cms-care-compare-hospice · CMS
cms-care-compare-hospice · CMS
cms-care-compare-hospice · CMS
The California concentration
California's share of the national hospice market is the dominant finding of this dataset: 2,155 Medicare-certified certifications in a single state, representing 31% of the U.S. total. Texas is a distant second at 1,081 — itself large by any national measure. Together, California and Texas account for 46.9% of all hospice certifications in the country.
The California figure is not a data anomaly: it reflects a documented pattern in the state's hospice market. The U.S. Department of Health & Human Services Office of Inspector General (OIG) has published multiple reports — spanning 2012 through 2024 — documenting rapid growth in small, for-profit hospice agencies, concentrated in Southern California. These agencies frequently enroll patients with longer-than-average stays, generating higher Medicare payments while the OIG has noted elevated rates of potentially avoidable hospitalizations and care quality concerns among subsets of this population. The concentration visible in this count is a supply-side artifact of that same reimbursement dynamic.
California's 83.1% for-profit rate — the highest among all states with more than 100 certifications — compounds the picture. Utah (81.2%), Louisiana (78.2%), and Georgia (75.7%) follow, all well above the 69% national average. In each of these states, the rapid growth of for-profit hospice has tracked Medicare reimbursement incentives rather than traditional geographic demand signals.
Hospice certifications by state — top 15
Sorted by total Medicare-certified hospice providers. For-profit percentage computed from CMS ownership-type classifications (excludes “Other/Not Reported” and null entries from the denominator; the column represents a floor, not a ceiling).
| State | Total | For-Profit | Non-Profit | Government | For-Profit % |
|---|---|---|---|---|---|
| California | 2,155 | 1,791 | 51 | 2 | 83.1% |
| Texas | 1,081 | 789 | 29 | 11 | 73% |
| Georgia | 259 | 196 | 24 | 1 | 75.7% |
| Arizona | 244 | 180 | 8 | 0 | 73.8% |
| Pennsylvania | 183 | 119 | 44 | 1 | 65% |
| Nevada | 179 | 96 | 2 | 0 | 53.6% |
| Michigan | 172 | 103 | 29 | 2 | 59.9% |
| Ohio | 168 | 98 | 52 | 2 | 58.3% |
| Illinois | 147 | 93 | 29 | 8 | 63.3% |
| Oklahoma | 133 | 86 | 16 | 3 | 64.7% |
| Missouri | 133 | 76 | 23 | 2 | 57.1% |
| Louisiana | 119 | 93 | 6 | 0 | 78.2% |
| Virginia | 112 | 68 | 25 | 0 | 60.7% |
| Indiana | 102 | 63 | 18 | 4 | 61.8% |
| South Carolina | 91 | 65 | 10 | 2 | 71.4% |
Source: CMS Care Compare Hospice, snapshot May 25, 2026. CMS-reported ownership classifications; “Other / Not Reported” and null entries (1,263 combined, 18.2%) are shown in full state data but excluded from the for-profit percentage denominator.
National ownership breakdown
CMS reports five discrete ownership categories for hospice providers. The for-profit and non-profit split has widened significantly over the past two decades as the hospice market grew: in 2000, approximately half of hospices were non-profit; by 2024, the ratio had essentially reversed.
| Ownership type | Count | Share |
|---|---|---|
| For-Profit | 4,790 | 69% |
| Non-Profit | 815 | 11.7% |
| Other / Not Reported | 452 | 6.5% |
| Government | 75 | 1.1% |
| Combination Gov. & Non-Profit | 28 | 0.4% |
| Unknown (null) | 783 | 11.3% |
For-profit extremes by state
The spread between the highest and lowest for-profit markets illustrates how differently this sector has developed by region. The ten states with the highest for-profit concentration are almost all Sun Belt or Mountain West markets; the lowest are concentrated in the Northeast, where non-profit and mission-driven hospice organizations established themselves early and have resisted displacement.
