How to start a hospice in Florida

Florida requires a Hospice license (may include freestanding inpatient facility and residential units) from Florida Agency for Health Care Administration (AHCA), Bureau of Health Facility Regulation, Home Care Unit to operate a hospice. Fee: License fee is set by rule and capped by statute at $1,200 per biennium (s. 400.605, F.S.). Changes during the licensure period (adding an inpatient facility, residential unit or beds) carry a $25 fee.

License required

Yes

License

Hospice license (may include freestanding inpatient facility and residential units)

Issuing agency

Florida Agency for Health Care Administration (AHCA), Bureau of Health Facility Regulation, Home Care Unit

Fee

License fee is set by rule and capped by statute at $1,200 per biennium (s. 400.605, F.S.). Changes during the licensure period (adding an inpatient facility, residential unit or beds) carry a $25 fee.

Renewal

Every 2 years

Accreditation

Joint Commission, CHAP and ACHC accreditation can be used for Medicare deemed status, but AHCA does not accept it in place of the state licensure survey.

Survey and inspection

AHCA field office staff survey for licensure; administrator changes must be reported 21 days in advance.

Certificate of need

Required

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

Fla. Stat. ch. 400, Part IV (ss. 400.601-400.611) and ch. 408 Parts I-II; Fla. Admin. Code ch. 59A-38 and 59A-35

1. Obtain a Certificate of Need from AHCA (required before applying for a hospice license)
2. Submit the Health Care Licensing Application — Hospice (AHCA Form 3110-4001) with checklist items and fee
3. Complete Level 2 background screening for required personnel (ch. 435 and s. 408.809, F.S.)
4. For an inpatient facility, obtain a certificate of occupancy signed by local zoning, building and electrical officials
5. Pass the AHCA licensure survey

Training

• Staff with direct contact with patients who have Alzheimer's disease or related disorders must complete Department of Elder Affairs-approved training (s. 400.6045, F.S.)

Program

Florida Medicaid (Agency for Health Care Administration)

Enrollment portal

Florida Medicaid Web Portal (FLMMIS) — Enrollment Wizard

Fiscal agent

Gainwell Technologies (Florida Medicaid Web Portal / FLMMIS)

Application fee

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

Florida also requires Level 2 background screening (fingerprint-based, under s. 408.809, F.S.) as part of enrollment and revalidation. 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

AHCA assigns each provider type a limited, moderate or high risk level under 42 CFR 455.450. 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

Florida calls revalidation 'renewal': AHCA re-enrolls every provider at least every five years, mailing a notice about 90 days before the provider agreement expires. Claims suspend if the online renewal is not finished by the expiration date. Federal rule (42 CFR 455.414): every enrolled provider must be revalidated at least once every 5 years.

Full Florida Medicaid enrollment guide →

For this business

Required (licensing source)

CON program

Yes

Program

Certificate of Need

Agency

Florida Agency for Health Care Administration (AHCA)

Services covered

• community nursing homes / skilled nursing facility beds
• hospice programs and hospice inpatient facilities
• intermediate care facilities for the developmentally disabled (ICF/DD)
• conversion from one type of covered facility to another

Florida certificate of need details →

State minimum wage

$15.00 an hour

Effective

2026-09-30

Scheduled increases

Stays $15.00 from 2026-09-30 through 2027-12-31; annual inflation adjustments resume with a September 2027 calculation that takes effect the following January 1.

Direct-care wage floor

The 2022-23 General Appropriations Act funded Medicaid fee schedule and managed care rate increases for the sole purpose of raising wages of Medicaid providers' direct care employees (including 1099 workers) to at least $15/hour.

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)

298 (as of Sep 13, 2026)

Medicare-certified hospices (CMS Care Compare)

61 (as of Aug 19, 2026)

Total Medicaid and CHIP enrollment (latest reported month)

3,565,369 (as of Jun 1, 2026)

All Florida Hospice Medicaid rates, ranked →