The California hospice moratorium has blocked new hospice agency licenses since January 1, 2022, and it will remain in place until January 1, 2027, or one year after the California Department of Public Health (CDPH) adopts its new emergency regulations, whichever comes first. During the freeze, CDPH cannot issue new hospice agency licenses, approve most changes of ownership, or authorize agencies to expand into new service areas.
What the Freeze Blocks
The central rule is straightforward. CDPH cannot issue a new license to operate a hospice agency. That includes applications that were already pending when the moratorium took effect on January 1, 2022. If paperwork was submitted but no license had been issued, that application was frozen along with every other one in the queue.1California Legislative Information. California Health and Safety Code 1751.70
The freeze also reaches existing licensees. CDPH cannot approve a request to add a new service location, change an agency’s geographic service area, or relocate an agency outside its currently approved area. The point is to stop existing holders from doing indirectly what the moratorium bars directly: pushing into new territory where oversight gaps allowed fraud to spread in the first place.
Renewals are a different story. If you hold a current hospice agency license in good standing, the moratorium does not affect your ability to renew it on schedule.2California Legislative Information. SB-664 Hospice Licensure: Moratorium on New Licenses
The Five-Year Ownership Transfer Rule
One fraud pattern that prompted the moratorium involved operators who obtained a license, provided little or no actual patient care, and then sold the license at a markup. The legislature closed that loophole. CDPH cannot approve a change of ownership for a hospice agency within five years of the date the license was first issued. For that five-year window, only the original licensee can use the license.3California Department of Public Health. AFL-22-28
CDPH can waive the five-year restriction in two narrow circumstances:
- The transfer is necessary to ensure existing patients continue receiving services without interruption.
- The agency can prove both genuine financial hardship and an unmet need for hospice services in its geographic service area. Both conditions must be met.
Even outside the five-year window, a hospice agency license is not freely transferable. A change of ownership goes through CDPH’s approval process in any case, and the moratorium adds an extra layer of scrutiny on top.3California Department of Public Health. AFL-22-28
Who and What Is Exempt
Hospice Facilities Are Not Covered
California law treats hospice agencies and hospice facilities as different things, and the moratorium reaches only agencies. A hospice facility is a brick-and-mortar health facility with no more than 24 beds, licensed under subdivision (n) of Health and Safety Code section 1250, that provides inpatient hospice care including routine care, continuous care, and respite care.4California Legislative Information. California Code HSC 1250 – Health Facilities A hospice agency, by contrast, delivers services primarily in patients’ homes or other community settings. The moratorium statute explicitly exempts hospice facilities from its restrictions.1California Legislative Information. California Health and Safety Code 1751.70
The Demonstrable Need Exception
An applicant who can prove unmet need for hospice services in a particular area may qualify for an exception. Under Health and Safety Code section 1751.75, CDPH can grant an exception where the applicant shows “demonstrable need” based on the concentration of existing hospice services in the proposed service area.2California Legislative Information. SB-664 Hospice Licensure: Moratorium on New Licenses
The process runs in two steps. Before submitting a full license application, the applicant sends written justification and supporting documentation to CDPH’s Centralized Applications Branch. The materials must show that the existing concentration of hospice providers in the area is insufficient to meet the population’s needs. If CDPH agrees, it notifies the applicant that they may proceed with a full application. If not, the application goes no further.5California Department of Public Health. AFL 21-53
The burden sits entirely with the applicant. CDPH weighs the request against all existing hospice services in the region, not just nearby competitors, and general assertions about underserved populations without granular geographic data tend not to clear the bar.
When the Moratorium Ends
The freeze will lift on January 1, 2027, or one year after CDPH adopts the required emergency regulations, whichever comes first.1California Legislative Information. California Health and Safety Code 1751.70 AB 177 required CDPH to adopt those regulations by January 1, 2026.6California Legislative Information. AB-177 Health
In late 2025, CDPH issued a five-day public notice for its proposed emergency regulatory action and submitted the proposed regulations to the Office of Administrative Law on December 9, 2025, targeting an effective date of January 1, 2026.7California Department of Public Health. AFL-25-32 The regulations implement recommendations from the State Auditor’s 2022 report and address staffing ratios, management qualifications, and other standards the auditor flagged as deficient.
If the regulations took effect on January 1, 2026 as proposed, the moratorium would lift one year later on January 1, 2027. That matches the statutory outer limit, so the practical end date is January 1, 2027 whether the regulations were adopted on time or shortly before. Anyone planning to apply should watch CDPH’s licensing announcements for confirmation that the regulations are in place and for any post-moratorium application procedures.
Why the Freeze Exists
California’s hospice industry grew faster than regulators could screen it, and a significant share of the new entrants turned out to be fraudulent. Federal enforcement actions revealed hospice owners billing Medicare for patients who did not qualify for end-of-life care or who never received the services claimed. The U.S. Department of Justice has prosecuted multiple California operators for false claims, enrolling patients who were not terminally ill, and paying kickbacks for referrals.
A California State Auditor report published in March 2022 found that CDPH’s licensing process did little to screen out bad actors and that rapid provider growth let fraud go undetected for years. The legislature halted new licenses while CDPH built a more rigorous framework. Each legislative extension since 2021 has reflected the same reality: lifting the freeze without the new regulations in place would reopen the door to the same problems that triggered it.
Medicare Enrollment Is a Separate Hurdle
A California license is only half the picture. Hospice providers must also enroll in Medicare to receive federal reimbursement, and that enrollment runs through the Centers for Medicare and Medicaid Services on its own enforcement track. CMS has taken a data-driven approach to fraudulent hospice providers, including unannounced site visits and revocations. Enhanced oversight in California, Arizona, Nevada, and Texas produced more than 200 Medicare enrollment revocations.8Centers for Medicare and Medicaid Services. CMS Proposes New Transparency Measures to Strengthen Oversight of Hospice Providers
As of early 2026 there is no federal moratorium on new hospice Medicare enrollments, though the National Partnership for Healthcare and Hospice Innovation has urged CMS to impose one. CMS has instead proposed a publicly available scoring system to flag providers with patterns suggesting inappropriate utilization or compliance problems, with high-scoring providers facing additional review.8Centers for Medicare and Medicaid Services. CMS Proposes New Transparency Measures to Strengthen Oversight of Hospice Providers For California applicants, this means that once the state freeze lifts, a new state license will not by itself guarantee Medicare enrollment.