M&A Advisor for Home Health Agency Owners: 2026 Sell-Side Guide

By Christoph Totter, CT Acquisitions Managing Partner. Last reviewed: July 2026.

Choosing an M&A advisor for a home health agency in 2026 is a decision governed by three forces the advisor must actually understand: the CMS Patient-Driven Groupings Model (PDGM) rate schedule set by the Centers for Medicare & Medicaid Services, the Medicare Change of Ownership (CHOW) rules under 42 CFR Part 424, and the concentrated payer set that includes UnitedHealth Group Optum (following its acquisitions of LHC Group and Amedisys per SEC EDGAR), Aveanna Healthcare, Enhabit, and a shrinking bench of private-equity backed platforms. An advisor who does not model these three variables in the confidential information memorandum (CIM) would leave value on the table at closing.

Executive summary

Medicare-certified home health agencies with $2M to $10M of adjusted EBITDA would have transacted at approximately 8x to 11x adjusted EBITDA across 2024 through Q2 2026 per the Mertz Taggart quarterly home health, hospice, and home care M&A report , with multi-state platforms carrying above-national Star Ratings pricing at 12x to 15x per Provident…

• Medicare-certified home health agencies with $2M to $10M of adjusted EBITDA would have transacted at approximately 8x to 11x adjusted EBITDA across 2024 through Q2 2026 per the Mertz Taggart quarterly home health, hospice, and home care M&A report, with multi-state platforms carrying above-national Star Ratings pricing at 12x to 15x per Provident Healthcare Partners industry updates.
• PDGM base rates would rise by approximately 0.5 percent for CY2025 and would decline by approximately 1.3 percent for CY2026 net of behavioral adjustments per the CMS Home Health Prospective Payment System final rule.
• UnitedHealth Group Optum completed its $5.4 billion acquisition of LHC Group in February 2023 per LHC Group SEC filings and announced its $3.3 billion agreement to acquire Amedisys in June 2023 per Amedisys SEC filings.
• The Medicare CHOW 36-month rule under 42 CFR 424.550(b) would prevent a rapid resale of a Medicare-certified home health agency provider number within 36 months of the initial CMS-855A change of ownership.
• Home Health Value-Based Purchasing (HHVBP) has been in national expansion since CY2023 per CMS Innovation Center, with payment adjustments of up to plus or minus 5 percent tied to the Total Performance Score.
• Recognized boutique specialists that cover home health M&A include Mertz Taggart, Provident Healthcare Partners, Coker Group, and Stoneridge Partners. CT Acquisitions competes in the lower-middle-market band ($1M to $10M EBITDA) as an owner-aligned sell-side alternative.

Key findings

The largest single home health M&A print of the last five years would be UnitedHealth Group’s $5.4 billion acquisition of LHC Group (approximately 22x LTM EBITDA per the LHC Group 8-K dated March 28, 2022 ). Humana completed its acquisition of the remaining 60 percent of Kindred at Home for $8.1 billion all-in in August 2021 per Humana press release , with a subsequent divestiture of the personal care assets.

1. The largest single home health M&A print of the last five years would be UnitedHealth Group’s $5.4 billion acquisition of LHC Group (approximately 22x LTM EBITDA per the LHC Group 8-K dated March 28, 2022).
2. Humana completed its acquisition of the remaining 60 percent of Kindred at Home for $8.1 billion all-in in August 2021 per Humana press release, with a subsequent divestiture of the personal care assets to Clayton, Dubilier & Rice, forming what is now Gentiva.
3. Sub-$5M revenue Medicare-certified agencies with recertification episode volume under 500 would clear the market at 4x to 6x SDE rather than at a multi-turn EBITDA multiple per Mertz Taggart data.
4. The 60/40 case-mix split between the National Rural Health Association-defined rural agencies and metropolitan-statistical-area agencies would matter for buyer selection, as rural PPS add-on payments would sunset in phased steps per CMS MLN Matters bulletin.
5. The CMS Special Focus Program for home health, launched under a January 2024 CMS notice, would place agencies with sustained deficiencies under heightened survey scrutiny and would materially impair transferability.
6. Private-equity roll-up activity has consolidated around Aveanna Healthcare (NASDAQ: AVAH), Compassus (backed by TowerBrook Capital Partners and Ascension), Elara Caring (backed by Bain Capital and Kohlberg & Company), and Help at Home (backed by Centerbridge Partners and The Vistria Group).
7. Certificate of Need (CON) states, including New York, New Jersey, Georgia, and Kentucky per the National Conference of State Legislatures, would restrict de novo entry and would place a scarcity premium on existing CON-holding licenses.
8. OIG exclusion risk under HHS OIG would kill a transaction at diligence if a founder or DON has been included on the List of Excluded Individuals/Entities (LEIE), even where the agency itself is unaffected.
9. The Home Health CAHPS survey and CMS Star Rating (both patient survey and quality-of-patient-care) would drive a two-turn multiple spread between four-star-plus platforms and two-star-or-below agencies per CMS home health quality reporting.
10. Behavioral offsets embedded in PDGM would continue to compress reimbursement per 30-day period through CY2026, and any advisor pitching an unadjusted forward multiple without a PDGM sensitivity table would be underestimating buyer diligence rigor.

