# Home Care vs. Home Health vs. Hospice: EBITDA Multiples Compared (2026) > One table, every segment: what home care, home health, hospice, private duty nursing, IDD, and behavioral health businesses actually sell for in 2026 — and the structural reasons hospice trades at 2–3 turns above non-medical home care. Source: https://www.hendonpartners.com/insights/home-care-home-health-hospice-multiples-compared Author: Neli Gertner Published: 2026-09-04 Category: Valuation Insights Tags: valuation, multiples, home-care, home-health, hospice, comparison ---"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](/insights/hhvbp-home-health-value-based-purchasing-valuation), 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](/insights/medicaid-mltss-home-care-agency-valuation), 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](/insights/home-care-ebitda-multiples-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](/insights/con-states-home-health-ma-guide) and [enrollment moratoria](/insights/cms-enrollment-moratorium-home-health-hospice) 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](/insights/medicaid-mltss-home-care-agency-valuation) (plus the margin overhang of the [80-20 rule](/insights/cms-80-20-rule-medicaid-home-care-valuation)). 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](/insights/most-active-home-care-private-equity-firms-2026), 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](/insights/caregiver-turnover-home-care-valuation) 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](/book). *Get a confidential, segment-specific valuation of your agency — grounded in actual 2026 closed-transaction comps. [Book a free 20-minute call](/book).* --- ## Frequently Asked Questions ### What EBITDA multiple does a home care agency sell for in 2026? Non-medical (private pay or Medicaid) home care agencies typically sell for 3–6× adjusted EBITDA in 2026. Agencies with $1M+ EBITDA, diversified payer sources, and strong caregiver retention reach the upper half; smaller or single-payer agencies trade in the lower half. ### Why do hospice agencies sell for higher multiples than home care agencies? Three structural reasons: hospice licenses are scarce (CON states and CMS moratoria restrict new entrants), revenue is ~90% Medicare per-diem with no rate negotiation risk, and demographic demand is compounding. Non-medical home care has low barriers to entry and more fragmented payer sources, so buyers pay less per dollar of earnings. ### Do Medicare-certified home health agencies sell for more than non-medical home care? Yes, generally 1.5–3 turns more. Medicare certification is a regulatory asset that takes 12–24 months to replicate, and certified agencies attract a deeper institutional buyer pool. In 2026, quality certified agencies trade at 5–9× versus 3–6× for non-medical agencies of similar EBITDA. ### How is a business with multiple service lines (home health + hospice + home care) valued? Buyers typically value each service line at its segment multiple and sum them, weighting for shared overhead. A combined agency with hospice earnings buried inside blended financials often appraises below its parts — separating P&L reporting by service line before a sale process can materially raise the total.