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Hospice M&A in 2026: 44 Projected Deals, Rising Multiples, and Diligence That Now Takes Longer

Writer: Christian Soriaga, CPA
Christian Soriaga, CPA
2 days ago
6 min read

Midyear projections put 2026 hospice transaction volume at 44 deals — a new post-COVID high, and a reversal of three straight years of decline. Roughly 30 of those are expected to be platform or bolt-on acquisitions rather than small tuck-ins. Valuations are climbing again after a long trough. And at the same time, the two things that decide whether a hospice deal closes at all have gotten harder: the enrollment moratorium that runs through at least November 13, 2026 restricts who can transact, and compliance diligence has stretched timelines out because buyers are now underwriting billing risk the way they used to underwrite census. If you are on either side of a hospice transaction this year, the valuation is the easy part. Here is what buyers are actually pricing.

Key Takeaways

  • Midyear projections point to 44 hospice transactions in 2026, a post-COVID high.

  • About 30 of the 44 are expected to be platform or bolt-on deals.

  • 2026 reverses a three-year decline in hospice deal volume that began after the 2021–2022 peak.

  • Reported peak-era multiples reached roughly 26x in 2019 and about 29x the following year; current multiples are climbing from a much lower trough.

  • Overall home-based care M&A volume fell in Q2 2026 even as hospice-specific activity strengthened — the segments have decoupled.

  • The nationwide hospice enrollment moratorium (effective May 13, 2026) blocks structures that require re-enrollment, including certain majority-ownership changes.

  • FY 2027 hospice payment update: 2.3%, with an aggregate cap of $36,174.75 and an estimated +$755 million industry-wide impact.

  • MedPAC projects a 9% hospice fee-for-service margin for 2026 — the number buyers normalize against.

  • Heightened scrutiny of compliance and billing is extending diligence and delaying closings.

Why Volume Turned

The resurgence began in late 2025 and firmed through 2026. Demand fundamentals never weakened — end-of-life care demand keeps swelling while the benefit stays underutilized nationally — but capital had gone quiet after the 2021–2022 peak, when interest rates, reimbursement uncertainty, and a wave of fraud headlines made hospice a hard underwriting story.

Metric

Value

Source

Projected 2026 hospice transactions

44

Hospice News, Sept. 4, 2026

Projected platform or bolt-on deals

~30

Hospice News, Sept. 4, 2026

Prior trend

3-year decline in volume

Hospice News

Peak-era multiple, 2019

~26x

Hospice News

Peak-era multiple, following year

~29x

Hospice News

Home-based care M&A, Q2 2026

Volume declined

HomeCare Magazine

FY 2027 hospice payment update

2.3%

CMS-1851-F

FY 2027 aggregate cap

$36,174.75

CMS-1851-F

FY 2027 aggregate industry impact

+$755 million

CMS-1851-F

Projected hospice FFS margin, 2026

9%

MedPAC, March 2026

Two rows in that table are in tension and both are true. Hospice-specific deal counts are projected to a post-COVID high, while overall home-based care M&A volume declined in the second quarter of 2026. Buyers are being selective across the home-based care landscape and concentrating on hospice specifically — which tells a seller something useful about who is at the table.

Recent activity illustrates the range. Bloom Healthcare acquired Christian Care House Calls in early September 2026. Frazier Healthcare Partners acquired MatrixCare from ResMed, carving the post-acute software business out as a standalone company. Hospice Savannah formed a larger parent organization, Georgia Care Innovators, to coordinate a widening set of services. Strategic buyers, private equity platforms, and nonprofit systems are all transacting, and each prices differently.

The Moratorium Is a Deal-Structure Problem

CMS imposed six-month nationwide moratoria on new Medicare enrollment of hospices and home health agencies effective May 13, 2026, published in the Federal Register on May 15. The current expiration is November 13, 2026, and CMS may extend in six-month increments.

The effect on M&A is not that hospice deals stopped. It is that the structure of a deal now determines whether it is legal to close.