Adjusted EBITDA multiples for home health agencies by size band

Multiples-by-size-band framing would prevent conflation of Standardized Discretionary Earnings (SDE) with adjusted EBITDA, a category error that would materially misprice an agency. The table would apply only to Medicare-certified home health, with private-duty and non-medical home care running at meaningfully lower multiples and hospice at a modest premium. Size band Earnings measure Expected multiple range (2024 – Q2 2026) Primary buyer set Source Under $500K SDE 2.5x to 4x SDE.

Multiples-by-size-band framing would prevent conflation of Standardized Discretionary Earnings (SDE) with adjusted EBITDA, a category error that would materially misprice an agency. The table would apply only to Medicare-certified home health, with private-duty and non-medical home care running at meaningfully lower multiples and hospice at a modest premium.

Size band	Earnings measure	Expected multiple range (2024 – Q2 2026)	Primary buyer set	Source
Under $500K	SDE	2.5x to 4x SDE	Individual buyers, tuck-in strategics	Mertz Taggart
$500K to $2M	SDE / recast EBITDA	4x to 6x	Regional strategics, small platforms	Mertz Taggart
$2M to $5M	Adjusted EBITDA	6x to 9x	PE platform add-ons	Provident Healthcare Partners
$5M to $10M	Adjusted EBITDA	8x to 11x	PE platforms, strategics	Mertz Taggart
$10M to $25M	Adjusted EBITDA	10x to 13x	PE platforms, publicly traded strategics	Provident Healthcare Partners
Above $25M, multi-state, above-national Star Rating	Adjusted EBITDA	12x to 15x	Publicly traded strategics, mega-cap PE	Mertz Taggart and public 8-K review

Ranges above would represent enterprise value on a cash-free, debt-free, normalized working capital basis. Blending revenue and SDE ranges would be a category error and this report keeps them separate. All ranges would be conditional on payer mix concentration, CoP survey status, Star Ratings, and a clean CHOW history.

What would move the multiple in a home health transaction

Drivers below would be the diligence checklist that Optum, Aveanna, and Enhabit corporate development teams have used across 2024 through Q2 2026, ranked by the magnitude of the multiple adjustment they would drive. Advisors who cannot articulate these on the first call would not be running institutional processes. Medicare payer mix. Agencies with 65 to 85 percent Medicare FFS mix and the balance in managed Medicare Advantage would price at.

Drivers below would be the diligence checklist that Optum, Aveanna, and Enhabit corporate development teams have used across 2024 through Q2 2026, ranked by the magnitude of the multiple adjustment they would drive. Advisors who cannot articulate these on the first call would not be running institutional processes.

