Hospice & palliative care

Choosing a Hospice in Virginia: Reading the Public Data

Save

Virginia requires a Certificate of Public Need before a new hospice can open, one of the country's most stringent such reviews, and it draws most of its hospice agencies toward Northern Virginia, Richmond, and Hampton Roads, leaving Southside and far Southwest Virginia thinner on options. Virginia also expanded Medicaid in 2019 after years of political fights over it. Here is how those specifics change the standard vetting method for this state.

Last updated: July 2026

Talk to a clinician

Gale can help you find a clinician in your state and request a visit.

Find care →

Start with Care Compare — then read Virginia's Certificate of Public Need

The starting point for judging hospice quality in Virginia is the same tool used everywhere: Medicare's Care Compare, searchable by county or city, which lists every Medicare-certified hospice serving that area along with its CAHPS Hospice family-experience scores 1. Virginia requires a Certificate of Public Need, its own name for a Certificate of Need law, before a new hospice can open, and Virginia's version has historically been among the strictest in the country.

That review process has kept Virginia's hospice field more concentrated than it would be under no cap at all, which makes each agency's actual numbers — its CAHPS scores, its live-discharge rate — worth pulling before assuming any name on the list is a safe default. It has also made Virginia's Certificate of Public Need law a recurring subject of legislative reform debates over the years, with lawmakers periodically narrowing which services it covers.

Northern Virginia, Richmond, and Hampton Roads versus Southside and the coalfields

Virginia's hospice agencies are concentrated in its dense corridors — Northern Virginia's DC suburbs, Richmond, and the Hampton Roads metro — while Southside Virginia and the far Southwest coalfield counties near the Kentucky and West Virginia borders generally have fewer agencies and longer distances for a nurse or aide to reach a patient's home.

That gap matters most for the hospice levels of care meant for a crisis rather than routine visits — continuous home care and general inpatient care both depend on how quickly a clinician can reach the patient 2. A family in far Southwest Virginia served by only one or two agencies should ask directly how that agency staffs crisis-level visits across a rural, mountainous service area, rather than assuming the same response time a Northern Virginia family would get.

Virginia's independent cities change how a search works

Virginia is one of the only states where cities can be legally independent of any county, and Richmond, Norfolk, Virginia Beach, Alexandria, and dozens of others are structured this way. A Care Compare search by county alone can miss agencies serving a nearby independent city, so it's worth searching by ZIP code or by the city's name directly rather than by county alone.

This is a genuine quirk of Virginia's map, not a technicality: roughly a third of Virginians live in an independent city rather than a county, and hospices routinely serve both a city and its surrounding county under one license. A search that returns nothing for a county name may simply mean the right search term was the city instead.

Virginia expanded Medicaid in 2019, after years of debate

Virginia expanded Medicaid eligibility under the Affordable Care Act in 2019, following years of legislative fights over the decision, and Medicaid covers hospice care for enrollees who qualify 3. That expansion reaches more low-income Virginia adults than the state's Medicaid program covered before 2019, though specific income limits and categories still determine who qualifies.

For a family without Medicare, without private insurance, and without a Medicaid category that fits, hospice for the uninsured in Virginia typically still runs through a hospice's own charity-care policy — worth asking about directly, since coverage isn't guaranteed and terms vary by agency. 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, since the mechanics vary by state 4.

Ownership and CAHPS in a Certificate-of-Public-Need state

Where Virginia's Certificate of Public Need law has limited how many hospices compete in an area, ownership status and CAHPS Hospice scores are a fast way to sort the names that remain. 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 are more common at for-profit agencies 6.

Ownership is public on Care Compare and isn't destiny on its own, but in a state where the field is already narrower than in a no-cap state, it's a reasonable first filter before calling — and a low score or an unusually high live-discharge rate is a fair reason to ask harder questions of a specific agency.

Checking a license or filing a complaint with Virginia's Office of Licensure and Certification

The Virginia Department of Health's Office of Licensure and Certification licenses and inspects hospices operating in the state, across both counties and independent cities, and is the place to check a license history or file a complaint, separate from Medicare's own hospice complaint process.

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 anywhere in Virginia, whether the agency serves a Northern Virginia county or an independent city like Richmond. The same checks apply identically to choosing a hospice in Wisconsin or choosing a hospice in Maryland; only the state agency's name and the local geography change.

Common questions

Yes. Virginia requires a Certificate of Public Need, its own name for a Certificate of Need law, before a new hospice can open, and it has historically been one of the country's strictest such reviews. That keeps the hospice field more concentrated than in a state with no cap, which makes comparing each agency's CAHPS Hospice scores worthwhile.

Virginia is one of the few states where cities are legally independent of any county, and Richmond, Norfolk, Virginia Beach, and dozens of others are structured this way. A Care Compare search by county alone can miss agencies, so searching by ZIP code or by the city's name directly is worth trying if a county search comes up short.

Yes. Virginia expanded Medicaid under the Affordable Care Act in 2019, reaching more low-income adults than its program covered before, and Medicaid covers hospice for enrollees who qualify. A family that doesn't fit an eligibility category may still need to ask a hospice about its own charity-care policy.

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 where Certificate of Public Need review has narrowed the field, checking each agency's own scores is a fast, worthwhile filter.

The Virginia Department of Health's Office of Licensure and Certification licenses and inspects hospices in the state and is the place to check a license or file a complaint. Medicare's Care Compare is a separate, useful check for CAHPS Hospice scores and other quality measures.

Related

Say it back

How would you explain this to someone you love?

Two or three sentences, just as you’d say it. Gale reflects back what you focused on — a mirror, not a quiz.

Talk to a clinician

Gale can help you find a clinician in your state and request a visit.

Find care →

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.
  • —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 Virginia. 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

← Back to the health library