Hospice volunteer requirements, state by state
Some volunteer requirements are federal and identical everywhere. Others, starting with criminal background checks, change from state to state. Here is which is which, with every state and D.C. listed.
- Federal vs state, made clear
- All 50 states + D.C. listed
- Tracking built into Volunteer Ledger
Built from federal hospice rules, CMS surveyor guidance, and a state-by-state review. Plain-language guidance only. Always confirm current requirements with your state licensing authority and accreditor.
Most of what goes in a hospice volunteer's file is set at one of three levels. Federal rules apply the same in every state. Background checks are a federal baseline for patient-facing volunteers, and then each state layers its own rules on top. TB, immunizations, CPR, and confidentiality are set by your state, your accreditor, or your own policy, not by a federal volunteer mandate.
Background checks vary the most from one state to the next. That's the table just below. But TB screening, immunizations, CPR, and training-hour minimums vary too, so the full state-by-state matrix further down covers all six at once. For the requirement-by-requirement breakdown, see the compliance guide.
How the requirements split
Before the tables, here's who sets each requirement. Some are federal and identical everywhere, background checks are a federal floor with a state overlay, and the rest come from your state, your accreditor, or your own policy.
Identical in all 50 states
Medicare Conditions of Participation, in 42 CFR §418.78. These don't change by state.
- Orientation & training: §418.78(a)
- Cost-savings documentation: §418.78(d)
- 5% level-of-activity: §418.78(e)
Background checks
A federal baseline for volunteers with patient contact (§418.114(d) via the §418.3 "employee" definition), then each state adds its own rules. This is where states differ most. See the table, then the full matrix.
- Criminal background check
Set outside the federal rules
No federal volunteer mandate. These come from your state, your accreditor, or your own policy. Requirements vary; confirm yours.
- TB screening (CDC baseline on hire)
- Immunizations (flu, COVID-19, Hep B)
- CPR / First Aid (role-dependent)
- Confidentiality, application, references
Training-hour minimums aren't federal. A handful of states set them (4 to 20 hours, shown in the matrix below), and accreditors such as ACHC set others. Full detail and sources are in the compliance guide.
What each state adds on top of the federal check
Start from the baseline: every volunteer with direct patient contact or access to patient records needs a criminal background check. That requirement is federal, and it applies in all 51 jurisdictions. Federal regulation §418.114(d)(2) then directs hospices to obtain those checks "in accordance with State requirements," so what changes by state is what gets added on top. Find your state below.
Its own volunteer-screening law sits on top of the federal check. It is often broader (all volunteers, not just patient-facing), and sometimes sets specific steps like fingerprinting or a state registry.
The federal check applies, plus a state wrinkle. It can hinge on supervision, hours, a registry-only check, or how the rule is read. Not a blanket volunteer mandate.
No added state rule. Run the federal check on volunteers with patient contact. A few states exclude volunteers from their own screening program by name, but the federal check still applies.
| State | On top of the federal check | Notes |
|---|---|---|
| Alabama | Federal baseline only | None |
| Alaska | Adds its own rule | None |
| Arizona | Federal baseline only | No state background-check law reaches hospice volunteers. The fingerprint-card statute (A.R.S. §36-411) doesn't cover hospice. Arizona does require volunteer TB screening; see the full matrix below. |
| Arkansas | Adds its own rule | None |
| California | Federal baseline only | State hospice rules (22 CCR §§74800–74908) require exclusion-list clearance and health screening for volunteers, but no criminal background check. The federal check still reaches patient-facing volunteers. |
| Colorado | Adds its own rule | Defines "employee" to include volunteers, so the state criminal-history check reaches them. Colorado also requires 20 hours a year of continuing education for direct-care volunteers. |
| Connecticut | Adds its own rule | None |
| Delaware | Federal baseline only | None |
| District of Columbia | Federal baseline only | Excludes volunteers from its own state screening program by name. The federal check (§418.114 + §418.3) still applies to patient-facing volunteers. |
| Florida | Conditional | None |
| Georgia | Adds its own rule | None |
| Hawaii | Adds its own rule | None |
| Idaho | Federal baseline only | None |
| Illinois | Adds its own rule | None |
| Indiana | Adds its own rule | None |
| Iowa | Federal baseline only | None |
| Kansas | Federal baseline only | None |
| Kentucky | Conditional | None |
| Louisiana | Conditional | None |
| Maine | Adds its own rule | None |
| Maryland | Federal baseline only | None |
| Massachusetts | Conditional | None |
| Michigan | Conditional | Its healthcare-worker check reaches volunteers only if the hospice grants them clinical privileges; otherwise the federal baseline applies. |
| Minnesota | Adds its own rule | None |
| Mississippi | Federal baseline only | None |
| Missouri | Conditional | None |
| Montana | Federal baseline only | None |
| Nebraska | Federal baseline only | State law expressly exempts hospice volunteers from its home-health-aide screening statutes; the federal check still applies to patient-facing volunteers. |
| Nevada | Federal baseline only | Excludes volunteers from its own state screening program by name. The federal check still applies to patient-facing volunteers. |
| New Hampshire | Adds its own rule | None |
| New Jersey | Federal baseline only | None |
| New Mexico | Conditional | None |
| New York | Federal baseline only | Excludes volunteers from its own state screening program by name. The federal check still applies to patient-facing volunteers. |
| North Carolina | Federal baseline only | None |
| North Dakota | Federal baseline only | State hospice statute (NDCC 23-17.4) and licensing rule (NDAC 33-03-15) are silent on criminal background checks; the federal baseline reaches patient-facing volunteers. |
| Ohio | Federal baseline only | Excludes volunteers from its own state screening program by name. The federal check still applies to patient-facing volunteers. |
