Hospice Ownership Structure: For-Profit Dominance in a $22B Sector
Ownership breakdown of 6,943 CMS-certified hospice providers: for-profit concentration at 77.8%, state distribution, and the CA/TX duopoly accounting for 52% of national hospice capacity.
Contents · 8 sections
Executive Summary
- The U.S. hospice sector is overwhelmingly for-profit: 77.76% of 6,160 CMS-certified facilities with known ownership are proprietary operators. This is markedly higher than hospital (~58%) or skilled nursing (~70%) for-profit rates across the post-acute sector.
- California hosts 2,155 of the 6,160 hospices with known ownership — 34.9% of the national total. A structural concentration driven by favorable reimbursement history, population density, and California's historically low barriers to hospice certification.
- California and Texas together account for 3,236 facilities, or 52.4% of the entire national hospice count. No other two-state combination approaches this level of geographic concentration in any CMS Care Compare dataset.
- Government-operated hospices represent just 1.22% of facilities — the smallest government ownership share of any post-acute sector tracked in CMS Care Compare data. Non-profit hospices account for 13.23%.
At a glance — for journalists, researchers, and AI agents
What this dataset covers
- National ownership-type breakdown for 6,160 CMS-certified hospice providers with known ownership.
- State distribution of hospice capacity with California and Texas accounting for 52.4% of the national total.
What this dataset does NOT cover
- Quality of care — CMS does not publish an overall hospice star rating.
- Individual provider assessments — this is aggregate research only.
Sources
- CMS Care Compare
- Hospice General Information
Snapshot date: 2026-05-25 (snapshot query date)
Dataset scope · Snapshot May 25, 2026
Includes: the healthcare-provider records this study covers, each tracing to a dated public-record source named in the citation footer. Does not include: providers outside the source named for this study, or records not present in that source at the snapshot date. Counts describe this Fonteum healthcare-provider dataset — not a representative census of the U.S. healthcare workforce.
Key findings
Ownership breakdown
The CMS Care Compare Hospice General Information dataset lists an Ownership Type field for each Medicare-certified hospice. Of 6,943 total facilities, 6,160 (88.7%) have a non-null ownership type on file. The remaining 783 facilities report no ownership classification.
Among the 6,160 with known ownership:
| Ownership Type | Count | Share |
|---|---|---|
| For-Profit | 4,790 | 77.76% |
| Non-Profit | 815 | 13.23% |
| Other | 452 | 7.34% |
| Government | 75 | 1.22% |
| Combination Government & Non-Profit | 28 | 0.45% |
For-Profit dominance at 77.8% is materially higher than comparable post-acute sectors. Hospital sector for-profit share runs approximately 58%; skilled nursing facility (SNF) for-profit share approximately 70%. Hospice is the most heavily for-profit of the three major post-acute facility types tracked in CMS Care Compare.
The "Other" category (7.34%) typically captures LLC structures and partnership entities that do not classify straightforwardly under the four main ownership types. California and Nevada carry elevated "Other" shares, reflecting the prevalence of LLC-organized hospice operators in those markets.
Source: CMS Care Compare Hospice General Information (federal public dataset) · Snapshot 2026-05-25. Fonteum does not independently rate, inspect, verify, endorse, or guarantee any hospice provider.
State concentration: the CA/TX duopoly
The geographic concentration of U.S. hospice capacity is unlike any other CMS Care Compare dataset. California and Texas together host more than half of all hospice providers nationally.
Top states by hospice count:
| State | Hospices | Share of national total |
|---|---|---|
| CA | 2,155 | 34.9% |
| TX | 1,081 | 17.5% |
| GA | 259 | 4.2% |
| AZ | 244 | 3.9% |
| PA | 183 | 3.0% |
| NV | 179 | 2.9% |
| MI | 172 | 2.8% |
| OH | 168 | 2.7% |
| IL | 147 | 2.4% |
| MO | 133 | 2.2% |
CA + TX = 3,236 hospices = 52.4% of the national total.
This concentration is structural, not a quality signal. California's hospice count reflects a combination of factors: population size (the most populous state), historically favorable hospice reimbursement rates, and relatively low barriers to Medicare hospice certification in the state's regulatory environment. Texas's count reflects size and Sun Belt demographic trends.
The gap between California (2,155) and the next-largest state, Texas (1,081), is 1,074 facilities — itself larger than any state outside California.
Source: CMS Care Compare Hospice General Information (federal public dataset) · Snapshot 2026-05-25. Fonteum does not independently rate, inspect, verify, endorse, or guarantee any hospice provider.
Limitations
- Ownership ≠ quality. Ownership type is a structural attribute of the operator, not a measure of care quality. CMS does not publish an overall hospice star rating. This study describes market structure; it makes no claim about quality of care.
