Hospice reform in 2026: what Congress and California are doing, and what it means for families

Hospice has been in the news this year for hard reasons: fraud investigations in Los Angeles County, and a bill in Congress to overhaul how Medicare pays for and polices hospice care. Families who need hospice now are left with a fair question. Is it still safe to choose? It is. The benefit itself hasn’t changed, and the rules that protect patients are still in force. This note explains what’s proposed, what’s already happening in California, and how to pick a hospice you can trust.

What’s happening in California

In 2021, California stopped issuing new hospice licenses, a moratorium that is still in place.¹ Since then the state has revoked more than 280 hospice licenses and placed 300 more under investigation.¹

On April 7, 2026, about 80 surveyors and investigators from three state departments and their partners reviewed businesses at a single address in Van Nuys.¹ Of the entities that had used that address, only 19 held a state license and could bill Medi-Cal.¹ The state’s release put it bluntly: “109 attempting to use this address have never been issued a California hospice license.”¹

The state’s Medi-Cal program now verifies a patient’s choice of hospice itself before it will process any hospice claim, and it refers credible cases of fraud to the California Department of Justice.¹

The scale is part of the story. As Los Angeles County supervisors moved this spring to tighten oversight, local reporting counted more than 4,700 home health and hospice agencies in the county.²

What the Hospice CARE Act would change

On March 17, 2026, Rep. Linda Sánchez of California introduced the Hospice Care Accountability, Reform, and Enforcement Act, H.R. 7966, and Sen. Mark Warner of Virginia introduced the identical bill in the Senate, S. 4118.³ The House bill has six cosponsors from both parties.³ Its sponsors say the hospice benefit has changed little since Congress created it in 1982.⁴ An earlier version was introduced in 2024.⁵

The bill would do three main things.⁴

• Keep bad actors out. A temporary pause on new hospices joining Medicare, with exceptions where communities need more access; public information on who owns and runs each hospice; more frequent inspections of new hospices; and limits on conflicts of interest when a clinician certifies that a patient qualifies.
• Change how care is paid for. Higher payment for in-person visits in routine home care, and higher payment for costly treatments that ease symptoms, such as radiation, chemotherapy, transfusions and dialysis.
• Do more for families. Respite care at home, a short inpatient respite benefit to help a patient move from the hospital to hospice, and a written explanation of benefits within 15 days of choosing hospice.

It would also let nurse practitioners and physician assistants certify that a patient qualifies for hospice.^4,5

National hospice groups called for thoughtful reform while saying some details, especially on payment, need more work. LeadingAge’s president and CEO, Katie Smith Sloan, said, “Hospice is at an inflection point.”⁵

As of October 2026, both bills sit with the committees they were sent to: Ways and Means and Energy and Commerce in the House, and Finance in the Senate.³ Neither has had a vote. A bill can change a great deal before it becomes law, or never become law at all.

A second idea: hospice inside Medicare Advantage

Today, if someone in a Medicare Advantage plan chooses hospice, Original Medicare pays for everything related to the terminal illness, and the plan keeps covering extra benefits and care for unrelated problems.⁶

In May 2025, Rep. David Schweikert of Arizona introduced the Medicare Advantage Reform Act, H.R. 3467, which would make Medicare Advantage plans responsible for hospice instead.⁷ National hospice groups opposed it. The National Alliance for Care at Home said the change would “dismantle this vital program.”⁷

What hasn’t changed

None of these proposals has changed a family’s rights today. Under Medicare:⁶

• Hospice is for a person whose doctors certify a life expectancy of six months or less if the illness runs its normal course, and who chooses comfort care over treatment to cure it.
• There’s no deductible. Drugs for pain and symptom relief are covered when they’re part of the plan of care. Medicare allows a copay of up to $5 a prescription for them, though there usually isn’t one. Inpatient respite care can cost 5% of the Medicare-approved amount.
• Medicare covers hospice only from a Medicare-approved provider.
• A person can stop hospice at any time, and can come back to it later if they’re still eligible.

How to choose a hospice with confidence

Medicare’s own guidance gives families a few firm rules.⁶

• Never accept gifts or perks for signing up. A legitimate hospice doesn’t pay people to enroll.
• Be wary of “free” offers. Medicare doesn’t provide “free” services like housekeeping, and you shouldn’t give your Medicare number to anyone offering them.
• Only doctors certify. Only the hospice doctor and the person’s own doctor, if they have one, can certify that someone is terminally ill.
• Report anything that feels wrong to 1-800-MEDICARE (1-800-633-4227).

Beyond the rules, ask questions and listen to the answers. Who answers the phone at 2 AM? How fast does a nurse come when symptoms get worse at night? Will the same team keep coming? Is there a social worker and a chaplain? A good hospice answers all of them plainly, before anyone signs anything.

Where HealthView stands

HealthView has cared for families in Southern California since 1967, and our hospice and palliative care line, (626) 505-1000, is answered by a person any hour. A conversation with one of our hospice nurses costs nothing and commits you to nothing. If hospice isn’t the right fit yet, we’ll say so, and talk about palliative care or home health instead.