| Oklahoma | Adds its own rule | None |
| Oregon | Adds its own rule | None |
| Pennsylvania | Federal baseline only | Pennsylvania never finalized its own hospice personnel rules, and its elder-protection screening law (OAPSA) is employment-based and doesn't clearly cover hospice. Volunteers ride the federal floor. |
| Rhode Island | Conditional | Its criminal-records statute is keyed to employment, so its reach to unpaid volunteers is unsettled. The hospice rule does require TB and health screening for volunteers with patient contact. |
| South Carolina | Adds its own rule | None |
| South Dakota | Federal baseline only | None |
| Tennessee | Conditional | None |
| Texas | Adds its own rule | None |
| Utah | Adds its own rule | Regularly-scheduled, unsupervised volunteers need state background-screening certification, and every volunteer gets a 12-hour training minimum. |
| Vermont | Adds its own rule | Its combined home-health and hospice rule requires background checks on volunteers who provide direct patient care. |
| Virginia | Federal baseline only | Excludes volunteers from its own state screening program by name. The federal check still applies to patient-facing volunteers. |
| Washington | Adds its own rule | None |
| West Virginia | Adds its own rule | Its Medicaid hospice manual counts volunteers as employees and requires a State Police fingerprint check (every 3 years) for patient-facing volunteers, even though the separate WV CARES registry exempts supervised volunteers. |
| Wisconsin | Conditional | None |
| Wyoming | Adds its own rule | None |
States control the mechanics: timing, type of check, fingerprinting, registries, and disqualifying offenses. They also change their rules over time. Confirm your state's current requirement and procedure with your state licensing authority. For the federal mechanism and who's covered, see Do hospice volunteers need a background check?
Look up your state
Search or choose your state to see, in plain English, what it appears to add beyond the federal hospice baseline and what to confirm.
Pick a state to see its summary, or compare every state below.
Compare all states
Use the matrix to compare what each state appears to add beyond the federal hospice baseline. Filter by status, switch between a simple and a detailed view, or tap any row for the full detail and citation.
Every jurisdiction sits on the federal baseline in 42 CFR §418.78 and §418.114(d). Orientation and training, plus a background check for patient-facing volunteers, apply in all 51. The columns show only what state law adds. Compiled from state hospice and health-facility rules and last reviewed June 2026; a general reference, not legal advice.
Turn your state's rules into trackable requirements. Volunteer Ledger lets you create requirement types, choose who they apply to, track expiration dates, and run readiness reports.
Track whatever your state requires
Volunteer Ledger doesn't run checks or guarantee compliance. It keeps each volunteer's requirements (federal, state, or your own policy) organized and dated, so the record is ready when a surveyor or administrator asks.
Set the requirements that fit your state
Turn on the requirement types your state and accreditor call for (background check, TB screening, training, immunizations, whatever applies) and skip the ones that don't. The list is yours to configure, not a fixed national template.
Flag who needs what by area of service
Tag volunteers by area of service, and Volunteer Ledger shows which ones fall under the patient-contact requirements and need a check on file. The scope question becomes a filter, not a manual roster audit.
See who's missing or expiring
Record completion dates and results, and Volunteer Ledger surfaces the upcoming and overdue items before they turn into a gap a surveyor has to ask about.
Pull a survey-ready volunteer file
Each volunteer's requirements, training, and hours sit in one file: one place, one export, ready to hand over at survey time.
See it in context: Hospice volunteer tracking software overview
Volunteer requirements by state, answered
Which requirements are federal, and which are set by the state?
Three volunteer requirements are federal and identical in every state, all in 42 CFR §418.78: documenting orientation and training (a), documenting cost savings (d), and the 5% level-of-activity minimum (e). Criminal background checks are a federal baseline for volunteers with patient contact (through §418.114(d) read with the §418.3 "employee" definition), and then vary state by state. TB screening, immunizations, CPR, and confidentiality agreements are set by your state, your accreditor, or your own policy, not by a federal volunteer mandate.
Do all states require background checks for hospice volunteers?
Every state and D.C. sits on the same federal baseline: a volunteer with direct patient contact or access to patient records needs a criminal background check under §418.114(d). On top of that, 20 states add their own volunteer-screening law, 10 add a conditional wrinkle, and 21 (including D.C.) add nothing beyond the federal baseline. A few of them (New York, Ohio, Nevada, Virginia, and D.C.) exclude volunteers from their own state program by name, but the federal check still applies to patient-facing volunteers.
Does my state require TB tests or immunizations for volunteers?
There is no federal volunteer mandate for either. The CDC recommends a baseline TB screening on hire for anyone working or volunteering in health-care settings (routine annual testing was dropped in 2019), and health-care-worker immunization requirements are set state by state and vary widely. Whether they apply to your volunteers depends on your state and your accrediting organization. Confirm with them.
Is this state guide legal advice?
No. This is general information compiled from federal regulations and state hospice and health-facility rules, not legal advice. State requirements change and vary in their details: timing, type of check, fingerprinting, registries, disqualifying offenses. Confirm your specific obligations with your state hospice licensing authority and your accreditor.
This page is general information, not legal advice. Hospice volunteer requirements come from federal regulation, your state's law, and your accreditor's standards, and they change. Confirm your specific obligations with your state hospice licensing authority and your accrediting organization.
Keep every volunteer's file survey-ready, whatever your state requires.
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