Home Care vs. Home Health vs. Hospice: EBITDA Multiples Compared (2026)

“What’s my agency worth?” always has the same true answer: it depends on which business you’re actually in. Owners say “home care” to mean six different industries — and buyers price those industries up to three full EBITDA turns apart. Here is the whole map in one place, with 2026 numbers.

The 2026 Multiples Table

Segment	Typical EBITDA Multiple (2026)	Primary Payer	What Moves You Up the Range
Hospice	6–12×	Medicare	ADC scale, cap cushion, referral diversity
Medicare-certified home health	5–9×	Medicare	Star ratings, HHVBP performance, episodic margin
Behavioral health (outpatient/community)	5–9×	Medicaid/Commercial	Clinician retention, payer contracts, census
IDD services	4.5–7.5×	Medicaid waiver	Waiver slot scarcity, compliance record, occupancy
Private duty nursing	4–7×	Medicaid/Private	Nurse retention, case mix, payer rates
Non-medical home care (Medicaid)	3.5–6×	Medicaid/MLTSS	MCO contract quality, state rate environment, scale
Non-medical home care (private pay)	3–6×	Private pay	Client concentration, hours growth, caregiver retention

Ranges reflect adjusted EBITDA for agencies between roughly $500K and $10M EBITDA. Sub-$500K businesses typically trade below these ranges or on revenue-based pricing. Platform-scale assets ($10M+) can exceed them. Detailed benchmarks: 2026 benchmark report.

Why the Gaps Exist (It’s Not About Quality)

A brilliantly run private-pay agency still trades below a mediocre hospice. The gap is structural:

1. Barriers to entry

Hospice and certified home health licenses take 12–24+ months to obtain — where they can be obtained at all. CON states and enrollment moratoria mean buying is often the only way in, so the license itself carries value. Non-medical home care can be entered in most states for a few thousand dollars in licensing — so buyers pay for your earnings, not your permission to operate.

2. Payer durability

Medicare per-diem and episodic revenue is contract-free and uniform. Medicaid revenue depends on state budgets and MCO relationships (plus the margin overhang of the 80-20 rule). Private pay depends on thousands of individual households. Buyers pay more per dollar of revenue that renews itself.

3. Buyer competition

More institutional capital chases hospice and certified home health than any other segment — PE platforms, national strategics, and payers all compete for the same scarce assets. In non-medical home care the buyer pool is broader but shallower-pocketed. Multiple expansion follows buyer density.

The Range Within Each Segment Is Yours to Control

The spread inside each row — often 2–3 full turns — is worth more than the spread between rows, and unlike your segment, you can change it:

• Scale: crossing $1M adjusted EBITDA typically adds a turn; crossing $3M adds access to a different buyer class entirely
• Concentration: no payer or referral source above 20–25%
• Retention: caregiver turnover below segment averages is a pricing argument buyers accept
• Management depth: an agency that runs without its owner earns a premium; an owner-dependent one takes a discount
• Clean compliance file: surveys, audits, EVV — boring, and worth real money

A $1.5M-EBITDA Medicaid home care agency moving from the bottom of its range (3.5×) to the top (6×) gains $3.75M — more than most owners’ entire opening expectation.

The Multi-Service Arbitrage

If you run home care + home health + hospice under one roof with blended financials, you’re probably being under-appraised. Buyers sum segment values — but only if they can see them. Separating your P&L by service line before going to market lets the hospice EBITDA price at hospice multiples instead of drowning in a home care blend. We’ve seen this single reporting change move total value by seven figures.

Bottom Line

Know your segment’s range, then work the levers that move you inside it. And if you’re more than 18 months from a sale, those levers are still fully available to you — which is exactly when to find out where you stand.

Get a confidential, segment-specific valuation of your agency — grounded in actual 2026 closed-transaction comps. Book a free 20-minute call.