All Wyoming hospices, whether they have been affected by the cap or not, want every Wyoming resident with a terminal illness to be able to access hospice care.

And they want them to receive the care as early as possible.

Connor said the programs and resources available help patients meet end-of-life goals and teach families how to transition after losing someone. If a person is at the hospice for only four days, then the hospice can't offer much help.

"The most important piece of hospice is about quality at the end of life," Connor said. "Not death."

Harbron said she believes the length-of-stay piece is OK, but the hospice benefit as a whole needs to be looked at by the government.

"The government needs to re-evaluate the cost and demand," Harbron said. "They need to re-evaluate what it costs to provide hospice."

Armstrong said she believes the cap will be addressed, but it's probably going to take two to three years for policymakers to pass legislation. She and others at the National Alliance for Hospice Access want "a time out for future collections on caps" until the government does something.

Larsen said he understands the need to have checks and balances so people don't abuse the hospice system, but the government needs to lengthen the cap or make it diagnosis-specific.

Even though his hospice closed its doors, it still has to pay the money back. Larsen said he has already returned $30,000.

He said he didn't have to file for bankruptcy. He just couldn't continue to pay salaries and administrative costs while paying the money back to the federal government.

He keeps his Wyoming license active in case he is ever able to return to the state.

"It's embarrassing," Larsen said. "We don't want to go out."

Some 400 hospices in 31 states are expected to receive letters in coming months asking them to repay $300 million in Medicare funds they received for hospice services provided in 2006, according to National Alliance for Hospice Access, a nonprofit coalition of independent hospices.