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Home Health Business Valuation: 2026 Multiples for Home Health, Home Care, and Hospice

Buy-side M&A across 100+ active capital partners · Healthcare services M&A: home health, home care, hospice, personal care, private duty · Updated June 22, 2026

Home health business valuation in 2026 is the most segmented exercise in healthcare services M&A. The headline 8x-15x EBITDA band collapses into three distinct sub-vertical bands once you separate Medicare-certified home health (PDGM 30-day episodes, HHVBP plus-or-minus 5%, CY2025 base $2,058.71), non-medical home care (HCBS Medicaid waiver, state minimum wage exposure, EVV-vendor lock-in), and Medicare hospice (per-diem reimbursement, the $35,361.44 cap per beneficiary, HOPE replacing HIS October 1 2025). Each sub-vertical carries different reimbursement risk, different state regulatory friction (CON moratoriums in 17 states, MLTSS payor mix shifts, CMS 855A CHOW timelines of 4-12 months), and a different active buyer pool. This guide maps the three sub-verticals, explains how PE-backed platforms and strategics like UnitedHealth, Humana, and Bain-backed Aveanna actually underwrite, walks through a worked example, and identifies the highest-impact pre-sale moves. If you operate a $2M-$50M EBITDA home health agency, home care franchise, or hospice agency, this is the framework you need before opening conversations with buyers. A deeper read on private equity valuation patterns in healthcare services covers parallel multiple compression dynamics in adjacent verticals.

Methodology and data sources

This valuation guide follows CT Acquisitions’ 5-tier source hierarchy: T1 SEC 8-K filings and press releases for major sponsor transactions, T2 CMS reimbursement rules and Federal Register notices, T3 sponsor portfolio pages and PE Hub / Axios deal reporting, T4 industry-research publishers (LevinPro HC, Mertz Taggart, BMI Mergers, Capstone Partners, Cain Brothers, Stoneridge Partners), and T5 M&A trade press. Every numeric multiple range on this page is reconciled against at least two T4 sources plus CT Acquisitions’ internal VERIFIED_MULTIPLES benchmark for home health, home care, and hospice.

Tier framing: Headline multiple ranges reflect mid-market transactions ($5M-$50M EBITDA). Premium tier multiples (where cited) reflect institutional buyer underwriting on businesses that clear specific scale, geography (CON-state), payor mix (Medicare-skewed or MLTSS-contracted), and compliance thresholds (clean OASIS-E sampling, HOPE-ready, EVV vendor stable). They are not universally available.

Verification window: All multiples and operator-tier figures verified June 22, 2026 against the named publishers’ most-recent reports plus CT’s active-engagement data. Multiples by tier are sensitive to CMS rule changes (HHVBP CY2026 adjustment, hospice cap inflation, OBBBA Medicaid funding changes), state Medicaid rate actions, and credit-market conditions; the cited ranges are starting points for transaction-specific valuation, not deal-specific quotes.

Home-health-specific industry-data sources: LevinPro HC (Mertz Taggart M&A reports), Stoneridge Partners home health, hospice and home care market reports, Cain Brothers Healthcare M&A updates, CMS Hospice Final Rule (CMS-1810-F published Federal Register August 4 2025), CMS Home Health Final Rule CY2025 (CMS-1803-F), CMS HHVBP fact sheet (HHVBP nationwide effective January 1 2025), CMS Hospice HOPE Information Resources (HOPE replaces HIS October 1 2025).

The short answer: 2026 home health, home care, and hospice multiples

Strategic-buyer outliers like UnitedHealth/Amedisys reflect synergy underwriting (Optum cross-sell into UNH Medicare Advantage) and are not benchmark multiples for sponsor-led transactions. The 164 divestitures the DOJ required (Pennant $146.5M, BrightSpring $239M, per the DOJ final judgment December 2025) priced closer to the 9x-12x sponsor-comp range.

The three sub-verticals (and why buyers split them)

Before any valuation analysis, identify which of these three describes your agency. The differences are reimbursement-driven and substantial.

1. Medicare-certified home health (skilled)

Medicare Part A skilled home health: nursing, physical therapy, occupational therapy, speech, medical social work, home health aide. Reimbursed under the Patient-Driven Groupings Model (PDGM) on 30-day periods of care across 432 case-mix groups, with the CY2025 30-day base payment at $2,058.71 per the CMS Home Health Final Rule (CMS-1803-F). Low Utilization Payment Adjustment (LUPA) thresholds vary by case-mix group; episodes below threshold get per-visit payment instead. HHVBP plus-or-minus 5% payment adjustment nationwide effective January 1 2025 per CMS HHVBP fact sheet. Margins: 14%-20% EBITDA at platform scale. Valuations: 8x-12x EBITDA depending on scale, state mix (CON vs non-CON), HHVBP TPS, and payor mix.

2. Non-medical home care (private duty and HCBS)

Personal care, companionship, and homemaker services. Funded through (a) private pay, (b) state Medicaid Home and Community Based Services (HCBS) waivers, (c) Medicaid Managed Long Term Services and Supports (MLTSS) plans, (d) Veterans Affairs aid and attendance, and (e) long-term care insurance. Wage-driven business: state minimum wage exposure is direct (CA SB 525 ratchets healthcare worker wages to $25/hr by 2033, NY Wage Parity at roughly $23/hr in NYC per NY Department of Labor, WA Cares Fund 0.58% payroll tax with benefits beginning July 2026 per WA ESD). Margins: 8%-14% EBITDA. EVV (Electronic Visit Verification) mandatory under the 21st Century Cures Act since 2020 for personal care and 2023 for home health (per CMS EVV guidance). Valuations: 7x-11x EBITDA depending on scale and payor mix.

