Hospice & palliative care

Choosing a Hospice in Texas: Reading the Public Data

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Texas's hospice market looks different depending on where you stand: Dallas and Houston have dozens of competing agencies with no license cap in sight, while a family in the Panhandle or the Rio Grande Valley may be choosing between one or two options reachable by a long drive. Here is how the state's regulatory quirks, its Medicaid rules, and its rural geography change what the standard vetting method turns up, and where to check a specific agency's record before enrolling.

Last updated: July 2026

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Start with Care Compare, then read what makes Texas's list different

The starting point for judging hospice quality in Texas is the same as anywhere else: Medicare's Care Compare tool, searchable by county or ZIP code, lists every Medicare-certified hospice serving that area along with its CAHPS Hospice family-experience scores 1. What changes in Texas is what that list looks like once it loads — and why.

Texas has no Certificate of Need law, so nothing requires a new hospice to prove unmet need in a county before opening and seeking Medicare certification. In a state this large, that produces a genuinely long list in many counties — more names to sort through, not fewer — and a stronger reason to lean on CAHPS Hospice scores and live-discharge data rather than picking whichever agency calls back first. The same Care Compare search that works for a family in Amarillo works identically for a family in Houston; only how long the results run differs.

The other Texas: hospice access outside the big metros

Outside Dallas, Houston, San Antonio, and Austin, hospice access in Texas depends heavily on distance. Vast rural stretches — the Panhandle, the Permian Basin, the rural counties of the Rio Grande Valley, deep East Texas — are often served by only one or two agencies, and a single hospice may cover several counties at once.

That geography matters most for the more intensive levels of Medicare hospice care — continuous home care for a brief crisis, and general inpatient care for symptoms that can't be managed at home 2. A hospice licensed to serve a five- or six-county rural stretch may still concentrate its clinicians near its home office, so it's worth asking directly how far a nurse would have to drive to reach a specific address during a middle-of-the-night crisis, not just whether the county is listed as covered. Some rural Texas hospices contract with a nearby hospital for inpatient beds rather than running their own unit, which can add another layer of travel when a patient's symptoms need more support than a home visit can provide.

Texas Medicaid's narrower eligibility, and what it means for hospice

Medicaid covers hospice care for enrollees who qualify in every state, including Texas 3. Texas has not expanded Medicaid eligibility under the Affordable Care Act, so its program reaches a narrower group than in expansion states — mainly children, pregnant women, parents who meet strict income limits, and people with disabilities, rather than any low-income adult under 65.

For a family without Medicare, without private insurance, and without a Medicaid category that fits, hospice for the uninsured in Texas typically runs through a hospice's own charity-care policy — worth asking about directly during an intake call, since terms vary by agency and coverage isn't guaranteed. For Medicaid enrollees who also live in a nursing facility, Medicaid generally pays a room-and-board rate to the hospice on the resident's behalf, though the specific arrangement is worth confirming with the facility, since the mechanics vary by state 4.

Ownership matters more when the list is long

With a Texas county's Care Compare list often running long, ownership status is a useful first filter before comparing every name individually. Nationally, family caregivers have rated for-profit hospices lower across every CAHPS Hospice domain than nonprofit hospices, and less likely to recommend them 5, and problematic live discharges — a patient sent off hospice while still declining — are more common at for-profit agencies 6.

Ownership is public on Care Compare and is not destiny — plenty of for-profit hospices score well — but with dozens of similarly sized agencies competing across the Dallas–Fort Worth, Houston, and San Antonio metros, sorting for higher CAHPS scores and a lower live-discharge rate first is faster than calling down an alphabetical list. The same filter works in a smaller Texas county with only two or three agencies; there just isn't as much sorting to do.

Checking a license or filing a complaint with Texas HHSC

The Texas Health and Human Services Commission licenses and inspects every hospice operating in the state and is the place to check a license history or file a complaint about a specific agency's care, separate from Medicare's own hospice complaint process. That state-level record can surface a finding that Care Compare's national quality measures don't capture.

Asking a hospice directly how it handles complaints, and whether it has had any recent state findings, is a fair question during an intake call — a hospice that answers plainly is telling a family something useful, and one that deflects is telling them something too. The same checks apply identically to choosing a hospice in California or choosing a hospice in Florida; only the state agency's name and the local geography change.

