Last updated: November 2026
California restricts new home health agency (HHA) and hospice licenses under separate moratoria. Integral Healthcare Solutions (IHS) drafts HHA unmet-need exception requests and licensing-readiness materials for applicants and existing agencies. Clients approve and submit the materials; the California Department of Public Health (CDPH) decides.
What is the California HHA licensing moratorium?
It is a statutory bar on new HHA licensure created by Senate Bill (SB) 164 (Chapter 27, Statutes of 2026), under Health and Safety Code Division 2, Chapter 8, commencing with Section 1725. The CDPH All Facilities Letter 26-28 (August 27, 2026; page opened 2026-11-05) says it began June 29, 2026 and runs until no later than 90 days after the effective date of the revised HHA regulations CDPH must adopt under the bill. CDPH may not issue a new initial license or approve the addition of a branch office to an existing license. The CDPH home health agency initial application page (page opened 2026-11-05) adds that a change of geographical service area, or of location outside the approved service area, is also subject to it. Renewals and other report-of-change applications, such as a change of mailing address, are not affected.
The CDPH 2026-27 license fee table (page opened 2026-11-05) lists 4,266 HHAs and 2,624 hospices, excluding state facilities.
Can anyone still get a new license?
Yes, through an exception. CDPH may grant one during the moratorium after making a written finding that the applicant has demonstrated unmet need for HHA services in the proposed service area, based on the concentration of all existing HHA services in that area. The letter includes applicants whose applications were pending on June 29, 2026.
After June 29, 2026, new HHA applicants send CAB unmet-need justification and evidence. CAB must find unmet need before inviting an application. Provisional and accreditation-route licensure also require unmet need; CDPH may request more evidence. For applications pending on June 29, 2026, CDPH specified automatic withdrawal if, by October 9, 2026, the applicant had not submitted notice of intent to withdraw, justification and supporting unmet-need documentation, or intent to continue the CHOW process. That deadline has passed.
What new requirements apply to agencies?
- Management personnel. An HHA must have an administrator, an administrator designee, a director of patient care services (DPCS) and a DPCS designee. For each it submits HS 215A (or its successor), a resume and all licensed facilities and HHAs where the person currently serves as management personnel: with the initial application, within 10 business days of a change, and, for currently licensed HHAs, once by March 31, 2027. A branch office of a parent HHA is exempt.
- Ownership fingerprints. A private HHA applicant must submit California Department of Justice fingerprints for anyone holding a 5 percent or greater interest in the owning entity.
- More grounds for denial, suspension or revocation, including the applicant's or licensee's presence on the HHS Office of Inspector General List of Excluded Individuals/Entities and failure to report a change in owner, management personnel, service area or location.
- Regulations. CDPH must adopt rules that include staff travel time and distance, how many HHAs management personnel may serve at once, and office space.
What about buying an existing agency?
State and federal rules both limit it. AFL 26-28 also allows CDPH to except a continuing HHA's change of ownership (CHOW) from the geographic-need requirement if the HHA previously met or can demonstrate it currently meets that requirement. CDPH may not approve a CHOW of a licensed HHA within five years of the date the license was first issued. CDPH may make an exception for extenuating circumstances if the HHA proves either a need to ensure continuity of care for existing patients, or both a financial hardship and that, if it closed, there would be an unmet need for HHA services in its service area. Under 42 CFR 424.550(b) (current text opened 2026-11-05), a change in majority ownership of an HHA or hospice by sale within 36 months after initial Medicare enrollment, or after the most recent change in majority ownership, means the provider agreement and billing privileges do not convey to the new owner unless an exception applies (for example, submission of two consecutive years of full cost reports since initial enrollment or the last change in majority ownership, whichever is later; low-utilization and no-utilization reports do not qualify). A non-exempt buyer must enroll anew and obtain a state survey or approved accreditation; the CMS notice below says the moratorium blocks that HHA reenrollment.
Does the moratorium apply to hospice?
Yes, a different one does. The CDPH hospice initial application page (page opened 2026-11-05) describes a bar, created by SB 664, on new hospice licenses on or after January 1, 2022, and until 365 days from the date the State Auditor publishes a report on hospice licensure. All Facilities Letter 25-04 (February 3, 2025; page opened 2026-11-05) says AB 177 extended it until January 1, 2027, or until one year after the date of adoption of the emergency regulations, and that renewals and other reports of change, including ownership changes, are unaffected by that moratorium. Additional locations, service-area changes and moves outside the approved service area remain subject to it. Confirm the current end date with CDPH.
All Facilities Letter 26-20 (June 26, 2026; page opened 2026-11-05) says hospice emergency regulations took effect June 22, 2026. Title 22 CCR, Division 5, Chapter 6.5, Articles 1-5 requires nursing services in person within two hours of notice of a medical need or safety concern, at any hour. Office space must be exclusive and unshared, in a commercial building owned by the licensee or leased or subleased exclusively for at least 12 consecutive months.
How does the federal Medicare moratorium differ?
It is a separate approval with a separate clock. The CMS notice of May 15, 2026 (page opened 2026-11-05) announces a six-month nationwide moratorium on Medicare enrollment of new HHAs, effective May 13, 2026, covering new HHAs, branches and practice locations unless the application reached the Medicare contractor before that date. Under 42 CFR 424.570 (current text opened 2026-11-05), CMS may extend a moratorium in six-month increments. CMS publishes a Federal Register document when it extends one, so confirm the current status there.