3. Medicare hospice

End-of-life care for Medicare beneficiaries with a prognosis of six months or less. Reimbursed on per-diem basis across four levels of care (Routine Home Care, Continuous Home Care, Inpatient Respite Care, General Inpatient Care). FY2026 Routine Home Care rate is $231.16 per day for days 1-60 per CMS Hospice Final Rule (CMS-1810-F published Federal Register August 4 2025). Per-beneficiary aggregate cap is $35,361.44 for FY2026 (cap year ending September 30 2026 per CMS hospice cap update). HOPE (Hospice Outcomes and Patient Evaluation) replaces HIS effective October 1 2025 with a 4% APU penalty for non-compliance per CMS Hospice HOPE Information Resources. VBID hospice carve-in ended December 31 2024 and full VBID model ended December 31 2025 per CMS Innovation Center announcement; hospice reverts to fee-for-service Medicare from January 1 2026 forward. Margins: 18%-25% EBITDA at platform scale. Valuations: 9x-15x+ EBITDA, highest in the category.

Most home health platforms operate two or three of these. Compassus operates all three (TowerBrook 50%, Ascension Health 50% per Compassus press release). Aveanna (Bain Capital plus JH Whitney) operates home health and private duty pediatric. Gentiva (CD&R 60% plus Humana 40%) is pure hospice after selling personal care to Addus for $350M December 2 2024 per Addus 8-K. The valuation approach depends on the mix; a 60% hospice + 40% home health agency is valued closer to the hospice band than the home health band.

Medicare home health: PDGM and HHVBP economics

Medicare home health valuation in 2026 turns on three CMS levers: PDGM 30-day episode economics, HHVBP performance, and OASIS-E quality reporting compliance. Buyers underwrite each one explicitly.

PDGM 30-day episodes and the 432 case-mix groups

Since January 1 2020, Medicare home health is paid on 30-day periods of care rather than 60-day episodes. Each 30-day period maps into one of 432 case-mix groups based on five clinical variables: timing (early or late), admission source (community or institutional), clinical grouping (12 categories), functional impairment (low, medium, high), and comorbidity adjustment (none, low, high). The CY2025 30-day base payment is $2,058.71 per the CMS Home Health Final Rule (CMS-1803-F published Federal Register November 2024). Case-mix weights range from approximately 0.5x to 1.8x of the base. LUPA thresholds (low utilization) vary by case-mix group; periods below threshold pay per-visit rather than the case-mix weighted period rate, which can cost agencies $1,200-$1,800 per LUPA episode.

Buyers will sample 30-90 days of episode data in diligence. They look for: (a) case-mix accuracy (overcoding triggers RAC audit risk and clawback), (b) LUPA rates above 8% national benchmark (suggests poor visit planning), (c) institutional admission source mix (community admissions pay less; institutional pays more), (d) functional impairment scoring accuracy, and (e) hospitalization rates inside 60 days of admission (HHVBP penalty driver).

HHVBP plus-or-minus 5% payment adjustment

The Expanded Home Health Value-Based Purchasing Model went nationwide January 1 2023 with payment adjustment beginning January 1 2025. CY2024 was the first full performance year; CY2026 payment year adjustments are plus-or-minus 5% based on Total Performance Score (TPS) per the CMS HHVBP fact sheet. TPS is composed of OASIS-based measures (improvement in dyspnea, ambulation, oral medication management, bathing), claims-based measures (acute care hospitalization, emergency department use), and HHCAHPS patient experience.

An agency with TPS in the top quartile of its cohort gets a plus-5% payment lift on every Medicare episode in CY2026. An agency in the bottom quartile gets minus-5%. On a $50M Medicare revenue book, this is a $5M swing. Buyers underwriting in 2026 are explicit: HHVBP-positive agencies trade at 1.0x-1.5x EBITDA above HHVBP-neutral peers; HHVBP-negative agencies face structural multiple compression.

OASIS-E and quality reporting

OASIS-E (Outcome and Assessment Information Set, version E) effective January 1 2023 with refinements continuing through 2025. Section A (administrative), Section GG (functional abilities), Section M (skin), Section N (medications), and the SDOH (social determinants of health) items are buyer-diligence focal points. Quality Reporting Program (QRP) non-compliance triggers a 2% APU reduction. Clean OASIS-E sampling is non-negotiable for any platform-tier multiple.

Non-medical home care: HCBS waiver and wage exposure

Non-medical home care is the largest sub-vertical by agency count but trades at lower multiples than Medicare home health or hospice because it carries direct wage exposure (50%-65% of revenue), payor concentration risk in states moving to MLTSS, and lower regulatory moats. The 2025-2026 transaction cohort tells the story.

State minimum wage exposure (the single biggest 2026 valuation driver)

• California SB 525: healthcare worker minimum wage ratchets from $23/hr in 2024 to $25/hr by 2028 (per CA Department of Industrial Relations); home care workers covered under the covered employee definition. CA HCBS agencies have lost 200-400 basis points of gross margin between 2023 and 2026.
• New York Wage Parity: $19.10/hr base plus $4.09/hr supplemental benefits in NYC, Westchester, Long Island per NY Department of Labor 2026 schedule. Buyers in NY HCBS specifically model wage-passthrough rate vs MLTSS payor rate freeze.
• Washington Cares Fund: 0.58% payroll tax effective July 1 2023 with benefits beginning July 1 2026 per WA ESD. State has the most aggressive long-term care funding model in the country; benefits the home care category structurally.
• Massachusetts, Illinois, New Jersey, Colorado: all on phased minimum-wage paths above $15/hr; HCBS rates do not always keep pace.