Common questions

No. Texas has no Certificate of Need law, so a new hospice does not need to prove unmet demand before opening and seeking Medicare certification. That keeps Care Compare lists long in most Texas counties, including rural ones, which makes comparing CAHPS Hospice scores and live-discharge rates more useful than it would be in a state with a tighter cap.

Yes. Outside the state's big metros, a single hospice agency may cover several rural counties at once, particularly in the Panhandle, the Permian Basin, and parts of South Texas. It's worth asking any agency directly how far a nurse would need to drive to reach a specific address during a crisis, not just whether the county is technically covered.

Yes, for enrollees who qualify, but Texas has not expanded Medicaid under the Affordable Care Act, so its eligibility rules are narrower than in expansion states. A family that doesn't fit an eligibility category may need to ask a hospice about its own charity-care policy for the uninsured instead.

Not automatically, but ownership correlates with real national differences: family caregivers have rated for-profit hospices lower on CAHPS surveys, and problematic live discharges are more common at for-profit agencies. In a state with as many competing agencies as Texas, checking a specific agency's own scores is a faster filter than assuming based on tax status alone.

The Texas Health and Human Services Commission licenses and inspects hospices operating in the state and is the place to check a license history or file a complaint. Medicare's Care Compare is a separate, useful check for CAHPS Hospice scores and other quality measures on any Medicare-certified hospice.

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When a hospice's answers should give you pause

  • —The intake team can't say who answers the clinical phone line overnight or on weekends.
  • —Nobody at the agency can produce or explain its CAHPS Hospice scores or its live-discharge rate when you ask.
  • —You're pressured to sign enrollment paperwork before comparing even one other agency, even in a county with several options.
  • —The person describing the plan of care is a marketer, not a nurse or clinician.

If the patient is in crisis and the hospice's on-call clinical line can't be reached, call 911 or go to the nearest emergency department — hospice enrollment does not replace 911 for a life-threatening emergency.

This article explains how to read publicly available hospice quality data for Texas. It does not recommend, rank, or claim availability of any specific hospice agency, and it is not a substitute for guidance from a hospice's clinical team or the patient's physician.

References

  1. 1.Centers for Medicare & Medicaid Services (2024). Find Healthcare Providers: Compare Care Near You (Hospice). Medicare.gov / Care Compare (CMS). link ✓That Care Compare is the official public tool for comparing Medicare-certified hospices by location, including CAHPS Hospice family-experience scores.
  2. 2.Centers for Medicare & Medicaid Services (2024). Medicare-Certified 4 Levels of Hospice Care. Medicare.gov / Care Compare (CMS). link ✓The definitions of continuous home care for a brief crisis and general inpatient care for symptoms that can't be managed at home.
  3. 3.Centers for Medicare & Medicaid Services (2024). Hospice Benefit Toolkit. Centers for Medicare & Medicaid Services (CMS). link ✓That Medicaid covers hospice care for people who qualify, as part of the general framing of the Medicare/Medicaid hospice benefit structure.
  4. 4.Centers for Medicare & Medicaid Services (2024). Hospice Payments (Medicaid). Medicaid.gov (CMS). linkThat for dually eligible nursing-facility residents, Medicaid generally pays a room-and-board rate to the hospice on the resident's behalf, and that the mechanics vary by state.
  5. 5.Anhang Price R, Parast L, Elliott MN, et al. (2023). Association of Hospice Profit Status With Family Caregivers' Reported Care Experiences. JAMA Internal Medicine. doi:10.1001/jamainternmed.2022.7076 ✓That family caregivers report worse care experiences across all CAHPS Hospice domains at for-profit than not-for-profit hospices, and are less likely to recommend them.
  6. 6.Teno JM, Plotzke M, Christian T, Gozalo P (2015). Characteristics of Hospice Programs With Problematic Live Discharges. Journal of Pain and Symptom Management. PMID 26004403That problematic (burdensome) live-discharge patterns are far more common at for-profit than not-for-profit hospices.

6 sources, numbered by first appearance. General health information, not medical advice. AI-assisted editorial content — citations link their sources. Editorial policy

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