The hospice home health moratorium began May 13, 2026, when CMS froze new Medicare enrollment for home health agencies and hospices nationwide. (https://rhislop3.com/cms-moratorium-on-hospices-and-home-health/ ). The freeze runs out November 13, about five and a half weeks away, and CMS hasn’t said whether it will extend it.
Coverage has focused on the regulatory question. For anyone with a merger or acquisition in motion, the question that matters is what each outcome does to timing, structure and price.
Where the hospice home health moratorium stands
CMS imposed the freeze through two Federal Register notices published May 15 (2026-09717 for home health, 2026-09718 for hospice). Under 42 CFR 424.570(b), each can be extended in six-month increments, and any extension or lifting is announced by Federal Register notice. CMS Announces Aggressive Nationwide Crackdown on Fraud with Six-Month Hospice and Home Health Agency Enrollment Moratoria | CMS
In July, CMS’s acting Center for Program Integrity director said the agency would give 60 days’ notice of an extension. That window closed in mid-September, and as of early October no notice has been published. CMS has no formal obligation to announce before the term ends, so silence is a signal, not a promise.
Two precedents pull in opposite directions:
- DMEPOS lapsed. CMS let the February 27 DMEPOS moratorium expire on August 27.
- Earlier home health moratoria were renewed. Geographically targeted moratoria begun in 2013 were extended repeatedly until they expired in January 2019. This time CMS considered a narrower approach and chose a nationwide one.
LeadingAge, which had backed the freeze, and the National Alliance for Care at Home have both urged CMS to let it expire. They argue fraud is concentrated in specific metro areas, not nationwide.
The freeze doesn’t stop all deals. The 36-month rule decides which ones.
The moratorium doesn’t shut down hospice and home health M&A. It blocks any transaction that requires a new initial Medicare enrollment, and the 36-month rule is what triggers one: since 2024, a non-exempt change in majority ownership within 36 months of initial enrollment or the last such change forces the agency to enroll as new. eCFR :: 42 CFR 424.550 — Prohibitions on the sale or transfer of billing privileges.
In practice:
- Likely blocked: majority-ownership changes inside the 36-month window, and asset deals that create a new entity without assuming the seller’s Medicare provider agreement.
- Generally able to proceed: equity deals outside the window, transactions at the grandparent level or higher, and deals that qualify for a 36-month-rule exception.
Two cautions. Sources disagree on stock purchases: one valuation advisory calls them frozen, while most legal commentary says properly structured equity deals proceed. And the scope of the exceptions is ambiguous, with no established CMS guidance. Treat this as a question for counsel.
Three outcomes, three different deal environments
The odds below are my own rough judgment from the evidence above, not sourced figures.
1. Full lapse, possibly with other safeguards (about 40%). Window-locked targets become sellable again and a backlog of deferred deals surfaces. De novo entry reopens, which should compress the scarcity premium on existing enrollments. CMS keeps other tools (capitalization requirements, high-risk screening, provisional enhanced oversight), so a lapse wouldn’t mean a return to the old environment.
2. Full nationwide extension (about 35%). This takes only a Federal Register notice, not rulemaking. Window-locked targets stay illiquid for at least six more months, buyers keep favoring equity and indirect structures, and the premium on existing enrollment holds. Buyers should treat an extension as a live possibility, not assume a November reopening.
3. Narrowed or split extension (about 25%). With two separate notices, CMS could extend hospice and release home health (or the reverse), or limit the freeze to higher-risk geographies. Hospice, facing its first-ever moratorium, is arguably likelier to stay frozen. A split would make valuations diverge by service line and complicate multi-state platforms.
The tension at the center of the decision
One valuation advisory treats an existing Medicare enrollment as an option with real value in a closed-entry market. A lapse erodes it, which sets up opposing incentives:
- Sellers with clean structures may want to close before November 13, while scarcity is priced in.
- Buyers may prefer to wait, especially on targets inside the 36-month window that can’t trade today.
- Growth-minded operators can’t add branches or practice locations during the freeze, so acquisitions may be their only route. That raises demand for exactly the deals the 36-month rule restricts.
An article in Hospice News put the mixed effect plainly: the moratorium may have helped somewhat on scarcity, but the 36-month rule has made hospice deals hard to execute. A good resource is here: Selling a Home Health, Hospice, or Home Care Agency in 2026
What to do before November 13
These are my suggestions to discuss with deal counsel,
- Map ownership history first. For every target, document the initial enrollment date and the last change in majority ownership. Anything inside 36 months needs a structure review.
- Don’t plan around a clean signal. The notice could land before, on or after November 13. Build timelines that work either way.
- Write the uncertainty into the contract. Options include outside dates, closing conditions tied to the outcome, price adjustments or earnouts keyed to enrollment status, and sign-now-close-later structures.
- Expect scrutiny of structuring. Law firms reviewing the DMEPOS experience say CMS applies the 36-month rule rigorously.
- Watch the proposed rule. The CY 2027 Home Health PPS proposed rule would extend the ownership-change carve-out to hospices and DMEPOS suppliers, which CMS describes as codifying existing policy.
The bottom line
November 13 is a regulatory date that works as a pricing event for dealmakers. The outcome decides whether existing enrollments keep their scarcity premium, whether window-locked targets can trade, and whether growth-minded buyers can expand only by acquisition. Whichever way CMS goes, the deals that hold up will be built for both outcomes.