| State | Providers | For-Profit % |
|---|---|---|
| California | 2,155 | 83.1% |
| Utah | 85 | 81.2% |
| Louisiana | 119 | 78.2% |
| Georgia | 259 | 75.7% |
| Alabama | 85 | 75.3% |
| Arizona | 244 | 73.8% |
| Mississippi | 83 | 73.5% |
| Texas | 1,081 | 73% |
| South Carolina | 91 | 71.4% |
| Tennessee | 60 | 70% |
| State | Providers | For-Profit % |
|---|---|---|
| New York | 40 | 7.5% |
| Maryland | 26 | 19.2% |
| Kentucky | 23 | 26.1% |
| Minnesota | 84 | 28.6% |
| Connecticut | 28 | 28.6% |
| Iowa | 70 | 30% |
| New Hampshire | 23 | 30.4% |
| Hawaii | 11 | 36.4% |
| Washington | 49 | 38.8% |
| Montana | 32 | 40.6% |
The New York contrast
New York State reports 40 Medicare-certified hospice providers — one of the lowest counts among large-population states — with a for-profit rate of just 7.5%. This stands at roughly a tenth of California's 83.1%rate, despite New York having a larger population. The explanation is structural rather than demographic: New York's hospice sector developed under state certificate-of-need laws and a strong non-profit hospital system tradition, creating a supply environment where mission-driven organizations established early and dominant positions. Entry by for-profit chains has occurred at a much slower rate than in Sun Belt markets.
Maryland (19.2%) and Kentucky (26.1%) follow a similar pattern — both states with strong academic medical center and non-profit health system presence that shaped the hospice market before the for-profit expansion of the 2000s and 2010s. The for-profit-vs-non-profit distinction matters for researchers analyzing hospice access because ownership type correlates with multiple input measures: staffing mix, enrollment intensity, lengths of stay, and the proportion of patients receiving more-intensive hospice levels (continuous home care, inpatient respite). This dataset provides the geographic foundation for those analyses; it does not report outcomes.
Policy context: hospice growth and federal oversight
Medicare hospice spending reached approximately $23 billion in fiscal year 2023, making it one of the largest and fastest-growing post-acute care categories. The number of Medicare-certified hospice providers more than tripled between 2000 and today's 6,943 — a rapid expansion concentrated in for-profit ownership. That growth has been uneven: concentrated geographically (California, Texas) and by ownership type (predominantly for-profit).
The OIG has published a series of reports identifying hospice as a program-integrity risk area. Concerns include inappropriate election of hospice for patients with non-terminal conditions, billing for higher-intensity levels of care that were not delivered, and the prevalence of so-called “live discharges” — patients who disenroll from hospice after election, which some analyses have linked to enrollment practices at certain for-profit providers. CMS has responded with targeted audits and enhanced scrutiny of providers in high-growth markets.
This dataset shows the supply side: where certifications exist, and who holds them. It does not assess whether those certifications translate to appropriate access or quality care for patients needing end-of-life services. Researchers analyzing access gaps — particularly in rural markets or among specific demographic groups — should cross- reference this dataset with Medicare claims data, HQRP quality reporting, and state-level certificate-of-need information.
All 51 jurisdictions
Complete state-level data for 50 states plus the District of Columbia. Sorted by total certification count. Territories are excluded from this table; the CMS source file contains a small number of records in Puerto Rico, Guam, and the U.S. Virgin Islands that are not included in the 6,894 state-only total used for percentage calculations.
