A national review of hospice ownership models, from 2018 to 2025.
The composition of the U.S. hospice system has shifted substantially since 2018, driven by rapid expansion of for-profit ownership and growing private equity investment. This report maps that transformation — illustrating how ownership models have changed from 2018 to 2025, including the increasing involvement of private equity (PE) — and fills a critical gap in current, publicly available data on the hospice market.
The U.S. hospice market grew from 4,744 to 6,921 Medicare-certified hospices between 2018 and 2025 — a 45.9% increase, with growth accelerating sharply in recent years.
For-profit hospices drove most of that expansion, growing 51.1% to reach 4,747 hospices by 2025, while nonprofit/government-operated hospices declined by 22.2% over the same period.
Among for-profit hospices with a documented change of ownership, more than 1 in 3 were associated with private equity funding — likely a conservative estimate given current disclosure gaps.
Growth has not been distributed evenly across the country. Nevada, California, and Arizona led growth with increases of 251%, 128%, and 83%, respectively, while 12 states saw their hospice markets contract over the same period — led by Mississippi, Alabama, and New York.
The hospice landscape is now primarily for-profit, and the gap is widening. For-profit hospices grew by more than 50% between 2018 and 2025, while the nonprofit and government-operated segment continued to shrink. This continued contraction may have implications for the diversity of providers patients can choose from when seeking care.
Tracking private equity activity across the hospice landscape is not straightforward — PE ownership is not systematically disclosed in Medicare enrollment records, and many transactions occur through stock sales or holding-company restructuring that generate no public administrative record.
Among for-profit hospices with a documented change-of-ownership (CHOW) transaction, more than 1 in 3 (38.7%) were associated with private equity funding. Because this analysis could only examine hospices with a documented ownership change, and because PE involvement isn't formally disclosed, this figure likely understates PE's true role in the hospice market.
Taken together, these findings point to increasing consolidation around larger, for-profit, and in many cases PE-backed hospices, as the nonprofit and government segment continues to contract. Linking these ownership shifts to patient-level data on care utilization, quality, outcomes, and costs is the critical next step to understanding how the rapidly changing hospice landscape is affecting the patients and families at the center of it.
Strengthening ownership transparency in hospice reporting is a foundational step toward more targeted program integrity efforts, better-informed payment and policy decisions, and greater accountability to the beneficiaries the hospice benefit is intended to serve.
This analysis examined the Medicare-certified hospice landscape at two points in time — 2018 and 2025 — using CMS Care Compare data, which reports each hospice's name, location, and self-reported ownership type. Hospices were tracked by unique CMS Certification Number (CCN) to identify which were operating in 2018 only, 2025 only, or both years.
To examine ownership changes, this analysis combined Care Compare data with CMS Change of Ownership (CHOW) transaction records, then cross-referenced hospices with a documented CHOW against PitchBook, a Morningstar company, to identify private equity involvement. Because CHOW filings capture only a subset of ownership activity, this approach is likely a conservative estimate of PE's full role in the hospice market.
For the complete methodology, data sources, state-level detail, and policy recommendations, see the full report below.
Elea Institute funded this research to help close a critical gap in publicly available data on the hospice market.