Hospice Care Quality and Spending Vary Widely by State
New data released by the Centers for Medicare & Medicaid Services (CMS) on February 18, 2026, reveals significant disparities in hospice care quality and per-beneficiary spending across the United States. California and Nevada hospice providers demonstrated the lowest care-quality scores despite having the highest per-beneficiary spending between January 1, 2023, and December 31, 2024. Conversely, Rhode Island and West Virginia achieved the highest quality scores during the same period.
CMS Hospice Quality Reporting Program
The CMS’ Hospice Quality Reporting Program (HQRP) gathers data from multiple sources, including direct submissions from hospice providers, Medicare hospice claims, and the Hospice Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. This comprehensive approach aims to provide a clearer picture of the care delivered to hospice patients nationwide.
State-by-State Breakdown of Hospice Quality and Spending (2023-2024)
The following table details the hospice care quality scores and per-beneficiary spending amounts by state, as reported by CMS:
| State | Hospice Care Index Overall Score | Per-beneficiary spending |
|---|---|---|
| Alabama | 9.3 | $16,588 |
| Alaska | 8.8 | $13,013 |
| Arizona | 8.8 | $19,693 |
| Arkansas | 9.4 | $14,880 |
| California | 8.3 | $26,927 |
| Colorado | 9.5 | $15,010 |
| Connecticut | 9.6 | $13,702 |
| Delaware | 9.5 | $16,216 |
| District of Columbia | 8.3 | $16,270 |
| Florida | 9.7 | $15,498 |
| Georgia | 8.8 | $17,489 |
| Hawaii | 9.6 | $16,248 |
| Idaho | 9.3 | $15,675 |
| Illinois | 9.1 | $15,181 |
| Indiana | 9.4 | $15,110 |
| Iowa | 9.5 | $11,469 |
| Kansas | 9.1 | $14,806 |
| Kentucky | 9.2 | $8,963 |
| Louisiana | 8.7 | $16,633 |
| Maine | 9.5 | $14,401 |
| Maryland | 9.7 | $12,484 |
| Massachusetts | 9.2 | $17,496 |
| Michigan | 9.0 | $16,300 |
| Minnesota | 9.2 | $15,390 |
| Mississippi | 8.6 | $17,427 |
| Missouri | 9.0 | $14,795 |
| Montana | 8.9 | $11,921 |
| Nebraska | 9.2 | $11,522 |
| Nevada | 8.1 | $21,733 |
| New Hampshire | 9.7 | $14,753 |
| New Jersey | 9.2 | $16,230 |
| New Mexico | 9.0 | $13,829 |
| New York | 9.2 | $11,765 |
| North Carolina | 9.5 | $14,453 |
| North Dakota | 9.3 | $9,600 |
| Ohio | 9.3 | $16,297 |
| Oklahoma | 8.7 | $15,649 |
| Oregon | 9.0 | $14,820 |
| Pennsylvania | 9.0 | $14,102 |
| Rhode Island | 9.8 | $15,028 |
| South Carolina | 9.1 | $16,788 |
| South Dakota | 9.0 | $10,390 |
| Tennessee | 9.6 | $13,528 |
| Texas | 8.4 | $19,852 |
| Utah | 9.2 | $16,794 |
| Vermont | 9.4 | $13,204 |
| Virginia | 9.2 | $14,079 |
| Washington | 9.0 | $13,612 |
| West Virginia | 9.8 | $12,734 |
| Wisconsin | 9.4 | $16,880 |
| Wyoming | 9.2 | $10,410 |
Recent Oversight of Hospice Agencies
Federal regulators have increased oversight of hospice agencies in Arizona, California, Nevada, and Texas due to reports of fraud, waste, and abuse, and concerns about market oversaturation. ProPublica investigations highlighted issues such as hospices sharing addresses and owners, selling licenses, and billing for nonexistent patients. The Centers for Medicare & Medicaid Services (CMS) is implementing a 12-month provisional period of enhanced oversight for new hospice agencies in these states, including prepayment review of claims, to address these concerns. Polsinelli and National Law Review provide further details on this enhanced oversight.
This data underscores the importance of continued monitoring and quality improvement efforts within the hospice care system to ensure patients receive appropriate and effective end-of-life care.
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