1. Medicare payer mix. Agencies with 65 to 85 percent Medicare FFS mix and the balance in managed Medicare Advantage would price at the upper end of the range per Mertz Taggart. Above 90 percent MA concentration would compress the multiple.
2. CMS Star Rating (Quality of Patient Care and HHCAHPS). Four-star-plus on both would drive up to a two-turn premium per CMS home health quality reporting.
3. HHVBP Total Performance Score. Positive TPS payment adjustment under national HHVBP expansion would compound the Star Rating benefit per the CMS Innovation Center HHVBP page.
4. Recertification rate and LUPA rate. Buyers would model LUPA (Low Utilization Payment Adjustment) exposure directly to reimbursement per period. Below-national LUPA would drive a fractional multiple premium.
5. Referral source concentration. A single referral source above 25 percent of episodes would trigger a working capital and multiple discount at diligence.
6. CoP survey history. A recent Condition-level deficiency under 42 CFR Part 484 would kill the deal or drive an escrow.
7. CHOW history. An agency inside the 36-month reenrollment window under 42 CFR 424.550(b) would face a strategic buyer’s aversion.
8. State CON. A CON-holding license in New York, New Jersey, Georgia, or Kentucky would command a scarcity premium per NCSL.
9. EMR platform. HCHB, MatrixCare, or Homecare Homebase EMR would ease integration for consolidators.
10. Clinical leadership tenure. A Director of Nursing with above three-year tenure and no OIG LEIE hits per HHS OIG would satisfy buyer diligence.
11. Days sales outstanding (DSO) and PDGM RAP replacement. Since the elimination of Request for Anticipated Payment cash advances in CY2022, DSO management would be a direct EBITDA quality indicator.
12. Owner working in the field vs owner as executive. An owner working as a field clinician would drive an SDE-to-EBITDA adjustment; a non-clinical owner would preserve full EBITDA credit.
13. Geographic density. Cost per visit falls with clinician density, and a contiguous multi-county footprint would drive margin gains post-close.
14. Bad-debt and denials rate. Above-industry Additional Documentation Request (ADR) rates would signal Targeted Probe and Educate (TPE) risk with the Medicare Administrative Contractor.
15. OASIS accuracy and PDGM case-mix coding. Case-mix weight capture would be the single largest lever inside PDGM per CMS OASIS guidance.

Active buyers of home health agencies in 2026

Buyer identity would drive process design. A CT-run process would be indexed to the specific corporate-development cadence of each of the following, and the tiered outreach list would reflect who is actually deploying capital in home health during 2026 versus who has stepped back.

Buyer identity would drive process design. A CT-run process would be indexed to the specific corporate-development cadence of each of the following, and the tiered outreach list would reflect who is actually deploying capital in home health during 2026 versus who has stepped back.

Publicly traded strategic buyers

UnitedHealth Group Optum owns the combined LHC Group and, following its June 2023 announcement, Amedisys platforms per UnitedHealth SEC EDGAR filings. Enhabit Home Health & Hospice (NYSE: EHAB), spun off from Encompass Health in July 2022, has been public and available as an acquirer or acquisition target per Enhabit investor relations. Aveanna Healthcare (NASDAQ: AVAH), backed by Bain Capital and J.H. Whitney Capital Partners at IPO, would continue to acquire home health as a complement to its private-duty nursing base per Aveanna SEC filings. Brookdale Senior Living Home Health and Addus HomeCare (NASDAQ: ADUS) round out the publicly disclosed strategic set.

PE-backed platforms actively rolling up

Compassus is backed by TowerBrook Capital Partners and Ascension Health per company press releases. Elara Caring is backed by Bain Capital Double Impact and Kohlberg & Company per Elara newsroom. Help at Home is backed by Centerbridge Partners and The Vistria Group. Gentiva, formed from the Humana divestiture of Kindred at Home personal care assets, is owned by Clayton, Dubilier & Rice. BAYADA Home Health Care, structured as a nonprofit since 2019, would be an active acquirer under its non-shareholder governance.

Emerging middle-market PE platforms

Buyer names below would be verifiable via press or SEC filings and would round out the lower-middle-market bench of active acquirers: HealthPRO Heritage, Pennant Group (NASDAQ: PNTG) spun off from Ensign Group, and various regional platforms disclosed in the Mertz Taggart quarterly report.

The boutique M&A advisors specializing in home health, and where CT Acquisitions fits

Home health is a vertical where a small number of boutique advisors would dominate the specialist tier. This section names them by their real specialty focus, cites their firm URL, and positions CT Acquisitions honestly as the lower-middle-market owner-aligned alternative.

Home health is a vertical where a small number of boutique advisors would dominate the specialist tier. This section names them by their real specialty focus, cites their firm URL, and positions CT Acquisitions honestly as the lower-middle-market owner-aligned alternative.