HCBS waiver structure and MLTSS shift

State Medicaid HCBS waivers (1915(c), 1915(i), 1915(k) Community First Choice, Section 1115 demos) fund the bulk of non-medical home care for Medicaid-eligible seniors and adults with disabilities. The structural shift in 2024-2026 is the move from FFS HCBS to MLTSS (Managed Long Term Services and Supports), where state Medicaid contracts with managed care organizations (Centene, UnitedHealth, Humana, Molina, CVS Aetna) to administer HCBS benefits. Buyers track MLTSS rate sufficiency state by state.

Active MLTSS state structures (buyer-diligence focal points)

• Pennsylvania Community HealthChoices (CHC): statewide MLTSS, three MCOs (UPMC, AmeriHealth Caritas, Keystone First). Mature program with reasonable rate predictability.
• New Jersey: Medicaid Managed Long Term Services and Supports under five MCOs; HCBS rates have lagged wage growth.
• Virginia Cardinal Care Plus (formerly CCC Plus): statewide MLTSS, six MCOs.
• Tennessee CHOICES: long-running MLTSS program through TennCare MCOs.
• Arizona ALTCS: single-MCO per region (county); the most concentrated payor structure in the country.
• Wisconsin Family Care: regional MCOs (Inclusa, Lakeland, Community Care, My Choice Wisconsin).
• Texas STAR+PLUS: statewide MLTSS expanded September 2024 to include additional populations per Texas HHSC.
• Oklahoma SoonerSelect: launched 2024 with full Aged Blind Disabled population by 2026 per OK HCA.

EVV vendor lock-in (the unsexy diligence killer)

Electronic Visit Verification is mandatory for personal care under the 21st Century Cures Act since January 1 2020 and for home health since January 1 2023 per CMS EVV guidance. State EVV implementations are either (a) open-vendor (agency chooses among certified vendors), (b) closed-vendor (state mandates a single vendor like HHAeXchange, Sandata, Tellus, or Therap), or (c) hybrid. EVV vendor migration costs $100K-$400K per agency and disrupts billing for 60-120 days. Buyers underwrite EVV stability explicitly: an agency mid-migration trades at a 0.5x-1.0x EBITDA discount until live and reconciled.

Medicare hospice: per-diem economics and the cap

Hospice is the highest-multiple sub-vertical in healthcare services M&A in 2026. Three reasons: per-diem reimbursement is predictable, length of stay (LOS) is a manageable operational lever (within compliance constraints), and the patient population is growing structurally with Boomer aging. Bristol Hospice’s reported $1B+ Webster Equity auction on roughly $140M EBITDA implies a 7x revenue multiple and 12x-15x EBITDA per PE Hub and Axios March 2026 reporting.

Four levels of care and FY2026 rates

Source: CMS Hospice Final Rule CMS-1810-F published Federal Register August 4 2025. Rates are wage-index adjusted by CBSA; figures shown are pre-wage-index national rates.

The aggregate cap ($35,361.44 per beneficiary FY2026)

The per-beneficiary aggregate cap is $35,361.44 for FY2026 per CMS hospice cap inflation update. The cap is calculated annually for each agency: total Medicare hospice payments divided by total Medicare beneficiaries served must not exceed the cap. Agencies over the cap must refund the excess. Cap exposure is the single largest hospice-specific diligence focus: a long-LOS population (high non-cancer diagnosis mix, dementia patients) compresses agency cap headroom. Buyers will rebuild cap calculations for trailing 3 years.

HOPE replaces HIS October 1 2025

The Hospice Outcomes and Patient Evaluation (HOPE) tool replaced the Hospice Item Set (HIS) for all admissions on or after October 1 2025 per CMS Hospice HOPE Information Resources. HOPE is more granular (more data elements per admission, ongoing assessments every 5 days for the first 30 days, then at planned intervals). Non-compliance triggers a 4% APU penalty for FY2026 hospice. Agencies that have not operationalized HOPE by Q4 2025 face material multiple compression.

VBID hospice carve-in ended December 31 2024

The CMS Innovation Center’s Value-Based Insurance Design Model hospice carve-in (which allowed Medicare Advantage plans to cover hospice benefit through participating plans) ended December 31 2024. The broader VBID model ended December 31 2025. Hospice reverts to fee-for-service Medicare reimbursement from January 1 2026 forward, regardless of MA enrollment status. This removes a complicating layer from hospice agency revenue forecasting and is a net positive for hospice multiples in 2026.

Length of stay (LOS) and case mix

Median LOS for Medicare hospice is approximately 18 days; mean LOS is approximately 90 days, driven by long-stay dementia, debility, and adult failure to thrive populations per NHPCO Facts and Figures 2024. Buyers underwrite three LOS bands: short (under 30 days, low-margin, cap-friendly), mid (30-180 days, optimal economics), long (180+ days, cap-exposed). A balanced LOS mix is most valuable.

How a home health business valuation actually gets calculated

1. Normalize the EBITDA. Adjust for owner compensation, related-party transactions (medical director stipends, rented facilities), nursing director-owner labor, one-time HHVBP improvement spend, one-time HOPE implementation costs.
2. Decompose the revenue by payor and sub-vertical. Medicare FFS home health, Medicare hospice, Medicaid HCBS (FFS or MLTSS), Medicare Advantage home health, private pay, VA, LTC insurance. The mix drives the applicable multiple band.
3. Rebuild the CMS reimbursement math. For home health: sample 30-90 days of PDGM episodes, validate case-mix accuracy, calculate LUPA rate, model HHVBP TPS impact. For hospice: rebuild cap calculation trailing 3 years, validate level-of-care distribution, audit eligibility documentation. For home care: validate EVV compliance rate (above 95% benchmark), audit MLTSS authorization documentation.
4. Map state regulatory exposure. CON status (high-value for Medicare HH agencies in NC, NJ, NY, OH, PA, VA, etc.), state Medicaid rate trajectory, state minimum wage trajectory, CMS 855A CHOW timeline for the specific state.
5. Compare to comparables. Adjust for scale, geographic concentration, payor mix vs sub-vertical comp set.
6. Apply the concluding multiple.