| State | Total | For-Profit | Non-Profit | Gov | Other | For-Profit % |
|---|---|---|---|---|---|---|
| California | 2,155 | 1,791 | 51 | 2 | 311 | 83.1% |
| Texas | 1,081 | 789 | 29 | 11 | 252 | 73% |
| Georgia | 259 | 196 | 24 | 1 | 38 | 75.7% |
| Arizona | 244 | 180 | 8 | 0 | 56 | 73.8% |
| Pennsylvania | 183 | 119 | 44 | 1 | 19 | 65% |
| Nevada | 179 | 96 | 2 | 0 | 81 | 53.6% |
| Michigan | 172 | 103 | 29 | 2 | 38 | 59.9% |
| Ohio | 168 | 98 | 52 | 2 | 16 | 58.3% |
| Illinois | 147 | 93 | 29 | 8 | 17 | 63.3% |
| Oklahoma | 133 | 86 | 16 | 3 | 28 | 64.7% |
| Missouri | 133 | 76 | 23 | 2 | 32 | 57.1% |
| Louisiana | 119 | 93 | 6 | 0 | 20 | 78.2% |
| Virginia | 112 | 68 | 25 | 0 | 19 | 60.7% |
| Indiana | 102 | 63 | 18 | 4 | 17 | 61.8% |
| South Carolina | 91 | 65 | 10 | 2 | 14 | 71.4% |
| Colorado | 87 | 55 | 21 | 3 | 8 | 63.2% |
| Alabama | 85 | 64 | 5 | 4 | 12 | 75.3% |
| Kansas | 85 | 48 | 9 | 7 | 21 | 56.5% |
| Utah | 85 | 69 | 6 | 0 | 10 | 81.2% |
| Minnesota | 84 | 24 | 26 | 3 | 31 | 28.6% |
| Mississippi | 83 | 61 | 4 | 7 | 11 | 73.5% |
| Wisconsin | 83 | 39 | 30 | 2 | 12 | 47% |
| Massachusetts | 77 | 44 | 22 | 0 | 11 | 57.1% |
| North Carolina | 76 | 34 | 36 | 4 | 2 | 44.7% |
| Iowa | 70 | 21 | 27 | 11 | 11 | 30% |
| Oregon | 66 | 30 | 23 | 1 | 12 | 45.5% |
| New Jersey | 61 | 39 | 18 | 0 | 4 | 63.9% |
| Tennessee | 60 | 42 | 6 | 2 | 10 | 70% |
| Florida | 58 | 25 | 23 | 0 | 10 | 43.1% |
| Idaho | 54 | 35 | 7 | 2 | 10 | 64.8% |
| New Mexico | 54 | 32 | 7 | 1 | 14 | 59.3% |
| Washington | 49 | 19 | 13 | 6 | 11 | 38.8% |
| Arkansas | 46 | 31 | 12 | 0 | 3 | 67.4% |
| Nebraska | 42 | 21 | 12 | 1 | 8 | 50% |
| New York | 40 | 3 | 27 | 2 | 8 | 7.5% |
| Montana | 32 | 13 | 14 | 1 | 4 | 40.6% |
| Connecticut | 28 | 8 | 11 | 0 | 9 | 28.6% |
| Maryland | 26 | 5 | 14 | 0 | 7 | 19.2% |
| Kentucky | 23 | 6 | 16 | 0 | 1 | 26.1% |
| New Hampshire | 23 | 7 | 7 | 0 | 9 | 30.4% |
| Wyoming | 21 | 9 | 3 | 6 | 3 | 42.9% |
| West Virginia | 18 | 8 | 9 | 0 | 1 | 44.4% |
| Maine | 17 | 8 | 3 | 0 | 6 | 47.1% |
| South Dakota | 17 | 7 | 4 | 1 | 5 | 41.2% |
| North Dakota | 13 | 6 | 6 | 0 | 1 | 46.2% |
| Rhode Island | 11 | 5 | 2 | 0 | 4 | 45.5% |
| Hawaii | 11 | 4 | 6 | 0 | 1 | 36.4% |
| Delaware | 11 | 6 | 4 | 0 | 1 | 54.5% |
| Vermont | 9 | 3 | 4 | 0 | 2 | 33.3% |
| Alaska | 6 | 3 | 1 | 1 | 1 | 50% |
| District of Columbia | 5 | 3 | 1 | 0 | 1 | 60% |
Source: U.S. Centers for Medicare & Medicaid Services, CMS Care Compare Hospice. Snapshot date: May 25, 2026. Fonteum does not rate or rank individual hospice providers.
Who this is for
Journalists investigating hospice market growth, CMS oversight, or end-of-life care access can use this state-level count as a starting point — particularly the California concentration and the for-profit dominance figures, which are defensible from federal data and have a clear news hook. The 46.9% share held by two states is quotable as a standalone finding.
