HOSPICE

Sell your hospice agency

If you want to sell your hospice agency, expect buyers to price it as a multiple of adjusted EBITDA and then test that number against hospice-specific risk: Medicare aggregate cap exposure, live discharge and length of stay patterns, quality reporting (HOPE and CAHPS), survey history, and whether the sale triggers the 36-month rule while CMS's nationwide moratorium on new hospice enrollment is in effect. A hospice for sale that is clean on these points draws PE-backed platforms and strategics. Lartico lets you meet approved hospice buyers confidentially, with no listing fee and no exclusivity; the buyer pays our fee at closing.

By Akim Guennani, Founder · Updated October 2026

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$36,174.75

Medicare hospice cap per beneficiary, FY 2027

About 28%

Hospices over the Medicare cap in 2023

May 13, 2026

Start of the six-month national hospice enrollment moratorium

Who is buying hospice agencies

Hospice keeps attracting capital. MedPAC counted 6,706 hospices serving Medicare patients in 2024, with growth driven by for-profit entrants, and LevinPro HC recorded 23 home hospice and palliative care acquisitions in 2025 and 20 in 2024.

Buyers fall into three groups: PE-backed hospice platforms doing tuck-ins (Bristol Hospice, backed by Webster Equity Partners, bought hospices in Alabama, Nevada and Tennessee in 2025 and 2026), home health operators adding hospice to an existing footprint (LifeCare Home Health bought Infinity Hospice Care in Nevada and Arizona in November 2025), and large strategics. In the UnitedHealth and Amedisys settlement, the Justice Department required the divestiture of 164 home health and hospice locations, which moved hospice locations to other operators.

What drives hospice agency valuation

Buyers start from adjusted EBITDA and move the multiple up or down based on how durable and how defensible that EBITDA is. In hospice, durability is mostly about census and referral sources; defensibility is mostly about whether the revenue would survive a Medicare audit.

Average daily census (ADC): Scale and its trend over the last 12 to 24 months, plus how concentrated referrals are (one hospital or one facility chain is a risk).
Length of stay mix: A balanced mix of short and long stays. A census built on very long stays raises cap and medical review questions.
Live discharge rate: MedPAC notes that high live discharge rates can signal quality or program integrity problems. Buyers compare yours to peers in your market.
Cap position: Your Medicare aggregate cap calculations by year and any overpayment demands, paid or open.
Quality and surveys: HQRP compliance (missing it cuts the annual update by four percentage points), HOPE submissions, CAHPS Hospice results, and recent survey findings.

Rules that shape a hospice sale

Since January 1, 2024, the 36-month rule applies to hospices: a change in majority ownership within 36 months of initial Medicare enrollment or the last change in majority ownership generally means the buyer must enroll as a new hospice, with a new survey or accreditation, unless an exception applies. On May 13, 2026, CMS imposed a six-month nationwide moratorium on Medicare enrollment of new hospices, and its FAQ says a non-exempt change in majority ownership counts as a new enrollment, so it would be denied while the moratorium lasts.

Location matters too. Hospices that are newly enrolled or change ownership in Arizona, California, Nevada, Texas, Georgia and Ohio can be placed in a provisional period of enhanced oversight (claims review for 30 days to one year). Some states also require a certificate of need or state approval for a hospice change of ownership. Your health care attorney should map these for your deal.

What buyers check in hospice diligence

Hospice diligence goes further into clinical records than most home care deals, because the main risk is that Medicare takes money back after closing. Buyers will sample charts for eligibility documentation, compare your live discharge rate and length of stay to local peers, and rebuild your cap calculation for each open year.

The table shows what a buyer typically asks for and why. None of it is unusual; having it ready shortens the process and protects your price.

Area	What buyers ask for	Why it matters
Census	Monthly ADC, admissions and discharges for 24 months, by referral source	Shows whether EBITDA is growing, flat or tied to one referrer
Length of stay	Average and median length of stay, share of patients past 180 days	Very long stays drive cap exposure and medical review
Live discharges	Live discharge rate by reason (revoked, no longer terminally ill, moved)	MedPAC flags high rates as a possible quality or integrity signal
Medicare cap	Cap calculations and MAC determinations for each open year	Overages are repaid to Medicare and can survive the sale
Quality	HQRP compliance letters, HOPE submission rates, CAHPS Hospice results	Missing HQRP cuts the annual update by four percentage points
Ownership history	Medicare enrollment date and every ownership change since	Determines whether the 36-month rule applies
Surveys and audits	Recent surveys, plans of correction, ADRs, TPE or prepayment review	Open findings become escrow, indemnity or price changes

Preparing your hospice agency for sale

Start six to twelve months before you talk to buyers. Most of the work is assembling records you already keep and resolving anything open.

Owner checklist

Confirm your Medicare enrollment date and every change in majority ownership, and ask counsel whether the 36-month rule or the enrollment moratorium affects your timing.
Gather your cap calculations and MAC cap determinations for every year still open, and note any overpayments paid or in dispute.
Pull 24 months of ADC, admissions, discharges, length of stay and live discharge data by referral source.
Collect HQRP compliance confirmations, HOPE submission reports (HOPE replaced the HIS on October 1, 2025) and CAHPS Hospice results.
File your last survey, plan of correction, accreditation report and any ADR, TPE, prepayment review or PPEO letters.
If you offer palliative care, separate its revenue, staffing and payer contracts so buyers can value it on its own.
Build an adjusted EBITDA bridge with owner compensation and one-time costs documented, ready for a quality of earnings review.
Check whether your state requires a certificate of need or prior approval for a hospice change of ownership.