CON states and the license-as-asset premium

Certificate of Need (CON) laws restrict new home health agency entry in 17 states per NCSL CON tracker: North Carolina, Georgia, Alabama, Mississippi, Kentucky, West Virginia, Arkansas, Illinois, Michigan, New Jersey, New York, Ohio, Pennsylvania, South Carolina, Tennessee, Virginia, Washington. In these states a Medicare-certified home health license is effectively non-replicable through application; the only way to acquire one is to buy an agency that holds one.

The valuation consequence is direct. A $5M EBITDA Medicare home health agency in Pennsylvania (CHC zone) trades at 10x-12x. The same operating profile in Texas (non-CON, free entry) trades at 8x-10x. The 1x-2x EBITDA spread is the license premium. CON state premiums are concentrated in hospice and Medicare home health; non-medical home care is generally not CON-regulated (Arkansas and a few others are exceptions).

Buyers track CON moratoria carefully. New Jersey lifted its hospice CON moratorium in 2014 but home health CON remains. Tennessee modified CON in 2021 to remove some categories but kept home health and hospice CON. Florida repealed most CON categories effective July 1 2019 but retained hospice CON. Verify CON status for your specific state and category before assuming the premium.

MLTSS payor mix and the Medicaid managed care shift

The structural shift from Medicaid fee-for-service to MLTSS (Managed Long Term Services and Supports) is the single biggest 2024-2026 buyer-side concern for non-medical home care. State Medicaid contracts with MCOs to administer HCBS benefits, which (a) introduces rate negotiation friction between agency and MCO, (b) creates payor concentration risk (a few MCOs hold most contracts in a given state), and (c) layers prior-authorization requirements on top of state Medicaid eligibility.

States with mature MLTSS programs (Tennessee CHOICES since 2010, Arizona ALTCS since 1989, Pennsylvania CHC since 2018) have established rate-update cadences. States in mid-transition (Oklahoma SoonerSelect 2024, North Carolina Tailored Plans, Texas STAR+PLUS expansion 2024) carry higher rate-volatility risk. Buyers map agency revenue exposure to MLTSS rate-action probability state by state.

MLTSS impact on valuation

• Premium: Agency in mature MLTSS state with diversified MCO contract book (no single MCO over 30% of revenue), strong utilization management track record (low denial rate), and demonstrated wage-passthrough negotiation.
• Average: Agency in mature MLTSS state with one dominant MCO contract.
• Discount: Agency in mid-transition state where MCOs are renegotiating rates downward, or agency in single-MCO state (Arizona) with concentration risk.

CMS 855A CHOW timeline and state licensure overlay

Change of ownership (CHOW) for Medicare-certified providers (home health, hospice, skilled nursing) flows through CMS Form 855A. The timeline is the single biggest non-financial deal driver in home health and hospice M&A. Timelines vary by state and Medicare Administrative Contractor (MAC) jurisdiction.

The financial implication: most home health and hospice deals close with a Medicare billing transition reserve (typically 5%-10% of purchase price held in escrow for 12-24 months) to cover risk of CMS processing delays, denied claims during transition, or RAC audit findings. Buyers and sellers should plan for 6-12 month operational disruption around CHOW.

EVV, Stark, AKS, and DOL companionship exemption

Stark Law and Anti-Kickback Statute (AKS)

Stark (42 USC 1395nn) prohibits physician self-referral for designated health services (home health is included); AKS (42 USC 1320a-7b) prohibits remuneration for referrals. Home health and hospice agencies are subject to both. Common diligence findings: physician medical director arrangements without proper fair-market-value documentation, marketing rep compensation tied to referral volume, free supplies or transportation to referral sources. Buyers will scrub physician arrangements line by line. Stark/AKS exposure is a material discount driver.

DOL companionship exemption

The Department of Labor companionship services exemption (29 CFR 552) historically exempted home care workers from Fair Labor Standards Act minimum wage and overtime requirements. The 2013 DOL final rule (effective January 1 2015 after Home Care Association of America v Weil litigation) narrowed the exemption substantially: third-party employers (agencies) cannot claim it; only individual families employing a single companion worker can. Agencies that misclassified workers under the old exemption face back-wage and overtime exposure. This is a 2026 diligence focal point for legacy agencies that have not adjusted classification.

EVV (Electronic Visit Verification)

Cures Act mandate for personal care services since January 1 2020 and home health since January 1 2023 per CMS EVV implementation guidance. State EVV models vary (Sandata, HHAeXchange, Tellus, Therap, Alora, AxisCare, ContinuLink as common vendors). EVV non-compliance triggers 100% Federal Medicaid Assistance Percentage (FMAP) reduction (state Medicaid loses federal match) which states pass through as claim denials. Agencies with EVV compliance under 95% are at material denial risk.

Worked example: $5M EBITDA non-medical home care in Pennsylvania CHC zone

Business profile:

• $32M revenue, $5M reported EBITDA (15.6% margin)
• Sub-vertical: 100% non-medical home care (personal care, homemaker, companionship)
• State: Pennsylvania, operating in three CHC zones (Southwest, Southeast, Lehigh-Capital)
• Payor mix: 78% Medicaid MLTSS (Community HealthChoices through UPMC, AmeriHealth Caritas, Keystone First), 12% private pay, 6% VA, 4% LTC insurance
• Workforce: 850 caregivers (45% W-2, 55% 1099-converted-to-W-2 in 2024 post-DOL companionship rule clarification), 22 office staff, 4 RN supervisors
• EVV: HHAeXchange (state-mandated vendor in PA), 97% visit verification compliance
• EBITDA composition: $32M revenue, gross margin 28% ($8.96M), G&A $3.96M, EBITDA $5M
• Owner comp $325K, replacement CEO market rate $275K. Personal expenses $35K. One-time EVV migration costs $85K (HHAeXchange transition 2024).
• Top MCO (UPMC) represents 38% of revenue
• CHC contracts mature, two years remaining on UPMC contract
• No CON exposure (PA does not require CON for non-medical home care)
• Founder still personally manages UPMC and AmeriHealth relationships

