On May 13, 2026, the Centers for Medicare & Medicaid Services (CMS) announced two six-month nationwide moratoria prohibiting new home health agencies (HHAs) and hospices from enrolling in Medicare. The moratoria follow the near-identical six-month nationwide enrollment moratorium of certain durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) companies. Given the immediate effect of the enrollment bans, HHA and hospice providers seeking to expand their businesses need to understand how the moratoria will force them to adjust their acquisition strategies and may negatively impact their businesses.
Preventing Fraud at the Front End: CMS’s Use of Enrollment Moratoria
Through the Affordable Care Act, Congress authorized CMS to temporarily pause the enrollment of new fee-for-service Medicare, Medicaid, or State Children’s Health Insurance Program (CHIP) providers and suppliers if necessary to prevent or combat fraud, waste, and abuse. CMS first implemented this authority in July 2013 when it issued six-month enrollment moratoria on new HHAs and ambulance suppliers in specific geographic areas. These moratoria were extended numerous times, widened in geographic scope, and ultimately ended almost six years later in January 2019. CMS did not use this authority again until February 2026 when it imposed a nationwide six-month moratorium on new DMEPOS suppliers considered “medical supply companies.”
Across administrations, CMS has consistently identified HHAs as posing a high risk of fraud, waste, and abuse. Hospices, initially deemed as having a moderate risk of fraud, waste, and abuse, joined HHAs (and DMEPOS suppliers) in the high-risk category in 2024. Throughout 2025 and continuing into 2026, CMS Administrator Mehmet Oz has frequently highlighted examples of fraud in these sectors in his public statements, and CMS cited examples of both criminal and civil enforcement actions in both moratoria. CMS also highlighted the geographic areas where the growth in HHA and hospice providers appears grossly disproportionate to the Medicare beneficiary population.
What Is Covered: Understanding the Breadth of CMS’s Moratoria
Effective May 13, 2026, no new HHAs, HHA branches, or HHA practice locations may be enrolled in Medicare. CMS explicitly includes HHA “branch offices” within the moratorium, even though these locations do not require separate Medicare enrollment. CMS states that it has long considered HHA branches to be a practice location of the HHA and that they are covered by CMS’s moratorium authority under 42 C.F.R. 424.570(a)(1)(i). Past moratoria included HHA “subunits”; however, CMS terminated the “subunit” designation in 2018, and it is not part of the current moratorium.
Likewise, no new hospices or hospice practice locations may be enrolled in Medicare. As with HHAs, hospice practice locations do not require new enrollments, but CMS is likely relying on its moratorium authority in Section 424.570(a)(1)(i) that permits it to impose restrictions on new practice locations.
Both HHAs and hospice providers are subject to the 36-month rule. Under that rule, an HHA or hospice provider that undergoes a nonexempt change in majority ownership (CIMO) within 36 months of its initial Medicare enrollment or its last CIMO must enroll as a new provider and undergo a state survey or accreditation. As a result, an HHA or hospice provider undergoing a nonexempt CIMO during the moratoria cannot re-enroll in Medicare as that provider type.
The moratoria apply nationwide, covering all 50 states, territories, and the District of Columbia. Although the moratoria are effective for six months, CMS may extend the moratoria in successive six-month periods, which the agency has repeatedly done in the past.
Key Exceptions: Understanding the Limits of the Moratoria
- Changes in practice location.
- Changes in provider or supplier information, such as phone number or address.
- Changes in ownership (except changes in ownership that require the new owners to submit a new enrollment application).
Finally, the moratoria will not prevent the processing or approval of enrollment applications for HHA or hospice providers that were pending and submitted before May 13, 2026.
Planning Ahead: Implications for Providers, Suppliers, and Investors
Providers, suppliers, and investors should consider several key implications.Shift away from pay-and-chase
These moratoria emphasize CMS’s continued dedication to moving away from the “pay-and-chase” model of fraud prevention. Expect more proactive fraud prevention strategies from CMS, including a proposed rule on new techniques to reduce fraud, waste, and abuse later this year.High likelihood of extensions
Expect the moratoria to last longer than six months. Based on CMS’s past actions, stakeholders should plan for the possibility that the moratoria remain in place for significantly longer, particularly given CMS’s belief that the lengthy 2013–2019 HHA moratorium brought the ratio of HHAs and Medicare beneficiaries into alignment.Transaction structuring considerations
Changes in ownership involving HHA and hospice providers may not implicate the moratorium if a new enrollment application is not required. Parties should closely assess whether the proposed transaction could trigger the 36-month rule (be on heightened alert for entities that initially enrolled in Medicare within the preceding 36 months or underwent a CIMO during that period).However, changes in ownership that do not require new enrollment applications carry additional risks and considerations that may be more difficult to account for than a typical asset purchase.
Limits on growth of existing providers
The moratoria’s prohibition on home health and hospice providers adding new branches or practice locations under their existing enrollments potentially limits natural growth. Instead, home health or hospice providers may need to use acquisitions to accomplish what is not possible through organic expansion.Ongoing federal and state activity
Congress and the Administration have made fraud mitigation in health care a top priority. This builds off CMS’s recent efforts, including directing states to “undertake a swift revalidation of Medicaid providers of services at high risk of waste, fraud, abuse, and corruption” and to improve their Medicaid fraud prevention efforts in part by demonstrating that they are effectively and aggressively prosecuting Medicaid fraud. This focus on fraud, waste, and abuse in Medicaid means stakeholders must diligently monitor relevant actions at both the federal and state levels.AlstonHealth State Law Hub
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