Who needs this and what triggers it
- A person who wants to open an HHA.
- A licensed HHA with a March 31, 2027 personnel filing.
- A buyer or seller weighing the five-year and 36-month tests.
- A hospice under the June 2026 emergency regulations.
How IHS helps
- Moratorium and exception assessment. We map the plan against the CDPH letter and list what counsel must confirm.
- Exception request drafting. We draft the unmet-need narrative and evidence list for the applicant to review, change and mail to CAB.
- Packet and personnel drafting. We prepare the policies, organizational materials and management-role files the CDPH packet points to.
- Mock review. We review draft materials and planned operations before submission and prepare corrections for client approval.
The client supplies market evidence, ownership records, staffing credentials, premises and financial records, and clinician approval of clinical content. IHS drafts materials; the client approves them.
CDPH decides. IHS gives no legal conclusions and does not submit materials or contact CDPH; the applicant does.
What to have ready
Checklist sources opened 2026-11-05.
- Identify the proposed HHA license or change under AFL 26-28 (August 27, 2026).
- Prepare HHA geographic unmet-need evidence under AFL 26-28.
- Prepare the four management-role files: HS 215A or successor, resume and current management appointments at licensed facilities and HHAs (AFL 26-28).
- For private HHA applicants, identify people with at least 5 percent ownership for fingerprinting (AFL 26-28).
- Check forms applicable to the proposed application against CDPH’s current HHA packet, including any Medicare enrollment forms.
- For acquisitions, collect initial license, initial Medicare enrollment and most recent majority-ownership-change dates; assess exceptions (AFL 26-28; current 42 CFR 424.550(b)).
- For hospice, assemble service-area calculations, personnel qualifications and office-control evidence under AFL 26-20 (June 26, 2026), addressing Title 22 CCR, Chapter 6.5.
When the list is mostly checked, the next step is a free introductory call to scope the work.
How it compares
| Item | What it is | Where to read more |
|---|---|---|
| Exception request | The route CDPH says to begin with for new HHA licensure after June 29, 2026. | CDPH All Facilities Letter 26-28 |
| Nonmedical home care organization license | A separate service topic: nonmedical home care organization licensing. | IHS's California home care organization licensing page. |
| Accreditor choice | Accreditation and state licensure are distinct; AFL 26-28 also covers licensure through accreditation. | IHS's home health and hospice page. |
What it costs
The CDPH 2026-27 license fee table lists the annual license fee for a home health agency at 2,946 dollars statewide for 2026-27, plus a Los Angeles County supplemental fee of 2,103 dollars. For a hospice it lists 2,780 dollars for a two-year license, plus 2,275 dollars in Los Angeles County. The supplemental fee does not apply to facilities outside Los Angeles County Department of Public Health regulation. Verify current fees with CDPH. IHS scopes each engagement after a free introductory call.
What this is not
- IHS does not guarantee a license or that CDPH will grant an exception.
- It is not legal advice. IHS is a consulting firm, not a law firm.
- It is not a filing service. IHS does not submit to or deal with CDPH for the applicant.
Frequently asked questions
Can I get a new California home health agency license right now?
Not in the ordinary way. CDPH may not issue a new initial HHA license, a bar that began June 29, 2026 and lasts until no later than 90 days after the revised HHA regulations take effect. CDPH says to begin with an exception request.
What does the SB 164 moratorium cover?
New initial licenses and the addition of a branch office. Changes of service area and moves outside the approved service area are subject to it too. Renewals and other reports of change are not affected.
How do I request an exception?
Send the Centralized Applications Branch (CAB) a written justification and supporting documentation of unmet need in the proposed service area, based on the concentration of all existing HHA services there. IHS drafts the narrative and evidence list; the applicant reviews and mails it.
What management personnel must an HHA name?
An HHA needs an administrator, administrator designee, DPCS and DPCS designee; parent-HHA branch offices are exempt. Each role requires HS 215A or successor, a resume and current management appointments at licensed facilities and HHAs. Submit these with the initial application, within 10 business days of personnel changes and, for currently licensed HHAs, once by March 31, 2027.
Does the moratorium apply to hospice?
Yes, a separate one does. CDPH's hospice page describes a bar on new hospice licenses from January 1, 2022 until 365 days after the State Auditor publishes a report on hospice licensure. A 2025 CDPH letter says AB 177 extended it until January 1, 2027, or until one year after the date of adoption of the emergency regulations.
Can I buy an existing California home health agency?
Not freely. CDPH may not approve a change of ownership within five years of the date the license was first issued, subject to exceptions for extenuating circumstances: continuity of care for existing patients, or both financial hardship and unmet need if the agency closed. A separate federal 36-month test applies to changes in majority ownership.
When does the California HHA licensing moratorium end?
No later than 90 days after the effective date of the revised HHA regulations CDPH must adopt under SB 164. The letter gives no calendar date.
How does this differ from the Medicare enrollment moratorium?
They are separate approvals. CMS imposed a six-month nationwide Medicare enrollment moratorium on new HHAs effective May 13, 2026, extendable in six-month increments.