EBITDA normalization:

• Reported EBITDA: $5.0M
• Owner compensation adjustment: +$50K ($325K minus $275K market)
• Personal expenses: +$35K
• One-time EVV migration costs: +$85K
• Normalized EBITDA: $5.17M

Multiple assessment:

• Starting benchmark for $5M-$15M EBITDA non-medical home care: 8.0x (midpoint of 7x-9x band)
• +0.5x for mature PA CHC market with multi-MCO contract book
• +0.3x for 97% EVV compliance and clean HHAeXchange operations
• +0.2x for 12% private-pay mix (de-risks Medicaid concentration)
• -0.5x for UPMC concentration (38% from single MCO)
• -0.4x for founder dependence on top-MCO relationships
• -0.3x for CA SB 525-style wage exposure in PA via state minimum wage trajectory (PA at $7.25/hr federal floor but CHC rates already pressuring labor cost up)
• Concluding multiple: 7.8x

Indicative valuation: $5.17M x 7.8x = $40.3M

18-month improvement path:

• Diversify MCO concentration (UPMC to under 30%): multiple to 8.1x. Outcome: $41.9M.
• Transition founder-led MCO relationships to VP of Payor Relations: multiple to 8.4x. Outcome: $43.4M.
• Expand private-pay mix from 12% to 20%: multiple to 8.7x. Outcome: $45.0M.
• Acquire one Medicare-certified home health license in PA (CON state, adds skilled HH revenue): multiple to 9.5x on blended sub-vertical mix. Outcome: $49.1M.
• Combined: plausible multiple 9.8x. Outcome: $50.7M.

$10.4M delta over 18 months of preparation. The CON-state license acquisition is the highest-impact move; PA Medicare home health licenses cannot be applied for, only acquired.

Active buyer map: PE platforms, strategics, and corrections

Get the buyer landscape wrong and the conversation goes sideways fast. Here are the corrections that matter for sellers entering the market in 2026.

Medicare home health and hospice strategics

• UnitedHealth Group / Optum: closed Amedisys $3.3B August 7-14 2025 per UNH 8-K. DOJ settlement required 164 divestitures across 19 states (Pennant $146.5M + 54 locations, BrightSpring $239M + 107 locations) per DOJ final judgment December 2025. Optum already owns LHC Group ($5.4B closed February 2023). Largest home health platform in the country post-Amedisys.
• Humana CenterWell: Kindred at Home rebrand; acquired Intrepid USA Q3 2024 per Humana press release. Pure-play Medicare home health and hospice.
• Enhabit Inc: went private to Kinderhook Industries May 18 2026 at $1.1B / $13.80/share / 10.2x EBITDA on $108M EBITDA per Enhabit 8-K filed May 18 2026. AREX Capital activism preceded; Aug 2023 strategic review failed.
• Compassus: TowerBrook Capital Partners 50% + Ascension Health 50% per Compassus press release. Not Optum. JV announced with OhioHealth at Home September 2024 and Providence October 2024 (Oregon approval May 18 2026).
• Aveanna Healthcare: Bain Capital + JH Whitney + Geneva Glen Capital; public on NASDAQ (AVAH). Home health, hospice, and private duty pediatric.
• Pennant Group (NASDAQ: PNTG): publicly traded; absorbed 54 Amedisys divestiture locations for $146.5M (largest transaction in Pennant history).
• BrightSpring Health Services (NASDAQ: BTSG): publicly traded; KKR backed; absorbed 107 Amedisys divestiture locations for $239M.

Medicare hospice platforms

• Gentiva: CD&R 60% + Humana 40%; sold personal care division to Addus HomeCare for $350M December 2 2024 per Addus 8-K. Pure hospice platform post-divestiture. Curo brand retired post-acquisition integration.
• Bristol Hospice: Webster Equity Partners; in active March 2026 auction attracting $1B+ bids on approximately $140M EBITDA per PE Hub and Axios. Most-watched hospice transaction in 2026.
• Three Oaks Hospice: Martis Capital since approximately October 2024 ($150M). Not Cressey & Co.
• Compassus: see above.
• BrightSpring Hospice: KKR-backed, NASDAQ-traded.
• VitalCaring: Vistria Group + Nautic Partners + Anthony Family Investment Partners. Operating under Delaware federal court decree from December 2024: 43% of future profits and $43.1M attorney fees owed to Encompass/Enhabit per court findings of misappropriated trade secrets (damages collected February 2026).

Non-medical home care platforms

• BAYADA Home Health Care: NONPROFIT 501(c)(3) since January 2019 per BAYADA Foundation announcement. Not CVC Capital. Not any PE. Founder Mark Baiada transferred ownership to BAYADA Foundation.
• Honor Technology: a16z + Baillie Gifford + T. Rowe Price. Not KKR. Acquired Home Instead August 2021.
• Comfort Keepers: Halifax Group since September 2023. Sodexo divested entire Worldwide Home Care division.
• Synergy HomeCare: Levine Leichtman Capital Partners since January 21 2025. NexPhase exited; LLCP is the third PE sponsor.
• HomeWell Care Services: Main Post Partners since January 21 2026 (FIRST PE sponsor). 138 agencies across 37 states with approximately $100M system-wide revenue.
• Senior Helpers: Advocate Aurora Enterprises since April 1 2021.
• CareCentrix: Sycamore Partners + Pessina family post-Walgreens take-private August 28 2025 per Walgreens 8-K.
• TEAM Services Group: General Atlantic since April 2026 at $3B (~10x EBITDA) from Alpine Investors.