Structure

Moratorium effect

Asset purchase requiring new enrollment

Blocked

CHOW preserving the seller's existing enrollment

Generally proceeds

Change in majority ownership triggering re-enrollment

Blocked

New location or branch addition

Generally blocked

Equity purchase below the majority-change threshold

Generally proceeds

Two consequences follow. First, an existing, clean hospice enrollment is scarcer than it was in April 2026, which supports pricing for sellers who have one. Second, the CY 2027 Home Health PPS proposed rule (CMS-1844-P) would add denial or revocation of enrollment as the penalty for violating the majority-ownership re-enrollment requirement, and would make all revocation grounds retroactive rather than prospective. A structure that quietly trips the majority-ownership rule would no longer just be non-compliant — it would put the enrollment and prior payments at risk. These remain proposed provisions, not final.

What Buyers Are Underwriting Now

Heightened scrutiny of compliance and billing is the single most-cited reason hospice closings are taking longer. The diligence list has moved well past census and payer mix.

Cap exposure

The aggregate cap is the first item on a sophisticated buyer's list because it creates a liability that is invisible in an income statement until it is assessed. With the FY 2027 cap at $36,174.75 per beneficiary, a hospice with a long-stay-heavy census can be profitable on paper and carrying an unrecorded repayment obligation. Buyers want cap calculations by cap year, not a representation that none is owed.

The Special Focus / spending variation metrics

CMS finalized a spending variation index in the FY 2027 hospice rule, building on the claims-based metrics CMS already publishes. A target scoring poorly is not merely a reputational issue — it signals the billing patterns that pre-payment analytics are being built to detect.

Length of stay and live discharge

Both are valuation inputs and risk inputs simultaneously. Long average length of stay lifts revenue per admission and raises cap exposure and audit exposure at the same time.

Ownership and managing-employee history

The CY 2027 proposal would extend denial and revocation authority to suspensions or exclusions involving a provider's owners and managing employees. Entity-level exclusion screening is no longer sufficient diligence.

Quality reporting compliance

Hospices that fail to submit required quality data take the FY 2027 payment update of 2.3% minus four percentage points — a 1.7% reduction rather than an increase. That is a permanent haircut on the acquired revenue base, and it is entirely knowable before signing.

What a Seller Should Do Twelve Months Out

Valuation in hospice is driven less by the multiple than by how much of the purchase price survives diligence. Sellers who prepare capture the difference.

  • Calculate your cap position by cap year and have the workpapers ready. An unquantified cap liability becomes an escrow, and escrows are priced pessimistically.

  • Reconcile claims data to the general ledger for the trailing 36 months. Unexplained variance reads as billing risk.

  • Clean up recertification documentation on your longest-staying patients before a buyer samples it.

  • Run owner and managing-employee exclusion screening on your own organization first.

  • Confirm quality-reporting compliance for every applicable period. A missed submission is a durable rate reduction.

  • Normalize your EBITDA properly — owner compensation, related-party rent, and non-recurring items are where sellers lose credibility fastest.

  • Determine which deal structures the moratorium permits for your specific ownership situation before going to market.

  • Document your referral sources and admission criteria. Concentration risk is a pricing input.

Most of this is not transaction work; it is bookkeeping and cost-report discipline done consistently enough that a buyer's accountants can tie it out in days rather than months. A hospice whose cost reports already agree with its claims data and its ledger closes faster and gives up less in escrow.

The Bottom Line

The 2026 hospice M&A market is the strongest it has been since 2022, and it is also the most selective. Buyers are paying up for clean enrollments — partly because the moratorium made them scarce — and discounting hard for cap exposure, documentation gaps, and ownership history they cannot verify. Sellers who spend the next twelve months making their numbers provable will not just get a better multiple; they will get a deal that actually closes. If you are preparing to buy or sell a hospice and want the cap position and quality of earnings worked out before you go to market, schedule a free consultation.

Sources

Last updated: September 2026.

Soriaga & Associates, LLC is a CPA firm with 25+ years of hospice and home health accounting, cost reporting, and transaction due-diligence experience.

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About the Author

Christian Soriaga, CPA is a partner of Soriaga & Associates, LLC — a CPA firm in Lisle, IL specializing in home health, hospice, home care, wound care, and dental practice accounting. With 25+ years serving healthcare and home-care agencies across Chicagoland, Christian helps agency owners navigate Medicare cost reports, payroll, tax planning, and fractional CFO services.

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