The Medicare Hospice Benefit (MHB) has been transformed. The new MHB has incorporated consideration of economics, ethics, legislation, and social views. Traditional goals of hospice are to provide comfort care, rather than curative care. While hospice concentrates on patients and families, it must also follow the Federal and State regulations that apply to hospice providers. Since 1983 goals of hospice remained essentially the same. However, in 2008 the goals of hospice were amplified by new legislation. With no instruction from the Centers for Medicare and Medicaid Services (CMS) on how to accomplish the mandated innovative goals, hospice administrators have been left on their own to figure out how to successfully comply. This situation has resulted in an administrative challenge. In this qualitative multiple case study, the perceptions of 10 Kansas hospice administrators were explored regarding leadership, goal-setting, and the new hospice paradigm. The qualitative research design included data collection via open-ended, in-depth interviews utilizing a series of eight semistructured interview questions. The study employed Locke and Latham's (2002) goal-setting theory. Findings that emerged from this study revealed how hospice administrators viewed creating, developing, and adapting their programs' goals to the new MHB. Six subthemes also surfaced representing how the hospice administrators' viewed the new hospice paradigm as: (a) the effect upon patients and families, (b) effect upon the hospice programs, (c) influences on the hospice administrators, (d) effect on leadership, (e) the financial burdens, and (f) the MHB being viewed as either punishing or encouraging. This qualitative study addresses a gap in the current literature and adds to the understanding of hospice administrators' leadership and goal-setting theory.