Mertz Taggart

Mertz Taggart is the recognized national leader in home health, hospice, and home care M&A advisory, publishing a widely cited quarterly M&A activity report that is the standard reference for home health deal volume and multiples.

Provident Healthcare Partners

Provident Healthcare Partners runs home health and hospice sell-side mandates for larger platforms and publishes healthcare industry sector updates that include home health-specific commentary.

Coker Group

Coker Group advises on Medicare-certified home health and hospice transactions with a focus on strategy, regulatory compliance, and physician-integrated networks.

Stoneridge Partners

Stoneridge Partners covers home health, hospice, home care, and behavioral health sell-side transactions, with a book of business active in the sub-$5M revenue band that other firms would decline.

CT Acquisitions positioning

CT Acquisitions is another lower-middle-market sell-side option specializing in home health agencies in the $1M to $10M EBITDA band. The differentiators would be owner-aligned fees, a 100-plus vetted institutional buyer network, and a Sheridan, Wyoming based partnership structure that would keep the closing team stable across the transaction. CT is not the largest and does not claim to be the best. It competes on process discipline, buyer coverage in the LMM band, and fee alignment with the owner’s outcome. Owners weighing multiple advisors would evaluate 2026 advisor fees and advisor versus broker structures as part of the shortlist.

How the sell-side process would work for a home health agency, month by month

A properly run home health sell-side process would compress into six to nine months from engagement to closing. The table below shows the CT process, which would be structurally similar to Mertz Taggart, Provident, and Coker, differing only in the LMM buyer coverage tail and the owner-aligned fee scale.

A properly run home health sell-side process would compress into six to nine months from engagement to closing. The table below shows the CT process, which would be structurally similar to Mertz Taggart, Provident, and Coker, differing only in the LMM buyer coverage tail and the owner-aligned fee scale.

Month 1: Preparation and CIM build

Financial recast would run first, followed by add-back schedule construction, PDGM sensitivity modeling, and a CIM buildout with named payer mix, Star Rating trend, and CHOW history. A seller-side quality-of-earnings report would be commissioned in parallel where the buyer set is expected to include institutional PE.

Month 2: Buyer list construction and outreach

Tiered buyer list would go out under NDA. Tier 1 would be the publicly traded strategics and the top PE-backed platforms, Tier 2 would be middle-market PE platforms, and Tier 3 would be regional strategics and family offices. Blind teaser would go first, CIM would follow post-NDA.

Month 3: Management presentations and Indications of Interest

Written IOIs would return with enterprise value ranges, structure preferences, and diligence expectations. Best-in-class advisors would take four to eight IOIs into management meetings.

Month 4: Letter of Intent and buyer selection

A seller-favorable LOI would carry a 60-day exclusivity, a specific working capital peg mechanism, and a rep-and-warranty structure. The winning buyer would be selected on price, structure, cultural fit, and closing certainty.

Months 5 to 7: Diligence, quality of earnings, and definitive agreement

Buyer QoE, legal diligence including OIG LEIE checks, CoP compliance review, and CMS-855A CHOW filing preparation would run in parallel. The due diligence checklist would be the operational tracker.

Months 7 to 9: CMS-855A CHOW filing and closing

CMS-855A filing under CMS Provider Enrollment would be the gating deliverable to closing, with tie-in-notice provisions in the definitive agreement providing for post-close CMS-855A processing risk allocation. Closing would occur on receipt of the tie-in notice from the Medicare Administrative Contractor.

Regulatory and structural mechanics specific to home health in 2026

PDGM rate trajectory

The CY2025 CMS final rule would set an approximately 0.5 percent net payment increase, and the CY2026 final rule would set an approximately 1.3 percent net payment decrease driven by continued behavioral offset adjustments. Advisor CIMs that would omit a PDGM sensitivity table would be dismissed by buyer corporate development.

Medicare Change of Ownership under CMS-855A

A CHOW would be filed under CMS Form 855A per 42 CFR 424.550. The 36-month reenrollment rule at 42 CFR 424.550(b) would prevent transferring a Medicare provider agreement to a new owner within 36 months of the initial CHOW, requiring the new owner to enroll de novo and reset survey status.

