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Texas Hospice Market Snapshot
2.4x - 3.8x
Profit multiple
$2,000,000 – $12,000,000
Typical value
900+
Hospice agencies
Very High
Buyer activity
What Makes Texas Unique
Texas has the second-highest number of hospice agencies in the US, driven by its large population, lack of CON requirements, and business-friendly regulatory environment.
The Dallas-Fort Worth metroplex is the most active hospice M&A market in Texas, with PE-backed platforms aggressively consolidating smaller agencies across the metro.
Houston's massive and diverse population supports high patient volume, but agencies must navigate a complex payer mix that includes significant Medicaid and uninsured populations.
No state income tax makes Texas highly attractive for hospice agency sellers and buyers alike, providing favorable economics for transaction structuring.
Texas has faced increased CMS scrutiny for hospice fraud in certain markets, agencies with clean compliance histories and strong documentation practices command significant premiums.
City Guides in Texas
Explore specific markets for local buyer activity, valuations, and service area insights.
Dallas
Very High Activity
2.4x - 3.8x$2,000,000 – $12,000,000
The DFW metroplex is the most active hospice M&A market in Texas, with PE-backed platforms aggressively consolidating smaller agencies across the metro.
Houston
Very High Activity
2.4x - 3.8x$2,000,000 – $12,000,000
Houston's massive and diverse population supports enormous hospice patient volume, with MD Anderson Cancer Center generating significant oncology hospice referrals.
Austin
High Activity
2.4x - 3.8x$2,000,000 – $10,000,000
Austin's booming tech economy has attracted a younger population, but the surrounding Hill Country communities have a rapidly growing retiree demographic driving hospice demand.
San Antonio
High Activity
2.4x - 3.8x$2,000,000 – $10,000,000
San Antonio's large military and veteran population, driven by Joint Base San Antonio (Lackland, Fort Sam Houston, Randolph), generates significant VA hospice referrals.
Fort Worth
High Activity
2.4x - 3.8x$2,000,000 – $10,000,000
Fort Worth and Tarrant County represent a distinct sub-market within DFW, with JPS Health Network and Texas Health Resources as the primary hospital referral sources.
Texas Hospice Regulations
Non-CON state, Texas does not require Certificate of Need for hospice, creating an open and highly competitive market with the second-highest agency count in the nation.
Texas does not require Certificate of Need for hospice agencies, the Texas Health and Human Services Commission (HHSC) handles licensing.
The HHSC conducts regular surveys and complaint investigations, and has increased enforcement activity in recent years due to federal fraud scrutiny.
Medicare-certified agencies must meet all federal Conditions of Participation, and Texas has been a focus area for CMS targeted probe-and-educate reviews.
Texas Medicaid covers hospice through both fee-for-service and managed care arrangements, with the STAR+PLUS program serving many dual-eligible beneficiaries.
How to Sell Your Hospice Business in Texas
1. Get a Current Valuation
Before anything else, know your number. Your agency's value is based on how much profit it makes in a year, after you add back things like your personal salary and expenses that a new owner wouldn't have. That adjusted profit gets multiplied by 2.4x - 3.8x to get your value.
Our free valuation calculator gives you a range in about 2 minutes, no email required, no strings attached. It factors in your revenue, patient census, payer mix, and Texas-specific market conditions.
2. Understand Texas's Regulations
Non-CON state, Texas does not require Certificate of Need for hospice, creating an open and highly competitive market with the second-highest agency count in the nation.
If you're selling to a private equity group or regional operator, your attorney should be familiar with Texas's specific requirements for Medicare certification transfers, state licensing, and any Certificate of Need rules.
3. Prepare Your Agency for Market
Buyers, whether PE platforms or individual operators, look at the same fundamentals:
- Clean financials, 3 years of tax returns and profit & loss statements
- Patient census, average daily census, admission trends, and length of stay
- Payer mix, Medicare percentage and any Medicaid or private pay revenue
- Survey history, clean surveys and no active compliance issues
- Staff stability, nurses, aides, and clinical leadership staying post-sale matters
- Referral relationships, strong hospital and physician referral networks add significant value
Want to see where your agency falls?
Our free calculator factors in your revenue, profit, and Texas market conditions.
4. Know Your Buyer Options
In Texas, you have four main buyer types, listed here by who typically pays the most:
Highest Multiples
PE Platforms
The top of the 2.4x-3.8x SDE range. Best for larger agencies with $2,000,000+ revenue and strong census. Larger buyers price on EBITDA, a different yardstick: platforms paid 11x-13x EBITDA for add-ons worth $30,000,000 to $120,000,000 (Hendon Partners, Q2 2026), far bigger than most local agencies.
Best for Most Sellers
Regional Hospice Groups
Within the 2.4x-3.8x SDE range. They know the local market and close reliably in 90-120 days.
Strategic Buyers
Hospital Systems
Within the 2.4x-3.8x SDE range. They want to control the care continuum from acute to end‑of‑life.
Traditional Route
Individual Operators
Within the 2.4x-3.8x SDE range. Often SBA-financed. Cleanest exit with a 60-90 day transition.
Not sure which buyer type is right for you? Book a free call and we'll walk you through your options based on your specific agency.
5. Timeline and What to Expect
From first conversation to closing, expect 6-12 months. The process: valuation (week 1) → preparation and marketing (weeks 2-8) → buyer matching and LOIs (weeks 8-16) → due diligence and Medicare transfer (weeks 16-32) → closing (weeks 32-48). Agencies in Texas with clean surveys, stable census, and strong financials often close faster, especially with PE buyers.
Frequently Asked Questions
What is my hospice business worth in Texas?
Hospice agencies in Texas typically sell for 2.4x - 3.8x their annual profit, with values ranging from $2,000,000 – $12,000,000. Factors like your payer mix, patient census, location within Texas, and buyer competition all affect the final number. Use our free valuation calculator for a personalized estimate.
Who is buying hospice agencies in Texas?
Active buyers in Texas include private equity platforms, regional hospice groups, hospital systems, and individual operators. Buyer activity in Texas is very high, meaning sellers can expect competitive offers from multiple buyers.
What are Texas's hospice regulations?
Non-CON state, Texas does not require Certificate of Need for hospice, creating an open and highly competitive market with the second-highest agency count in the nation. Texas does not require Certificate of Need for hospice agencies, the Texas Health and Human Services Commission (HHSC) handles licensing. The HHSC conducts regular surveys and complaint investigations, and has increased enforcement activity in recent years due to federal fraud scrutiny. Medicare-certified agencies must meet all federal Conditions of Participation, and Texas has been a focus area for CMS targeted probe-and-educate reviews. Texas Medicaid covers hospice through both fee-for-service and managed care arrangements, with the STAR+PLUS program serving many dual-eligible beneficiaries.
How long does it take to sell a hospice agency in Texas?
The typical timeline to sell a hospice agency in Texas is 6-12 months from listing to close. Agencies with clean financials, stable census, strong survey history, and no compliance issues close faster. Private equity transactions can sometimes close in 90-120 days if the agency is well-prepared.
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