By: Dianne Munevar, Michaela Maxwell & Tyler Oberlander

The U.S. hospice market looks meaningfully different today than it did eight years ago. The number of Medicare-certified hospices has grown by more than 40 percent since 2018. For-profit providers now make up the clear majority of the market, and private equity investment is a meaningful — and almost certainly undercounted — part of this growth and evolution. Yet the public data available to describe these shifts has not kept pace with how the market is actually changing.

A new report from Healthsperien, The Hospice Landscape: A National Review of Hospice Ownership Models Over Time, funded by The Elea Institute, uses CMS Care Compare data, CMS Change of Ownership (CHOW) filings, and PitchBook data to map how the Medicare-certified hospice landscape has evolved between 2018 and 2025. Three findings stand out.

The market has grown rapidly, but unevenly. The number of Medicare-certified hospices rose from 4,744 in 2018 to 6,921 in 2025, a 45.9 percent increase. Growth has concentrated in a handful of states — Nevada (+251 percent), California (+128 percent), and Arizona (+83 percent) led the expansion — while 12 states saw their hospice markets contract over the same period, with Mississippi, Alabama, and New York recording the largest reductions.

The market is now predominantly for-profit, and the gap is widening. For-profit hospices expanded by 51.1 percent to reach 4,747 by 2025. Over the same period, the number of nonprofit and government-operated hospices declined by 22.2 percent, from 1,169 to 910. The continued contraction of the nonprofit and government segment has implications for provider diversity in the markets patients choose from.

Private equity is a growing, and likely undercounted, feature of for-profit hospice ownership. Among the 287 for-profit hospices that filed a CHOW transaction between 2018 and 2025, 38.7 percent — 111 hospices — were associated with private equity funding according to PitchBook. This figure is almost certainly conservative. Medicare enrollment records do not require PE disclosure, and many transfers of effective ownership occur through stock sales or holding company restructuring that bypass CHOW filing requirements altogether.

That last point is the policy story underneath the market story. CMS has made real progress on hospice transparency by publishing Care Compare and CHOW transaction data, but it currently lacks a mechanism to attribute private equity affiliation, parent-company structures, or the change-of-information activity that characterizes a growing share of today’s market. The result is a blind spot: regulators, researchers, and the public can see that the hospice landscape is in structural transition, but cannot fully see who owns what.

Updating public reporting requirements to capture parent-company and affiliate-group structures, private equity affiliations, and change-of-information activity — paired with consistent definitions and regular refresh cycles — would be a foundational step toward more targeted program integrity, better-informed payment and policy decisions, and greater accountability to the beneficiaries the hospice benefit was designed to serve.

What comes next. This landscape analysis establishes the structural picture. The next question — and the one that matters most to patients and families — is how these ownership shifts relate to the care people actually receive. Healthsperien is building on this work with a follow-on research agenda examining how ownership category (nonprofit and government, for-profit without identified PE involvement, and for-profit with PE involvement) relates to care utilization, quality, patient outcomes, costs, staffing patterns, and Hospice Care Index performance. The cohorts identified in this report will form the basis of that comparison. Stay tuned.