How to increase your home health business value before selling

Highest ROI

• Acquire or build into a CON state. A Medicare-certified home health license in NJ, NY, OH, PA, VA, NC, or GA cannot be applied for; it must be acquired. The license premium alone justifies a tuck-in acquisition.
• Improve HHVBP TPS. Move from bottom-quartile to top-quartile TPS over 18-24 months through OASIS coding accuracy, ED utilization reduction, and HHCAHPS investment. Worth 1.0x-1.5x EBITDA.
• Reduce LUPA rate below 8% national benchmark. Each percentage point of LUPA reduction recovers $200K-$400K of EBITDA on a $20M Medicare revenue book.
• Diversify MCO payor concentration. No single MCO over 30% of revenue. Adds 0.5x-1.0x EBITDA.
• Operationalize HOPE before October 1 2025 deadline. Avoid 4% APU penalty and de-risk diligence.
• Build hospice service line if you operate Medicare home health and have eligible patients. Hospice multiples are 3x-5x higher than home health.
• Transition founder relationships. Dedicated VP of Payor Relations and VP of Clinical Operations 18-24 months before sale.

Medium ROI

• Migrate to a stable EVV vendor and reach 95%+ compliance.
• Build private-pay mix to 15%-25% of home care revenue.
• Implement HomeCare HomeBase or MatrixCare on the EMR side; clean data lifts diligence speed.
• Document Stark/AKS-compliant medical director and marketing arrangements.
• Reclassify any remaining DOL-companionship-exemption workers; resolve back-wage exposure.
• Add MLTSS contracts in states where you operate but are missing payor coverage.

Lower ROI

• Website redesign.
• Brand consolidation across acquired locations.
• Minor service line additions (occupational therapy in markets where PT already saturates referrals).

Common mistakes that destroy home health valuations

• Overcoded PDGM episodes. Buyers will sample episodes against documentation; RAC audit clawback risk discounts the multiple by 0.5x-1.0x EBITDA, and material findings can kill deals outright.
• HHVBP-negative TPS without an improvement plan. Bottom-quartile TPS is a structural minus-5% on every Medicare episode; buyers will not pay through that without a credible improvement plan.
• Hospice cap exposure not modeled. A long-LOS population with cap headroom under $5,000 per beneficiary is a material risk; buyers will haircut the multiple aggressively.
• EVV under 95% compliance. Claim denial risk is direct and immediate.
• MLTSS concentration over 50% with a single MCO. Payor concentration risk in MLTSS markets compresses multiples by 0.5x-1.5x EBITDA.
• Founder selling every top MCO and physician referral relationship. Post-close retention is real risk.
• DOL companionship exemption misclassification. Back-wage and overtime exposure compounds with interest; this is a deal-killer in diligence if not resolved pre-sale.
• Stark/AKS exposure from informal physician arrangements. Even small medical director payments without FMV documentation trigger material discount.
• CHOW timeline not communicated to staff and referral sources. Operational disruption during 4-12 month CHOW process degrades trailing-12 EBITDA and erodes buyer confidence.

Want a specific valuation for your agency?

CT Acquisitions offers confidential home health business valuations for founders and executive teams operating Medicare-certified home health, non-medical home care, and Medicare hospice agencies. We specialize in the $1M-$25M EBITDA range across the three sub-verticals with direct buy-side relationships across the active sponsor-backed platforms, hospice strategics, and managed-care payvider acquirers. CT Acquisitions is paid by the buyer at close; founders pay nothing. Book a 15-minute conversation or visit our home health seller hub for state-by-state data.

About the Author

Christoph Totter is the founder of CT Acquisitions, a buy-side partner headquartered in Sheridan, Wyoming. We work directly with 100+ buyers, search funders, family offices, lower middle-market PE, and strategic consolidators, including direct mandates with the largest healthcare-services consolidators that other intermediaries cannot access. The buyers pay us when a deal closes, not the seller. No retainer, no exclusivity, no contract until close. Connect on LinkedIn · Get in touch

Sources and references

Every multiple range, operator-tier figure, CMS reimbursement figure, and transaction citation on this page is sourced to a published primary source or to CT Acquisitions’ internal benchmark dataset.

• CMS Home Health PPS Home Health Final Rule CY2025 (CMS-1803-F): PDGM 30-day base $2,058.71, 432 case-mix groups, LUPA thresholds.
• CMS Hospice Payment Information Hospice Final Rule FY2026 (CMS-1810-F) published Federal Register August 4 2025: RHC $231.16/day, cap $35,361.44.
• CMS HHVBP Model Expanded HHVBP nationwide payment adjustment effective January 1 2025 (plus-or-minus 5%).
• CMS Hospice HOPE Information Resources HOPE replaces HIS October 1 2025 with 4% APU penalty for non-compliance.
• CMS EVV Guidance Mandatory for personal care 2020 and home health 2023.
• NCSL Certificate of Need State Laws 17-state CON list for home health and hospice.
• UnitedHealth Group 8-K (August 2025) Amedisys close at $3.3B (August 7-14 2025).
• DOJ Antitrust Division final judgment (December 2025) 164 divestitures across 19 states: Pennant $146.5M, BrightSpring $239M.
• Enhabit Inc 8-K filed May 18 2026 Take-private to Kinderhook Industries $1.1B / $13.80/share / 10.2x EBITDA on $108M EBITDA, $1.06B revenue.
• Addus HomeCare Corporation 8-K (December 2 2024) Acquisition of Gentiva personal care division for $350M.
• PE Hub and Axios (March 2026) Bristol Hospice (Webster Equity) active auction attracting $1B+ on approximately $140M EBITDA.
• Reuters (April 2026) TEAM Services Group sale to General Atlantic at $3B (~10x EBITDA) from Alpine Investors.
• LevinPro HC, Mertz Taggart M&A Activity Reports (2025-2026) Home health, home care, hospice quarterly transaction trackers.
• Stoneridge Partners 2026 Home Care, Home Health, Hospice Market Reports Sub-vertical multiple bands and transaction commentary.
• CT Acquisitions VERIFIED_MULTIPLES dataset Locked vertical-specific multiple ranges reconciled against the above; updated quarterly.
• CT Acquisitions PE Roll-Up Tracker series Cross-references include veterinary, dermatology, dental DSO, HVAC.