Example: how cap exposure and timing change a deal

Cap exposure is easiest to see with numbers. The cap is calculated across your whole patient population for the year, not per patient, so a few very long stays can be absorbed if the rest of the census is balanced.

A hospice with a cap overage and a recent ownership change

An owner bought a 60 ADC hospice 30 months ago and now wants to sell. For the last cap year, the agency had 400 beneficiaries counted toward the cap, giving an allowed amount of about $14.47 million at $36,174.75 each, against $15.20 million of Medicare payments. That is an overage of about $730,000 owed back to Medicare. The buyer asks for an escrow covering that year and any open year with a similar pattern. Because the last change in majority ownership was 30 months ago, the buyer's counsel also flags the 36-month rule: closing now would generally require a new enrollment, which CMS says would be denied under the moratorium. The parties agree to close after the 36-month mark. The figures are hypothetical.

How Lartico fits in

Lartico is a confidential marketplace, not a broker. You describe your hospice anonymously, approved PE-backed platforms and strategics request access, and you decide who signs an NDA and sees your data room. Owners pay nothing and sign no exclusivity; the buyer pays Lartico's fee at closing.

Sources and methodology

Public transactions provide market context, not a valuation quote for a private practice. Illustrative examples use hypothetical assumptions and are not predictions. This guide is educational and is not legal, tax, accounting, or investment advice.

1. Fiscal Year 2027 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Program Requirements Final Rule (CMS-1851-F) (Centers for Medicare & Medicaid Services). FY 2027 cap of $36,174.75, 2.3% payment update, four percentage point HQRP reduction for non-reporting hospices.
2. FY 2026 Hospice Wage Index, Payment Rate Update and Hospice Quality Reporting Program Requirements Final Rule (Centers for Medicare & Medicaid Services). Implementation of the HOPE tool on October 1, 2025.
3. Report to the Congress: Medicare Payment Policy, Chapter 10, Hospice services (March 2026) (MedPAC). 6,706 hospices in 2024; about 28 percent of hospices exceeded the cap in 2023; high live discharge rates as a possible quality or integrity signal.
4. Announcement of Nationwide Temporary Moratorium on Enrollment of Hospices (Federal Register (CMS)). Six-month nationwide moratorium on Medicare enrollment of new hospices, effective May 13, 2026.
5. Home Health and Hospice Nationwide Moratorium Q&As (revised July 9, 2026) (Centers for Medicare & Medicaid Services). Non-exempt changes in majority ownership under 42 CFR 424.550(b) are treated as new enrollments and are subject to the moratorium.
6. Calendar Year 2024 Home Health Prospective Payment System Final Rule (CMS-1780-F) (Centers for Medicare & Medicaid Services). Extends the 36-month change in majority ownership rule in 42 CFR 424.550(b) to hospices.
7. Period of Enhanced Oversight for New Hospices in Arizona, California, Nevada, Texas, Georgia & Ohio (MLN7867599, February 2026) (Centers for Medicare & Medicaid Services). Covers new enrollments and changes of ownership; lasts 30 days to one year; Georgia and Ohio added December 30, 2025.
8. Hospice medical review (PPEO and Expanded Prepayment Review) (Centers for Medicare & Medicaid Services). States and start dates for enhanced oversight and expanded prepayment review.
9. Justice Department Requires Broad Divestitures to Resolve Challenge to UnitedHealth's Acquisition of Amedisys (U.S. Department of Justice). 164 home health and hospice locations in 19 states, about $528 million in annual revenue, in the $3.3 billion deal (August 7, 2025).
10. Bristol Hospice buys Hope Hospice & Palliative Care (LevinPro HC (Levin Associates)). Webster Equity Partners-backed Bristol's 2025 and 2026 deals; 23 hospice and palliative deals in 2025 and 20 in 2024.
11. LifeCare Home Health Acquires Infinity Hospice Care (Hospice News). Nevada and Arizona hospice with a Las Vegas-area inpatient facility; terms not disclosed.

Reviewed October 2026

Questions owners ask

Straight answers, before you commit to anything.

How much is my hospice agency worth?+

Most hospice agencies are valued as a multiple of adjusted EBITDA. The multiple depends on ADC and its trend, referral diversity, length of stay mix, live discharge rate, cap history, quality reporting and survey results. Smaller agencies with open compliance questions price lower than larger, clean ones. A buyer's quality of earnings review will test the EBITDA you present.

Where can I find a hospice agency for sale, or list mine?+

Many hospice deals never appear in public listings because owners do not want staff, referral sources or competitors to know. On Lartico, owners create an anonymous profile and approved buyers (PE-backed platforms and strategics) request access. Owners decide who sees their identity, and an NDA is signed before that happens.

Can I sell my hospice within 36 months of buying or enrolling it?+

You can, but under 42 CFR 424.550(b) a change in majority ownership within 36 months of initial enrollment or the last majority change generally requires the buyer to enroll as a new hospice, unless an exception applies (for example, two consecutive years of full cost reports since the last change). While CMS's nationwide hospice enrollment moratorium is in effect, CMS says such a change would be denied. Confirm timing with counsel before you go to market.

Does the hospice cap affect the sale price?+

Yes. If your Medicare payments exceed the aggregate cap (the FY 2027 per beneficiary amount is $36,174.75), you owe the overage back. MedPAC estimated that about 28 percent of hospices exceeded the cap in 2023. Buyers review several years of cap calculations and often ask for an escrow or indemnity for cap years still open at closing.

Do I need a broker to sell a hospice agency?+

No. Some owners hire a broker or banker; others sell directly to a buyer they know. Lartico is not a broker: owners pay nothing, sign no exclusivity, and choose which approved buyers to talk to. The buyer pays Lartico's fee at closing.

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