6 states where hospice use is growing

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6 states where hospice care is growing

Hospice care is no longer something people think about only in the final days. More Americans are choosing to use hospice services earlier, and choosing it at home.

In 2023, more than half of all Medicare decedents used hospice services, according to the Medicare Payment Advisory Commission. That figure, 51.7%, is the highest seen in four years.

But some states are seeing a sharper uptick than others. Whether it’s better access, changing demographics, or policy shifts, Hospice Care highlights the six states that are leading the charge.

California: Booming growth, tighter rules

California added hundreds of new hospice providers in just one year. In fact, between 2021 and 2022, 342 new agencies were licensed. That’s a significant increase.

Texas: More hospices, more oversight

Texas has long been a hotspot for hospice expansion, especially in urban and suburban areas. In 2022 alone, the state added 75 providers, most of them for-profit.

But all that growth came with baggage. Concerns over aggressive marketing and questionable billing prompted federal officials to launch a special oversight program in parts of the state. Texas is now one of four states included in the Centers for Medicare and Medicaid Services’ pilot for pre-claim review of hospice services.

Arizona: Aging population drives demand

Arizona is aging, and fast. With more retirees settling in the state, demand for hospice care has soared. The state’s enrollment rose enough to land it on the CMS’s radar for enhanced monitoring.

In rural counties especially, providers are leaning into telehealth tools and remote monitoring to make up for long travel distances. This strategy has helped reach patients who might otherwise fall through the cracks.

Nevada: Expanding reach with virtual tools

Nevada may not have added as many hospices as California or Texas, but it’s quietly making big moves. Twenty-four new providers launched in 2022, with many focused on underserved communities.

One reason for the growth? Telehealth. Video check-ins and remote symptom tracking have allowed smaller agencies to care for patients across long distances, something especially helpful in a spread-out state like Nevada.

Michigan and Virginia: Growing beyond expectations

Neither Michigan nor Virginia are typically seen as a hospice hotbed. However, both added a surprising number of providers in a short window (12 in Michigan and 10 in Virginia), according to MedPAC.

These states are proving that hospice expansion isn’t just happening in the Sun Belt. Suburban and even some rural counties are seeing more patients enroll, and earlier in their disease progression.

Why the rise in hospice use?

A few factors are at play:

• People want different care. Some patients are rejecting aggressive end-of-life interventions and opting for comfort-focused services instead.
• Medicare is paying more. CMS approved a 2.6% increase for hospice payments in 2025.
• Technology is helping. Telehealth waivers extended through 2025 are allowing hospices to reach more patients with fewer in-person visits.
• Cultural shifts matter. Some families are getting more comfortable having tough conversations earlier, especially after the COVID-19 pandemic.

Gaps still exist

Despite the growth, not everyone is benefiting equally. RAND reports that Black and Hispanic patients are still less likely to enroll in hospice, and when they do, it’s often for shorter periods. That points to bigger issues, like language barriers, cultural misunderstandings, and trust in the system.

Experts say more education, diverse staffing, and community outreach are critical to closing those gaps.

Final word

Hospice care isn’t just for the last few days anymore. It’s becoming a regular part of how people navigate serious illness, and how families say goodbye.

States like California, Texas, and Arizona are showing what rapid expansion looks like. But they’re also revealing the challenges that come with it: oversight, equity, and making sure quality doesn’t fall through the cracks.

This isn’t just about health care. It’s about how people choose to live at the end and how they support each other in those moments.

This story was produced by Hospice Care and reviewed and distributed by Stacker.