California’s hospice moratorium blocks the California Department of Public Health from issuing new hospice agency licenses, approving most changes of ownership, and authorizing geographic expansions. It took effect on January 1, 2022, and runs through January 1, 2027, unless CDPH adopts strengthened emergency regulations that would lift it one year after their effective date.1California Legislative Information. California Health and Safety Code 1751.70
What the Moratorium Blocks
The central prohibition is on new licenses. CDPH cannot issue one to any new applicant, and applications that were already pending on January 1, 2022 were frozen along with the rest.1California Legislative Information. California Health and Safety Code 1751.70
The freeze reaches further than that. Existing licensees also cannot get CDPH approval to add a new service location, change their geographic service area, or relocate outside their currently approved area. These restrictions prevent current agencies from using expansion applications as a workaround.
License renewals sit outside the moratorium. If you hold a current hospice agency license in good standing, you can renew 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 obtaining a license, providing little or no patient care, and then flipping it at a markup. In response, CDPH cannot approve a change of ownership within five years of the date the license was first issued. During that window, only the original licensee can operate under it.3California Department of Public Health. AFL-22-28
Two waivers are possible inside that five-year window:
- Continuity of care. The transfer is necessary so existing patients continue receiving services without interruption.
- Financial hardship plus unmet need. The agency proves genuine financial hardship, and there is an unmet need for hospice services in its service area. Both conditions must be shown.
A hospice agency license is not freely transferable in any case. Every change of ownership goes through CDPH’s approval process, and during the moratorium the five-year rule adds another layer on top.3California Department of Public Health. AFL-22-28
Who and What Is Exempt
Hospice Facilities Are Not Covered
California law separates hospice agencies from hospice facilities, and only agencies fall under the moratorium. 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, providing inpatient routine care, continuous care, and respite care.4California Legislative Information. California Code HSC 1250 – Health Facilities A hospice agency, by contrast, primarily delivers services in patients’ homes or other community settings. The moratorium statute explicitly exempts hospice facilities.1California Legislative Information. California Health and Safety Code 1751.70
The Demonstrable Need Exception
An applicant can seek an exception by proving unmet need in a specific area. Under Health and Safety Code section 1751.75, CDPH may grant one if the applicant demonstrates 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 is front-loaded. Before submitting a full license application, the applicant sends a written justification with supporting documentation to CDPH’s Centralized Applications Branch. The documentation must show that the existing concentration of providers cannot meet the population’s needs. If CDPH agrees, it notifies the applicant that they may proceed with a full application. If it does not, the application goes no further.5California Department of Public Health. AFL 21-53
The burden sits entirely with the applicant. CDPH weighs the submission against all existing hospice services in the region, not just direct competitors. General claims about underserved populations, without granular geographic data, will not carry the request.
When the Moratorium Ends
The moratorium expires on January 1, 2027, or one year after CDPH adopts the required emergency regulations, whichever is earlier.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
CDPH moved on that deadline. In late 2025, the department 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 a January 1, 2026 effective date.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 identified as deficient.
If the emergency regulations took effect on January 1, 2026 as proposed, the moratorium lifts on January 1, 2027. That is also the statutory outer limit, so January 1, 2027 is the practical end date. Anyone planning to apply should watch CDPH’s licensing announcements for confirmation of the regulations’ adoption and the post-moratorium application procedures.
Why California Imposed the Freeze
The moratorium responded to rapid growth that outpaced oversight. Federal enforcement revealed that some California hospice owners were billing Medicare for patients who did not qualify for end-of-life care or who never received the services claimed. The Department of Justice has prosecuted multiple operators in the state for false claims, enrolling patients who were not terminally ill, and paying kickbacks for referrals.
A California State Auditor report published in March 2022 confirmed that CDPH lacked the tools and staffing to screen applicants effectively. The audit found that the licensing process did little to weed out bad actors and that provider growth had created a system where fraud could go undetected for years. The legislature halted new licenses entirely while CDPH built a more rigorous framework.
Medicare Enrollment Is a Separate Track
The California moratorium governs state licensing. Hospice providers also need to enroll in Medicare to receive federal reimbursement, and that enrollment sits with the Centers for Medicare and Medicaid Services. CMS has taken a data-driven approach to fraudulent providers, including unannounced site visits and enrollment 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
There is no federal moratorium on new hospice Medicare enrollments as of early 2026. Even after California’s state freeze lifts, a new state license does not guarantee Medicare enrollment, and CMS has revoked enrollment from providers that do not meet its standards.