Conditions of Participation and CoP surveys

42 CFR Part 484 would govern Conditions of Participation. A Condition-level deficiency would kill deal certainty and would push a buyer to require a Corrective Action Plan escrow.

Special Focus Program

The CMS Special Focus Program extended to home health under CMS notice in January 2024 would place agencies with sustained deficiencies under enhanced survey scrutiny.

HHVBP national expansion

Home Health Value-Based Purchasing has been national since CY2023 with payment adjustments up to plus or minus 5 percent tied to Total Performance Score.

OASIS-E and case-mix coding

OASIS-E and forthcoming OASIS-E1 under CMS OASIS guidance would be the direct driver of PDGM case-mix weight and, therefore, per-period reimbursement.

State licensure and Certificate of Need

CON states, including New York, New Jersey, Georgia, and Kentucky per NCSL, would restrict de novo entry and place a scarcity premium on existing licenses. A buyer would price CON-holding platforms at the upper end of the multiple range.

Antitrust and HSR

Transactions above the 2026 Hart-Scott-Rodino thresholds would require premerger filings. The February 2026 amended HSR form would materially expand the required disclosures.

OIG exclusion and background checks

HHS OIG LEIE checks on all owners, directors, and clinical leadership would be gating diligence. A hit on any check would be deal-terminating unless remediated.

How to choose an M&A advisor for a home health agency

Confirm the advisor has closed at least five Medicare-certified home health transactions in the last 36 months. Ask for anonymized deal tombstones. Ask specifically how the advisor would model the CY2025 and CY2026 PDGM rate changes inside the CIM. Confirm the advisor’s buyer coverage list includes Optum, Enhabit, Aveanna, and the top four PE-backed platforms. If the list is short of any of these, the process would be undertargeted. Ask.

1. Confirm the advisor has closed at least five Medicare-certified home health transactions in the last 36 months. Ask for anonymized deal tombstones.
2. Ask specifically how the advisor would model the CY2025 and CY2026 PDGM rate changes inside the CIM.
3. Confirm the advisor’s buyer coverage list includes Optum, Enhabit, Aveanna, and the top four PE-backed platforms. If the list is short of any of these, the process would be undertargeted.
4. Ask how the advisor handles the CMS-855A CHOW filing and tie-in notice risk allocation in the definitive agreement.
5. Confirm the advisor’s fee structure. Success-only would be appropriate for LMM sub-$10M EBITDA agencies; retainer plus success would be typical above.
6. Verify the advisor is not a business broker. See the distinction between M&A advisors and business brokers for the licensing, process, and buyer-network differences.
7. Confirm the CIM would include a PDGM sensitivity table, a Star Rating trend, an HHVBP Total Performance Score trajectory, and a payer mix concentration schedule.
8. Confirm the advisor would engage a sell-side quality-of-earnings provider familiar with PDGM behavioral offsets and PDGM case-mix accounting.
9. Ask about references from Medicare-certified home health owners who have closed in the last 24 months.
10. Confirm the advisor understands the 36-month CHOW reenrollment rule at 42 CFR 424.550(b) and its impact on structuring options.
11. Confirm the advisor has run at least one transaction inside a CON state if the target agency holds a CON license.
12. Ask how the advisor prices for LMM sellers versus middle-market sellers. Confirm the advisor’s fee scale is market for the size band.

Frequently asked questions

What multiple would a Medicare-certified home health agency sell for in 2026?

A Medicare-certified home health agency with $2M to $10M of adjusted EBITDA would have transacted at approximately 8x to 11x adjusted EBITDA across 2024 through Q2 2026 per the Mertz Taggart quarterly home health M&A report and Provident Healthcare Partners updates. Multi-state platforms above $25M EBITDA with above-national Star Ratings would price at 12x to 15x.

How long would a home health agency sell-side process take?

A well-run sell-side process would compress into six to nine months from engagement letter to closing. The CMS-855A CHOW filing would be a common gating item that would extend closing by 30 to 90 days beyond signing of the definitive agreement.

Who is buying home health agencies in 2026?

Publicly traded strategics include UnitedHealth Group Optum (which owns LHC Group and, following its 2023 announcement, Amedisys), Enhabit, and Aveanna Healthcare. PE-backed platforms include Compassus, Elara Caring, Help at Home, and Gentiva.