Last verified: June 22, 2026. Next refresh: quarterly (target 2026-09-22).

Disclaimer: This guide is general valuation framework intelligence, not legal, tax, accounting, or transaction advice. CT Acquisitions is a buy-side M&A advisor.

Home Health Business Valuation Multiples

Home health business valuation multiples typically run 8x to 11x EBITDA for $5M-$15M Medicare-certified home health agencies, 7x to 9x EBITDA for non-medical home care of comparable size, and 9x to 12x EBITDA for Medicare hospice of comparable size, with hospice ceiling reaching 15x+ at platform scale. The single biggest driver is sub-vertical mix; the second is CON-state license footprint; the third is payor concentration risk in MLTSS markets.

The factors that move home health, home care, and hospice valuations most are sub-vertical mix, CMS reimbursement compliance posture (PDGM coding, HHVBP TPS, hospice cap, HOPE), CON-state license value, MLTSS payor diversification, EVV compliance rate, and transferability of founder-led referral and MCO relationships.

Frequently asked questions about home health business valuation

What is the average home health business multiple in 2026?

The simple average across all three sub-verticals is 9x-10x EBITDA. Medicare home health $5M-$50M EBITDA trades at 8x-12x with Enhabit/Kinderhook 10.2x as the cleanest mid-cycle anchor. Non-medical home care $5M-$50M+ trades at 7x-11x with TEAM/General Atlantic at approximately 10x as the high-water mark. Medicare hospice $5M-$50M+ trades at 9x-15x+ with Bristol/Webster active auction at approximately 12x-15x on $140M EBITDA. The sub-vertical mix matters more than the aggregate size.

Is non-medical home care worth less than Medicare home health?

At equivalent EBITDA scale, yes. Non-medical home care trades at 7x-9x at the $5M-$15M EBITDA band vs 8x-11x for Medicare home health, because of (a) wage exposure (50%-65% of revenue), (b) MLTSS payor concentration risk, and (c) lower regulatory moats (most states do not require CON for non-medical). Non-medical home care at $50M+ EBITDA closes the gap to 9x-11x because scale creates negotiating power with MCOs.

How much does CON state status add to my Medicare home health valuation?

Typically 1x-2x EBITDA. A Medicare-certified home health license in PA, NJ, NY, OH, VA, NC, GA cannot be applied for, only acquired. The scarcity premium is direct. A $5M EBITDA agency in PA trades at 10x-12x EBITDA; the same operating profile in TX (non-CON) trades at 8x-10x.

Do I add back owner salary to EBITDA?

Partially. Normalize to a market-rate replacement cost for the executive role you actually fill. For a $5M EBITDA non-medical home care platform, owner compensation add-back is typically $50K-$200K depending on actual compensation vs market replacement CEO ($250K-$400K). Add back personal expenses, related-party rents and medical director stipends, and one-time costs (HOPE implementation, EVV migration, RAC audit defense).

What is HHVBP and how does it affect my home health valuation?

The Expanded Home Health Value-Based Purchasing Model adjusts Medicare home health payment by plus-or-minus 5% based on Total Performance Score (TPS). CY2026 payment adjustments reflect CY2024 performance per CMS HHVBP fact sheet. An HHVBP-positive agency (top-quartile TPS) trades at 1x-1.5x EBITDA above HHVBP-neutral. An HHVBP-negative agency faces structural multiple compression because buyers underwrite forward Medicare revenue at the lower adjusted rate.

How does the hospice $35,361.44 cap work?

The per-beneficiary aggregate cap is $35,361.44 for FY2026 per CMS hospice cap inflation update. Each agency’s annual cap is calculated as total Medicare hospice payments divided by total Medicare beneficiaries served; this must not exceed the cap, and excess must be refunded to CMS. Long-LOS populations (dementia, debility, adult failure to thrive) compress cap headroom. Buyers rebuild cap calculations for trailing 3 years; agencies with under $5,000 of cap headroom per beneficiary face material multiple discount.

How long does a Medicare home health CHOW take?

4-12 months total from deal close to clean Medicare billing under new ownership. CMS Form 855A must be submitted within 30 days of change of ownership; MAC review and processing runs 90-240 days depending on jurisdiction (Palmetto, CGS, NGS, Noridian). State licensure transfer adds 60-180 days, longer in CON states. Most deals close with a 5%-10% purchase price escrow against Medicare billing transition risk.

What happened to the VBID hospice carve-in?

The CMS Innovation Center’s Value-Based Insurance Design Model hospice carve-in ended December 31 2024 and the full VBID model ended December 31 2025. Hospice reverts to fee-for-service Medicare reimbursement from January 1 2026 forward, regardless of Medicare Advantage enrollment status. This is a net positive for hospice multiples in 2026 because it removes a complicating revenue layer from hospice forecasting.

Is BAYADA owned by private equity?

No. BAYADA Home Health Care is a 501(c)(3) nonprofit since January 2019 per BAYADA Foundation announcement. Founder Mark Baiada transferred ownership to BAYADA Foundation in a structural decision specifically to keep the agency out of PE hands. BAYADA is not CVC Capital and is not any PE firm.

Who owns Compassus?

