How to start a hospice in California

California requires a Hospice agency license (Health and Safety Code ch. 8.5); separate hospice facility license for inpatient hospice facilities from California Department of Public Health, Center for Health Care Quality, Centralized Applications Branch (CAB) to operate a hospice.

License required

Yes

License

Hospice agency license (Health and Safety Code ch. 8.5); separate hospice facility license for inpatient hospice facilities

Issuing agency

California Department of Public Health, Center for Health Care Quality, Centralized Applications Branch (CAB)

Moratorium or freeze

Health and Safety Code §1751.70 (SB 664, extended by AB 177) bars CDPH from issuing new hospice agency licenses. Per CDPH AFL 25-04 the moratorium runs until January 1, 2027, or one year after the emergency regulations are adopted. It also covers new multiple locations and service-area changes, but not renewals, changes of ownership, or moves within the approved service area. CDPH adopted the hospice emergency regulations effective June 22, 2026.

Medicare oversight

CMS places hospices in this state that newly enroll in Medicare, reactivate, or change ownership into a Provisional Period of Enhanced Oversight (medical review such as prepayment review). It began 2023-07-13 for California.

Medicare certification

Medicare certification is separate from the state license (state survey or CMS-approved accreditor). CMS imposed a nationwide 6-month moratorium on new Medicare hospice enrollments (including new practice locations) effective 2026-05-13, extendable in 6-month increments; applications received by the Medicare contractor before that date are still processed, accreditation cannot be used for deemed-status entry during the moratorium, and a hospice undergoing a non-exempt ownership change within 36 months of enrollment must re-enroll as new and is therefore blocked. The federal notice leaves Medicaid/CHIP hospice moratoria to each state.

Regulation

Cal. Health & Safety Code §§1745 et seq., 1751.70, 1753.1; 22 CCR Division 5, Chapter 6.5, Articles 1-5 (emergency regulations eff. 2026-06-22)

1. Check whether the moratorium on new hospice agency licenses applies (it covers new licenses, multiple locations, service-area changes and moves outside the approved service area)
2. If allowed, apply to CDPH CHCQ Centralized Applications Branch (changes use the HS 200 Licensure and Certification application)
3. Document the geographic service area (GSA) calculation — a licensed nurse must be able to arrive in person within two hours — and show unmet need for each county
4. Meet the management-personnel and exclusive commercial office-space requirements of the 2026 emergency regulations
5. Do not start, advertise or serve a GSA until CDPH approves it in writing

Staffing

• Administrator: bachelor's or higher in a health-related field and 2 years full-time supervisory/managerial experience (hospice, HHA, primary care clinic or health facility) within the last 5 years; no discipline in 7 years; designee required
• Director of Patient Care Services: RN with a health-related bachelor's + 2 years hospice/HHA supervisory experience, or RN with 4 years such experience, within the last 5 years
• Medical Director: California-licensed physician with 2 years supervisory/managerial hospice, HHA or palliative experience within the last 5 years; limits on serving multiple hospices
• Licensed nurse available in person 24/7 within two hours of a reported need

Program

Medi-Cal

Enrollment portal

Provider Application and Validation for Enrollment (PAVE)

Fiscal agent

California MMIS Fiscal Intermediary (claims/billing); fee-for-service enrollment itself is done by the DHCS Provider Enrollment Division (PED)

Application fee

DHCS charges $750 for applicable applications submitted in calendar year 2026, paid by EFT inside PAVE (or cashier's check for paper applications). DHCS exempts individual practitioners and physician and non-physician practitioner groups. Federal rule (42 CFR 455.460): the state must collect the CMS application fee from institutional providers that are newly enrolling or re-enrolling; individual physicians and non-physician practitioners are exempt, as are providers already enrolled in (or that already paid the fee to) Medicare or another state's Medicaid/CHIP. CMS set the fee at $750 for calendar year 2026.

Fingerprinting

Federal rule (42 CFR 455.434, 455.450(c)): providers the state places in the 'high' categorical risk level, and anyone owning 5% or more of such a provider, must submit fingerprints for a criminal background check.

Site visit

For managed care network providers that a plan screens itself, DHCS requires the plan to repeat post-enrollment site visits at least every five years for moderate-risk and every three years for high-risk providers (APL 22-013). Federal rule (42 CFR 455.432, 455.450(b)-(c)): the state must do site visits before and after enrollment for providers in the 'moderate' or 'high' risk levels, and any enrolled provider must allow unannounced on-site inspections.

Revalidation

Revalidation requests come through PAVE. In June 2026 DHCS told CMS it would run a risk-based two-year campaign to revalidate high-risk providers early, beyond the federal schedule. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full California Medicaid enrollment guide →

CON program

No

California certificate of need details →

State minimum wage

$16.90 an hour

Effective

2026-01-01

Scheduled increases

Rises to $17.40 on 2027-01-01 (annual CPI adjustment).

Direct-care wage floor

SB 525 health care worker minimum wage covers licensed home health agencies (and skilled nursing facilities owned or controlled by a hospital or integrated system); independent SNFs, residential care and congregate living health facilities are not covered. Rates are tiered by facility type; for the residual 'all other covered health care facilities' tier the minimum is $23.00/hour from 2026-07-01, rising to $25.00 on 2028-07-01.

HCBS 80/20 rule

Federal baseline: 42 CFR 441.302(k) requires the state to show that each provider spends at least 80% of Medicaid payments for homemaker, home health aide and personal care services under 1915(c) waivers on direct care worker pay and benefits. Compliance starts 2030-07-09 (for managed care, the first rating period starting on or after that date); annual payment-adequacy reporting under 441.311(e) starts 2028-07-09. A state may set a lower share for state-defined small providers and exempt providers facing hardship, each only through a public notice-and-comment process. The eCFR text has not changed since 2024-07-09. No state-published 80/20 implementation step (small-provider criteria, hardship exemption or reporting guidance) was found for this state in the official sources reviewed.

Hospice agencies (community based) — active organization NPIs (NPPES)

5,582 (as of Sep 13, 2026)

Medicare-certified hospices (CMS Care Compare)

1,913 (as of Aug 19, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

11,659,421 (as of Jun 1, 2026)

All California Hospice Medicaid rates, ranked →