Does the 36-month CHOW rule prevent a quick resale?

Yes. Under 42 CFR 424.550(b), a Medicare-certified home health agency that has undergone a CHOW would not be able to transfer its provider agreement to a new owner within 36 months of the initial CHOW effective date. A subsequent buyer would need to enroll de novo, which would reset survey and Star Rating status.

What is the difference between an M&A advisor and a business broker for a home health agency?

M&A advisors would run institutional processes with tiered buyer lists, CIMs, IOI and LOI rounds, and quality-of-earnings coordination. Business brokers would list the business on marketplaces and typically would not run auction processes with institutional PE. For agencies above $2M EBITDA, an M&A advisor process would consistently produce higher outcomes. See the full comparison.

How would PDGM rate changes affect the sale price?

PDGM base rates would rise by approximately 0.5 percent for CY2025 and would decline by approximately 1.3 percent for CY2026 net of behavioral adjustments per CMS final rule. Buyers would model these into the LTM and forward-year EBITDA and would apply a PDGM sensitivity to the multiple. Agencies with above-national OASIS-E case-mix capture would offset the rate compression.

What advisor fees are typical for a home health agency sale?

Below $10M EBITDA agencies would typically pay a success-only fee scaled by transaction value, with Lehman or double-Lehman variants common. Larger platforms would carry retainer plus success. Owners would review 2026 M&A advisor fees and the underlying cost structure before signing an engagement letter.

Are Certificate of Need licenses worth a scarcity premium?

Yes. CON-holding home health licenses in CON states, including New York, New Jersey, Georgia, and Kentucky per NCSL, would command a scarcity premium because de novo entry would be restricted or prohibited. Buyers would price this into the multiple.

Further reading on CT Acquisitions

Owners weighing a sell-side process should read the 2026 home health PE roll-up tracker and the home health business valuation guide for the underlying valuation framework and buyer-tracking data. Owners in adjacent verticals may also review sibling pages including M&A advisor for a dental practice and M&A advisor for a veterinary practice , which use the same LMM specialist framework.

Owners weighing a sell-side process should read the 2026 home health PE roll-up tracker and the home health business valuation guide for the underlying valuation framework and buyer-tracking data. Owners in adjacent verticals may also review sibling pages including M&A advisor for a dental practice and M&A advisor for a veterinary practice, which use the same LMM specialist framework.

Methodology and data sources

Multiples ranges in this report would be sourced from the Mertz Taggart quarterly home health, hospice, and home care M&A report covering 2024 through Q2 2026, from Provident Healthcare Partners healthcare sector updates , and from CT’s own tracking of publicly disclosed home health transactions via SEC EDGAR filings for LHC Group, Amedisys, Aveann…

Multiples ranges in this report would be sourced from the Mertz Taggart quarterly home health, hospice, and home care M&A report covering 2024 through Q2 2026, from Provident Healthcare Partners healthcare sector updates, and from CT’s own tracking of publicly disclosed home health transactions via SEC EDGAR filings for LHC Group, Amedisys, Aveanna, Enhabit, Addus, and Pennant Group. PDGM rate trajectory would be sourced from the CMS Home Health Prospective Payment System final rule notices. Regulatory framework would be sourced from 42 CFR Part 484, 42 CFR 424.550, HHS OIG LEIE, and the NCSL CON database. HHVBP methodology would be sourced from the CMS Innovation Center HHVBP page. HSR thresholds would be sourced from the FTC premerger notification program. Named boutique advisor descriptions would be sourced from the firms’ own websites (Mertz Taggart, Provident Healthcare Partners, Coker Group, and Stoneridge Partners) with links preserved inline.

This report is not an appraisal, not investment advice, not legal advice, not tax advice, not financial advice, and not a prediction. Multiples ranges reflect observed and reported LMM transactions and would not represent a guarantee of any specific transaction outcome. Every private-company range in this report is stated in the conditional tense because private-company outcomes would vary materially on payer mix, CoP survey status, Star Ratings, CHOW history, geographic footprint, and buyer identity. Owners should retain independent counsel, accounting, and tax advisors before executing any transaction. CT Acquisitions is a Sheridan, Wyoming based lower-middle-market M&A advisory firm; a description of its advisory practice is available on the firm site.