Researchers and policy analysts can join this dataset to Medicare claims, HQRP quality reporting, or OIG exclusion data using the CMS Certification Number (CCN) as the shared identifier. Every state row in this study maps to a well-defined CMS data grain; the methodology version is pinned so the join is reproducible.
Patients and families evaluating hospice options can use the state-level for-profit percentages as context for the market they are navigating. High for-profit concentration does not imply poor care — it implies a market shaped more heavily by reimbursement incentives than by mission-driven organization. The right tool for assessing a specific provider is the CMS Hospice Quality Reporting Program, not this enrollment-count study.
Methodology
Source.The CMS Care Compare Hospice public dataset published by the U.S. Centers for Medicare & Medicaid Services via the CMS Provider Data Catalog. CMS declares its own publication cadence; this study uses the committed May 25, 2026 snapshot and its listed hospice certifications with CCN, facility name, address, state, CMS region, ownership type, and certification date. CMS data is U.S.-Government-Works (public domain). The snapshot used for this study was accessed on May 25, 2026 and reflects 6,943 records with 6,943 unique CCNs (zero duplicate certifications).
Ownership classification.CMS assigns one of five ownership-type categories to each hospice: For-Profit, Non-Profit, Government, Combination Government and Non-Profit, and null/not-reported. This study groups For-Profit as the primary category; all others are identified individually. The for-profit percentage per state uses a denominator of For-Profit + Non-Profit + Government only, excluding the “Other / Not Reported” and null entries (1,263 records, 18.2% of total). This produces a conservative for-profit share that represents providers with explicit classifications; the true share could be higher if unclassified providers are predominantly for-profit.
Geographic scope. This study covers 51 jurisdictions: the 50 U.S. states plus the District of Columbia. CMS territories (Puerto Rico, Guam, U.S. Virgin Islands) are present in the raw file but excluded from the main analysis because their markets operate under distinct regulatory and reimbursement frameworks. The 6,894 figure used for state percentage calculations is the 50-state + DC total.
Reproducibility. All figures in this study derive directly from the CMS Care Compare Hospice dataset via the data layer at src/lib/research/hospice-availability.ts. Methodology version hospice-availability/v1 is pinned. A newer artifact, if published, should be treated as a separately dated study rather than inferred from CMS cadence. The source dataset is available directly from CMS at CMS Care Compare — Hospice General Information.
Limitations
- Certification ≠ active operations. A Medicare certification does not guarantee that a provider is actively enrolling patients. CMS revocation data is updated separately and is not joined here. Some certifications may represent providers with low patient volumes or temporary suspensions.
- Unclassified ownership. 1,263 records (18.2%) carry an ownership classification of “Other / Not Reported” or null. These are excluded from the for-profit percentage calculation, which means the reported percentages are computed on a subset of providers rather than the full population. Treat them as a floor.
- No quality outcomes. This dataset counts certifications and classifies ownership type. It does not include patient-level quality measures, care quality ratings, CMS star ratings, HQRP quality scores, or any outcome data. For hospice quality information, consult the CMS Hospice Quality Reporting Program.
- Single snapshot. This study reflects the May 25, 2026 CMS snapshot. Certifications change as new hospices are approved and existing ones are terminated or revoked. A future quarterly snapshot may show materially different counts in high-growth markets.
- Territories excluded. Puerto Rico, Guam, and the U.S. Virgin Islands are present in the CMS source file but excluded from the state-level analysis. The 50-state-plus-DC total is 6,894; the 49 territory providers bring the full national file to 6,943. State percentages use the 6,894 denominator, so including the territories would shift some national percentages marginally.
- No facility rating. Fonteum does not rate, rank, score, or recommend any individual hospice provider. This study describes market structure at the state level using federal data.
Frequently asked questions
- How many Medicare-certified hospice providers are there in the United States?