- Known-ownership denominator. 783 of 6,943 facilities (11.3%) have no ownership type on file. All percentages in this report use the 6,160-facility denominator of facilities with known ownership.
- Snapshot date. Data reflects CMS Care Compare as of May 2026. CMS updates quarterly; figures will drift over time.
- No individual facility assessments. This is aggregate research. No individual provider is rated, endorsed, or criticized.
- CA concentration is structural. California's hospice count reflects population size, regulatory history, and reimbursement dynamics — not a judgment on California hospice quality or on providers in any other state.
- "$22B sector" reference. The $22B figure refers to total Medicare hospice expenditure as published in CMS public payment reporting; it is not a Fonteum estimate.
Source: CMS Care Compare Hospice General Information (federal public dataset) · Snapshot 2026-05-25. Fonteum does not independently rate, inspect, verify, endorse, or guarantee any hospice provider.
Methodology
All figures derive from direct SQL aggregation on the cms_care_compare_hospice table in the Fonteum Supabase database (project rfabugntpwelbpbexgcz). The table is populated from the CMS Care Compare Hospice General Information federal public dataset — the same underlying data published at data.cms.gov.
Queries run 2026-05-25:
- Total facility count:
SELECT count(*) FROM cms_care_compare_hospice→ 6,943 - Known-ownership count:
SELECT count(*) FROM cms_care_compare_hospice WHERE ownership_type IS NOT NULL→ 6,160 - Ownership breakdown:
SELECT ownership_type, count(*) ... GROUP BY ownership_type ORDER BY count DESC - State distribution:
SELECT state, count(*) ... GROUP BY state ORDER BY count DESC
No estimated, interpolated, or third-party-derived figures are used. All numbers are counts from the federal dataset.
Source: CMS Care Compare Hospice General Information (federal public dataset) · Snapshot 2026-05-25. Fonteum does not independently rate, inspect, verify, endorse, or guarantee any hospice provider.
Limitations
- Ownership type is a structural attribute, not a quality measure. No quality claim is made about any ownership category.
- 783 of 6,943 facilities (11.3%) have no ownership type on file; all percentages use the 6,160-facility denominator.
- CMS updates Care Compare quarterly; figures will drift after the May 2026 snapshot date.
- Fonteum does not independently rate, inspect, verify, endorse, or guarantee any hospice provider.
Methodology
Read the full methodology
Source. CMS Care Compare publishes a Hospice General Information dataset listing every Medicare-certified hospice provider in the United States, with ownership type for each. This study aggregates those records at the national and state level from a May 2026 snapshot loaded into the Fonteum database.
What this study reports. National ownership-type breakdown (For-Profit / Non-Profit / Government / Other / Combination) and state-level provider counts. All figures are direct counts from the federal dataset; no estimation or interpolation is used.
Ownership ≠ quality. CMS does not publish an overall hospice star rating. This study reports market structure only — no quality claim is made about any ownership type or any individual provider.
Source: CMS Care Compare Hospice General Information (federal public dataset) · Snapshot 2026-05-25. Fonteum does not independently rate, inspect, verify, endorse, or guarantee any hospice provider.
Source. CMS Care Compare publishes a Hospice General Information dataset listing every Medicare-certified hospice provider in the United States, with ownership type for each. This study aggregates those records at the national and state level from a May 2026 snapshot loaded into the Fonteum database.
What this study reports. National ownership-type breakdown (For-Profit / Non-Profit / Government / Other / Combination) and state-level provider counts. All figures are direct counts from the federal dataset; no estimation or interpolation is used.
Ownership ≠ quality. CMS does not publish an overall hospice star rating. This study reports market structure only — no quality claim is made about any ownership type or any individual provider.
Source: CMS Care Compare Hospice General Information (federal public dataset) · Snapshot 2026-05-25. Fonteum does not independently rate, inspect, verify, endorse, or guarantee any hospice provider.
Technical appendix
Show technical details · script paths · field names
Dataset. CMS Care Compare — Hospice General Information (federal public dataset). Loaded into cms_care_compare_hospice table, Supabase project rfabugntpwelbpbexgcz. Snapshot date: 2026-05-25.
Queries. All figures are count(*) aggregations on the live cms_care_compare_hospice table. No intermediate CSV or JSON artifact; the table is the source of truth for this snapshot.
Wave. §sprint3-hospice-ownership-analysis (2026-05-25). Methodology version: cms-care-compare-hospice/v1.
Doctrine. Tier-2 research under healthcare-only scope (LOCKED-HEALTHCARE-ONLY-SCOPE, doctrine v1.6). No provider profiles written. No quality claims. No fake trust language.
Open for the script paths, raw dataset filenames, and per-field aggregation rules behind this snapshot. Reader-facing methodology above already covers source, date, and limitations.