By Tyler Long, MBA, LNHA, Executive Director of Hospice Savannah
Why the six-month prognosis requirement is often misunderstood by patients, families, and healthcare professionals.
“Six months or less.”
We’ve said it for decades. It’s how we explain who qualifies for hospice; it’s the north star of eligibility. We have convinced ourselves that if we say it enough, it will erase our compliance concerns, prevent audits, and lower our discharge rates. However, this phrase is costing more than we think, the cost is access.
The problem is that families don’t hear a clinical guideline. They hear a countdown to the last day. A deadline they aren’t ready to meet. So, they make their own call and think, “This can’t be the last birthday, the last holiday, the last time everyone’s in one room.” So, the referral waits. The patient lands back in the hospital. The caregiver handles one more crisis alone. By the time hospice shows up, we’ve lost weeks or months we could have used well.
The phrase built to keep out bad actors now also keeps out the right patients too.
To be fair, the recent hospice headlines raise a valid concern, and I understand why. Federal and state investigators are dismantling ghost hospice agencies that billed Medicare using stolen patient IDs, including a $267 million scheme in Los Angeles (Kilgore, 2026). That deserves everything they’re throwing at it. But each time we tighten the language to stop fraud, we make the front door harder to open for families who actually need us. Both things are true at once.
To reinforce this view, consider Dara Corrigan. She spent her career at CMS protecting Medicare from hospice fraud. Then she placed both of her parents in hospice within days of each other. “It was surreal being on the other side,” she said (Kilgore, 2026). The people writing the rules and the people living the rules are often looking at two completely different things. And the hospice sits in the middle, trying to protect both.
So, what do I believe? We stop leading with the countdown. The question at the door shouldn’t be “does this person have six months left?” It should be “would this person benefit from our support today?”
Same patient. Completely different starting point.
The most important question isn’t how much time someone has left. It’s whether they need us now.
What we lead with in that first conversation decides whether we’re opening the door or holding it closed.
Reference:
Kilgore, W. (2026, June 11). What a CMS fraud chief learned by caring for her parents in hospice. Well Beings. https://wellbeings.org/what-a-medicare-hospice-fraud-chief-learned/ citeturn2search37
About the Author:
Tyler Long, MBA, LNHA, is Executive Director of Hospice Savannah, the hospice organization of the Georgia Care Innovators family. He has spent his career on the operations side of hospice and palliative care, focused on getting the right care to families sooner.