- As of the CMS Care Compare Hospice snapshot dated May 25, 2026, the file lists 6,943 Medicare-certified hospice providers nationally. 6,894 of them operate across the 51 jurisdictions analysed here — the 50 states plus the District of Columbia — and the remaining 49 are in U.S. territories (Puerto Rico, Guam, and the U.S. Virgin Islands), which are reported in the file but excluded from the state-level analysis. Each entry carries a unique CMS Certification Number (CCN), confirming zero duplicates in this count.
- Why does California have so many hospice certifications compared to other states?
- California holds 2,155 Medicare-certified hospice certifications — 31% of the national total — with an 83% for-profit rate. The state's hospice market has been subject to ongoing federal scrutiny: CMS and the OIG have documented rapid growth in small, for-profit hospices, particularly in Southern California, driven by reimbursement incentives that reward enrollment over episode length.
- What percentage of U.S. hospice providers are for-profit?
- Nationally, 69% of Medicare-certified hospice providers are classified as for-profit in CMS data. This share rises sharply in California (83.1%), Utah (81.2%), and Louisiana (78.2%), and falls to single digits in New York (7.5%) and below 20% in Maryland (19.2%) and Kentucky (26.1%).
- Which states have the fewest Medicare-certified hospice providers?
- Alaska (6), the District of Columbia (5), Vermont (9), Hawaii (11), Delaware (11), and Rhode Island (11) report the fewest Medicare-certified hospice providers. Small state population is the primary driver; however, Alaska and Vermont also have geography-constrained provider markets that limit certification density relative to population.
- How does CMS certify and track hospice providers?
- CMS certifies hospice providers under 42 CFR Part 418 and publishes certification, ownership, location, and contact fields in Care Compare. This study uses the committed May 25, 2026 snapshot; publisher cadence does not establish a newer Fonteum load.
- Does this study rate or rank individual hospice providers?
- No. Fonteum does not rate, score, or recommend individual hospice providers. This study counts and categorizes certifications in the committed CMS snapshot by state and ownership type.
- What does the CMS Care Compare Hospice dataset cover?
- The committed 2026-05-25 Hospice General Information snapshot includes the CMS-listed CCN, facility name, address, state, ownership type, CMS region, and certification date fields. It does not include patient-level quality measures or outcomes data.
Data source
Source data is available directly from CMS. Download the full hospice provider file from the CMS Provider Data Catalog:
Source: U.S. Centers for Medicare & Medicaid Services, CMS Care Compare Hospice. Snapshot accessed May 25, 2026. CMS data is U.S.-Government-Works (public domain); this derived study is published under CC-BY-4.0.
Related
- Care Compare: Hospice — browse all 6,943 Medicare-certified hospice providers with address, ownership, and CMS region information.
- County-Level Nursing-Home RN Staffing Deserts — ranked study of the 50 U.S. counties with the lowest registered-nurse staffing in nursing homes, built on CMS Payroll-Based Journal data.
- Nursing Homes Banned from New Medicare Admissions (DPNA) — facilities barred from accepting new Medicare admissions under CMS enforcement, with state-by-state action counts.
- NPI lookup — search any U.S. provider by NPI or name and read the NPPES, PECOS, and OIG record behind it.
- OIG LEIE Sanctions — providers and entities excluded from federal healthcare programs, cross-searchable by NPI, name, and state.
Cite this study
@techreport{fonteum_2026_hospice_availability,
title = {Hospice Provider Availability by State: 6,943 Medicare-Certified Providers, 69% For-Profit},
author = {{Fonteum Research Bureau}},
institution = {Fonteum},
year = {2026},
type = {Data study},
note = {Methodology version hospice-availability/v1. Reviewed by Jennifer Montecillo, MD.},
url = {https://fonteum.com/research/hospice-provider-availability-by-state-2026}
}Fonteum Research Bureau. (2026). Hospice Provider Availability by State: 6,943 Medicare-Certified Providers, 69% For-Profit. Fonteum. Retrieved May 25, 2026, from https://fonteum.com/research/hospice-provider-availability-by-state-2026
Fonteum Research Bureau. “Hospice Provider Availability by State: 6,943 Medicare-Certified Providers, 69% For-Profit.” Fonteum, June 6, 2026. https://fonteum.com/research/hospice-provider-availability-by-state-2026.