For over three decades Hospice has been challenging the way the health care system views end of life care. In 1986 Congress passed the Consolidated Omnibus Budget Reconciliation Act (P.L. 99-272) which included provisions that made Hospice a permanent benefit under Medicare and gave states the option to include Hospice as a benefit under Medicaid.  Thirty years later, Hospice continues to warrant changes regarding issues of access, societal awareness, and acceptance.