Compassus is owned 50% by TowerBrook Capital Partners and 50% by Ascension Health per Compassus press releases. It is not Optum-owned. Compassus operates joint ventures with OhioHealth at Home (September 2024) and Providence (October 2024 with Oregon regulatory approval May 18 2026).

Should I sell my hospice agency in 2026?

2026 is structurally favorable for hospice sellers because (a) VBID ended and hospice reverts to FFS Medicare, removing a revenue complication, (b) the Bristol/Webster auction has reset top-of-market expectations at 12x-15x EBITDA on platform-scale, (c) HOPE has now been operationalized at well-run agencies, removing transition risk for buyers, and (d) CD&R/Humana (Gentiva), Webster (Bristol), and Martis (Three Oaks) are all signaling continued appetite. The biggest 2026 risk is OBBBA Medicaid funding adjustments that could compress home care multiples in dual-eligible-heavy hospice markets.

How do MLTSS contracts affect my home care valuation?

Materially. State Medicaid contracts with managed care organizations (Centene, UnitedHealth, Humana, Molina, CVS Aetna) to administer HCBS benefits. Buyers map agency revenue to MCO concentration, contract maturity, and rate-action probability. A mature MLTSS state (TN CHOICES, PA CHC, AZ ALTCS, VA Cardinal Care Plus) with diversified MCO contract book (no single MCO over 30%) supports premium multiples. A single-MCO state (AZ ALTCS regional structure) or mid-transition state (OK SoonerSelect) carries discount.

How much will I pay in taxes on the sale?

Federal long-term capital gains plus 3.8% NIIT on goodwill portion. State taxes vary materially (TX, FL, WA, NV no state income tax; CA, NY high). For hospice and home health platforms operating in multiple states, state-by-state nexus and apportionment matter. Structural planning (F reorg, Section 1202 QSBS where applicable, installment sale, equity rollover) can reduce effective rate. See our complete selling playbook.

What is the best time of year to sell a home health agency?

LOI timing typically aligns with Q3 or Q4 (so buyers have clean trailing 12 months that includes a full Medicare FY for hospice). Close in Q1 or Q2 of the following year ahead of new CMS rate cycles. For agencies with HHVBP exposure, close before payment-year adjustment so buyer underwrites the adjustment forward.

What is the typical multiple for a home health business?

2026 multiples range from 7x EBITDA for $5M non-medical home care to 15x+ EBITDA for platform-scale hospice. Most transactions cluster: Medicare home health 8x-12x, non-medical home care 7x-11x, Medicare hospice 9x-15x+. The Enhabit/Kinderhook take-private at 10.2x EBITDA (May 18 2026, $1.1B) is the cleanest mid-cycle Medicare home health anchor.

How is a home health agency valued?

Revenue decomposition by sub-vertical (Medicare home health, non-medical home care, Medicare hospice) and by payor (Medicare FFS, Medicare Advantage, Medicaid HCBS, MLTSS, private pay, VA, LTC insurance), PDGM episode and HHVBP rebuild for home health, hospice cap rebuild trailing 3 years, EVV compliance audit, CON state license valuation, Stark/AKS scrub, MLTSS concentration analysis.

What is the most valuable type of home health business?

Medicare hospice at platform scale ($50M+ EBITDA) with diversified geographic footprint, balanced LOS mix, cap headroom above $7,500 per beneficiary, HOPE-ready operations, and minimal MA cross-over exposure now that VBID has ended. This profile trades at 12x-15x+ EBITDA. Bristol Hospice (Webster) is the active 2026 comp.

How much is a home health agency with $5M EBITDA worth?

Medicare home health in a CON state with HHVBP-positive TPS: $50M-$60M (10x-12x). Non-medical home care in MLTSS state with diversified MCO book: $40M-$45M (8x-9x). Medicare hospice with healthy cap headroom and HOPE-ready: $50M-$60M (10x-12x). The sub-vertical drives the band.

Do EVV compliance issues affect home care valuation?

Yes, materially. EVV non-compliance under the Cures Act mandate (personal care 2020, home health 2023) triggers claim denials and reduced Federal Medicaid Assistance Percentage at the state level. Buyers require 95%+ EVV compliance; agencies below this trade at 0.5x-1.0x EBITDA discount until compliance is achieved.

What is the difference between home health and home care for valuation purposes?

Medicare-certified home health (skilled nursing, therapy) is reimbursed by Medicare under PDGM and trades at 8x-12x EBITDA. Non-medical home care (personal care, companionship) is reimbursed by Medicaid HCBS, MLTSS, private pay, VA, and LTC insurance and trades at 7x-11x EBITDA. The reimbursement model, regulatory regime (CON typically applies only to skilled home health and hospice), and labor structure differ substantially.

How does the OBBBA Medicaid funding affect home care valuations?

The One Big Beautiful Bill Act (OBBBA) Medicaid funding provisions create medium-term rate-pressure risk for HCBS programs in states with high Medicaid expansion exposure. Buyers in 2026 are explicitly modeling 2027-2028 MLTSS rate stress scenarios. Agencies in states with stronger Medicaid funding posture (TX, FL) face less risk than agencies in expansion-heavy states.

What happens to my Medicare billing during a CHOW?

Most buyers accept assignment of the seller’s PTAN at close, which preserves continuous Medicare billing. The CMS Form 855A change of ownership triggers MAC review (90-240 days) but billing continues under the assigned PTAN. If the buyer rejects assignment (rare in home health, occasional in hospice), a new PTAN issuance can take 4-12 months and billing is suspended until resolution.

Related resources

• Home health, home care, and hospice seller hub, state-by-state data
• How to Sell a Service Business (full playbook)
• Veterinary PE Roll-Up 2026 (parallel healthcare-services rollup)
• Dermatology PE Roll-Up 2026
• HVAC PE Roll-Up 2026
• Free confidential valuation tool