clear: one state well ahead, a cluster of northeastern states and Oregon between 15% and 24% above the median, then a long run of states within a few percent of it.
New York Medicaid pays $317.60 a day for hospice routine home care. That ranks 1st of the 21 states compared and is 70.1% above the national median.
The gap to the rest is large. Massachusetts, in 2nd place, pays $231.13, so New York's advantage on each patient day is substantial. For a hospice with a steady census, that difference compounds across every day of care.
The caveat is managed care. In New York, plans negotiate their own hospice rates, and the published rate applies out of network. If many of your patients are enrolled in plans, what you are paid depends on your contracts. Use the published rate as the anchor in negotiation, and ask plans early what they pay.
Research the state's requirements for opening a hospice, how many hospices already serve your target area, and how hard it is to recruit hospice nurses and aides locally before treating the rate as the reason to choose New York.
See every hospice rate on the New York hospice Medicaid rates page.
Massachusetts pays $231.13 a day for routine home care, ranking 2nd of the 21 states compared and 23.8% above the national median.
Massachusetts leads the cluster of states behind New York, though only narrowly: Maine, Rhode Island and New Jersey all pay within a few dollars a day. That makes Massachusetts a strong state on rate, but not one where the rate alone should decide the choice among its neighbors.
Plans in Massachusetts negotiate their own rates, and the published rate applies out of network. As in New York, contract terms will matter for any patients enrolled in plans. Research licensing, the existing hospice market in your area, and nurse staffing before committing. Compare the other levels of hospice care on the state page as well, since a hospice rarely bills routine home care alone.
See the Massachusetts hospice rates page.
Maine pays $223.84 a day for routine home care, ranking 3rd of the 21 states compared and 19.9% above the national median.
Maine sits just behind Massachusetts and just ahead of Rhode Island. Its position in the top three rests on the routine home care day itself.
We have no managed-care rule on file for hospice in Maine, so ask the state how hospice claims are paid before budgeting on the fee schedule. The local questions are distance and staffing: how far your team would travel between patients, and whether you can recruit enough nurses and aides to cover your area. A hospice team spends much of its day on the road in any spread-out service area, and that time is paid but not separately billed.
Details are on the Maine hospice Medicaid rates page.
Rhode Island pays $222.38 a day for routine home care, ranking 4th of the 21 states compared and 19.1% above the national median, just behind Maine.
Plans in Rhode Island negotiate their own hospice rates, and the published rate applies out of network. That makes Rhode Island's published figure a strong negotiating anchor but not a guaranteed rate for patients enrolled in plans.
For a new hospice, research the state's requirements for opening, the number of existing providers, and how readily you can hire hospice-trained staff. In a small market, a handful of established hospices can hold most referral relationships, so find out where your referrals would come from before you rely on the rate.
See the Rhode Island hospice rates.
New Jersey pays $219.21 a day for routine home care, ranking 5th of the 21 states compared and 17.4% above the national median.
New Jersey rounds out the group of states within a few dollars of Massachusetts. On the routine home care rate alone, there is little to separate it from Maine or Rhode Island; the decision among them rests on local factors.
We have no managed-care rule on file for hospice in New Jersey, so ask the state how hospice claims are paid. As with any location, research the state's requirements for a new hospice, the competitive landscape in your area, and staffing. Compare the higher levels of care on the state page too, since they can change the overall picture for a hospice that offers them.
Read more on New Jersey hospice Medicaid rates.
Oregon pays $215.11 a day for routine home care, ranking 6th of the 21 states compared and 15.2% above the national median.
Oregon is the only state outside the Northeast in the top six. Its rate sits a few dollars below New Jersey's and well above the next state, Kansas, at $202.68.
Plans in Oregon negotiate their own rates, and the published rate applies out of network. For a hospice whose patients are largely enrolled in plans, the contract rate will matter more than the published figure. Research local referral sources, inpatient bed access for patients who need a higher level of care, and the state's requirements for opening a hospice.
See the Oregon hospice rates page.
Arkansas sits far below every other state. It pays $80.36 a day for routine home care, ranking 21st of the 21 states compared and 56.9% below the national median.
The other lowest-ranked states sit much closer to the median. South Carolina pays $173.92 a day, 6.8% below it, and pays hospice directly, outside managed care. Missouri pays $178.98, Wyoming $180.08, Michigan $180.60 and Idaho $181.75, all within a few percent of the national figure.
That means, outside Arkansas, a lower rank in hospice costs relatively little per day. A state ranked 18th may still be a sound choice if staffing, competition and payer mix work in your favor.
States are ordered by their Medicaid rate for a day of hospice routine home care, ranked among the 21 states compared.
We do not calculate a wage-based margin for hospice. A daily rate pays for a team, and there is no single occupation whose wage fairly represents the cost of a hospice day. The gap to the national median is the cleanest way to compare states on a like-for-like basis.
Every rate is compiled from official state Medicaid publications, and each one on the site links to its source document. See the methodology for how services and units are matched.
A high daily rate tells you what Medicaid pays for each day a patient is in your care at the routine level. It does not tell you how many days you will bill, or how many of your patients will be covered by Medicaid rather than other payers.
Hospice economics depend on things the rate leaves out:
- how long patients stay in your care, which shapes both revenue and cost;
- your mix of routine, continuous, respite and inpatient days;
- whether you can staff nurses, aides, social workers and chaplains at local wages;
- referral relationships and the number of hospices already competing for them.
Licensing and any approval required to open a hospice vary by state; research them first. Then use the rate ranking to compare the states that remain on your list.
Hospice in the top 12 states shows three managed-care patterns:
- Plans must pay at least the published rate (Kansas, Iowa): the published daily rate is a floor.
- Plans negotiate; the published rate applies out of network (New York, Massachusetts, Rhode Island, Oregon, Wisconsin, Arizona): your contract decides your rate.
- Paid directly by the state, outside managed care (Georgia, and South Carolina among the lower-ranked states): you collect the published rate.
Maine, New Jersey and South Dakota have no rule on file for hospice. In New York in particular, a high published rate is only as good as the contracts you can secure with plans. Kansas is the strongest state in the top 10 where the published rate is also a guaranteed floor in plan contracts, at $202.68 a day.
Routine home care is the headline rate, but the other levels of care can change the picture. National medians:
- Continuous home care (hourly): $66.11 an hour.
- Inpatient respite (daily): $530.15 a day.
- General inpatient care (daily): $1,157.99 a day.
A hospice that offers inpatient care or crisis care at home should compare these lines state by state on the state pages, alongside the routine home care rank.
Start with the hospice Medicaid rates by state hub to compare every level of hospice care. Then review the state pages for your shortlist, such as New York, Massachusetts, New Jersey and Oregon, to see each rate with its source.
For full access while you build a budget, see pricing. The methodology page explains how rates are compared.