The Home Health Enrollment Moratorium Expires November 13, 2026 — Unless CMS Extends It

2 days ago

6 min read

The nationwide freeze on new Medicare home health and hospice enrollment hits its six-month mark on November 13, 2026, and CMS can renew it in six-month increments without a new rulemaking. Two of the industry's largest associations spent the first week of September writing to CMS to argue against exactly that. The National Alliance for Care at Home sent its letter on September 4, 2026; LeadingAge — which originally backed the moratorium — sent its own on September 9, 2026. For any owner sitting on a purchase agreement, a branch expansion, or a majority-ownership change, the next eight weeks decide whether the door opens in November or stays shut into May 2027. Here are the dates, the mechanics, and the accounting decisions that turn on them.

Key Takeaways

The moratoria took effect May 13, 2026 and run six months, putting the current expiration at November 13, 2026.
CMS published two separate Federal Register notices on May 15, 2026 — 2026-09717 for home health agencies and 2026-09718 for hospices.
The legal basis is 42 CFR 424.570(a)(2): a finding of "significant potential for fraud, waste or abuse."
Moratoria may be extended in additional six-month increments at CMS's discretion.
The National Alliance for Care at Home (Sept. 4) and LeadingAge (Sept. 9) both urged CMS to let the freeze lapse.
The Alliance argues national data does not show fraud "so pervasive and geographically uniform" as to justify a 50-state freeze.
Existing enrolled agencies keep billing normally — the freeze blocks new enrollments, not operations.
The CY 2027 proposed rule (CMS-1844-P) would make all enrollment revocation grounds retroactive and add new revocation bases tied to change in majority ownership.
MedPAC's March 2026 report recommended a 7% cut to the 2027 home health base rate, citing margins it considers too high.

What the Moratoria Actually Freeze

The scope

A temporary enrollment moratorium under 42 CFR 424.570 lets CMS stop accepting new Medicare enrollment applications in a provider category when the agency determines there is significant potential for fraud, waste, or abuse. CMS had used geographic moratoria before — targeted metros in Florida, Texas, Illinois, and Michigan. The 2026 action is different in one respect that matters enormously: it is national, covering all 50 states, the District of Columbia, and the territories.

Metric	Value	Source
Effective date	May 13, 2026	Federal Register, May 15, 2026
Initial duration	6 months	42 CFR 424.570
Current expiration	November 13, 2026	Calculated from effective date
HHA notice document number	2026-09717	Federal Register, Vol. 91, No. 94
Hospice notice document number	2026-09718	Federal Register, Vol. 91, No. 94
Extension increment	6 months, renewable	42 CFR 424.570

Who is not affected

The moratoria are frequently misread as a billing restriction. They are not.

Situation	Status during the freeze
Enrolled agency, no ownership change	Unaffected — bill and operate normally
Revalidation of an existing enrollment	Proceeds
New agency seeking a Medicare number	Blocked
New practice location / branch	Generally blocked
Change of majority ownership triggering re-enrollment	Treated as new enrollment — blocked

That last row is where deals die. A change of ownership that is structured as a CHOW generally lets the buyer step into the seller's existing enrollment. A change in majority ownership of a home health agency or hospice within the regulatory look-back window forces re-enrollment as a new provider — which the moratorium blocks outright. Two transactions that look identical at the LOI stage can land on opposite sides of that line.

Why the Associations Want It to Lapse

The September letters make an access-to-care argument rather than a compliance argument. The Alliance's position is that fraud concentrated in a handful of markets does not justify a nationwide instrument, and that the providers best positioned to close access gaps in underserved counties are precisely the ones the freeze stops. LeadingAge's reversal is the more striking signal: the association originally supported the moratorium as breathing room for CMS to design a durable program-integrity fix, and now argues that CMS has had that time.

Hospice News reported on September 9, 2026 that the Alliance also flags balance-sheet damage — providers who built pipelines, hired, and signed leases against a Medicare number that never arrived.

Metric	Value	Source
Alliance letter date	September 4, 2026	Home Health Care News
LeadingAge letter date	September 9, 2026	Home Health Care News
States covered by moratoria	All 50 + DC + territories	Federal Register
Freestanding HHA Medicare FFS margin, 2023	20.2%	MedPAC
Freestanding HHA Medicare FFS margin, 2024	21.2%	MedPAC
Projected HHA Medicare FFS margin, 2026	19%	MedPAC, March 2026
Projected hospice FFS margin, 2026	9%	MedPAC, March 2026

Those margin figures are the counterweight. MedPAC's March 2026 report to Congress recommended a 7% reduction to the 2027 home health base rate on the view that aggregate margins remain well above what payment adequacy requires. An agency reading only the association letters will miss that the same policy conversation contains a live recommendation to cut rates.

The Enrollment Provisions Hiding in the CY 2027 Proposed Rule

The moratorium is temporary. The enrollment provisions CMS proposed on July 1, 2026 in the CY 2027 Home Health PPS proposed rule (CMS-1844-P) are not. Three of them reshape transaction risk permanently if finalized.

Retroactive revocations

Under current rules, some revocation grounds take effect prospectively — 30 days after CMS mails notice — while others reach back to the date noncompliance began. CMS proposes making all revocation grounds retroactive. The accounting consequence is direct: a revocation no longer just stops future billing, it opens a recoupment window on everything paid since the noncompliance started.

Change in majority ownership

Hospices, HHAs, and DMEPOS suppliers already must re-enroll as a new provider and undergo survey or accreditation after certain changes in majority ownership. CMS proposes to add denial or revocation of enrollment as the penalty for violating that requirement.

Owner and managing-employee lookthrough

CMS currently may deny or revoke when the provider has a suspended or revoked license in another state, or is excluded from Medicaid or another federal program. The proposal extends that to suspensions and revocations involving the provider's owners or managing employees. Diligence that stops at the entity is no longer diligence.

These are proposed provisions in CMS-1844-P, not final rules. The comment period closed with 657 submissions; a final rule is expected later in CY 2026.

What to Do Between Now and November 13

The moratorium's expiration is binary and dated, which makes it one of the few regulatory events an agency can plan around precisely.

Confirm which side of the CHOW line your deal falls on before spending another dollar on diligence. Ask your MAC in writing.
Run owner-level and managing-employee-level exclusion checks on both sides of any transaction, not just entity-level checks.
Quantify the recoupment tail a retroactive revocation would create on the target's book, and price it.
Reconcile the target's open Medicare cost reports, ADRs, and settlements. A change of ownership does not erase the seller's Medicare liabilities — the buyer inherits them.
Model two scenarios in your CY 2027 budget: the freeze lapses November 13, and the freeze extends to May 2027. The second scenario has no new revenue line from expansion.
Stack the freeze against the rate picture — the proposed 2.1% CY 2027 update, the proposed -3.0% temporary adjustment, and MedPAC's 7% cut recommendation all hit the same base.

Clean Medicare cost report filing is what makes a target defensible in diligence and what makes your own agency ready to move the day the freeze lifts. Sound bookkeeping between now and November is the difference between having a valuation and having a guess.

The Bottom Line

November 13, 2026 is the date. CMS has the authority to renew for another six months, the two largest associations have asked it not to, and the CY 2027 proposed rule suggests the agency's longer-term answer is not moratoria but broader revocation authority reaching owners, managing employees, and past payments. Agencies that treat the next eight weeks as preparation rather than waiting will be the ones that transact in November. If you need a clean read on what you would be buying — or what you would be selling — schedule a free consultation.