Starting a hospice in California

The moratorium on new hospice licenses

California paused new hospice licenses in 2022 (SB 664) and extended the pause several times, most recently through AB 177 (2024). CDPH's rulemaking documents state that AB 177 ends the moratorium on January 1, 2027, or one year after the emergency regulations were adopted, whichever is sooner. The regulations were adopted June 22, 2026, so the expected end date is January 1, 2027. While it lasts, the moratorium blocks new licenses, new branch locations, service-area expansions and moves outside an approved area. Renewals, changes of ownership and moves within the same area are not affected. Confirm the status with CDPH before you file.

New hospice regulations (June 2026)

Emergency hospice regulations, 22 CCR 74800 and following, took effect June 22, 2026, and CDPH has said it intends to make them permanent. They spell out the application contents, including proof of insurance and of funds to operate for at least 90 days. A home health agency or other licensed facility needs a separate hospice license, and each additional hospice location pays its own fee.

Insurance the application requires

• General liability covering the premises and operation of at least $100,000 per claim and $300,000 annual aggregate (22 CCR 74812(c)(18))
• Workers' compensation covering the premises and operation of at least $100,000 per claim and $300,000 annual aggregate (22 CCR 74812(c)(19))
• Those are state minimums. Payers, facilities you contract with and your own risk usually call for professional and general liability of $1M per occurrence / $3M aggregate

Medicare certification

Medicare certification requires either a state survey or accreditation by a CMS-approved accrediting organization. New hospices are screened at Medicare's highest risk level, enter a provisional period of enhanced oversight starting with their first claim, and generally cannot transfer billing privileges if majority ownership changes within 36 months of enrollment. Build those timelines into your launch plan.

Workers' comp and payroll for hospice staff

In-home hospice nursing is generally classified with nursing care in private residences, 8827(2), at an approved advisory pure premium rate of $2.794 per $100 of payroll for policies starting on or after September 1, 2026. Inpatient hospice facilities can be classified differently, so we confirm the class with the carrier for your model. Office-only staff may qualify for clerical class 8810.