Q1 2026 home-based care M&A activity reflected a stabilized market: deal volume modestly higher than Q4 2025, continued buyer selectivity, and clear segmentation between premium-quality assets attracting competitive bids and average assets pricing at the lower end of typical ranges.
This quarterly report summarizes our read of Q1 2026 activity across home health, hospice, home care, pediatric, and behavioral health, and what it suggests for the rest of 2026.
A note on methodology: this report reflects our perspective as active sell-side advisors observing transactions across home-based care. Specific transaction terms are confidential; aggregate themes are drawn from our deal flow, buyer conversations, and broader industry market intelligence.
Deal volume modestly higher than Q4 2025. The seasonal slowdown that typically affects Q4 transaction completion gave way to a more active Q1, in line with normal year-over-year patterns. Year-over-year comparison to Q1 2025 shows comparable volume, with no meaningful acceleration but no contraction either.
Buyer selectivity remained pronounced. PE platforms and strategic buyers continue to apply rigorous diligence, particularly on payer mix quality, clinical compliance, workforce stability, and growth defensibility. Quality assets attracted multiple offers; average assets transacted but with less competitive tension.
Multiple stability. Headline multiples were stable to modestly improved versus the second half of 2025. Compression that affected the market in 2022–2023 has not reversed materially, but it has stabilized at current levels and quality assets are seeing competitive bidding return.
Add-on activity dominant. As in prior quarters, the majority of transaction count was add-on acquisitions to existing PE-backed platforms. New platform investments occurred but at lower count.
Hospice continued to lead home-based care M&A by both volume and multiple strength in Q1 2026.
Quality hospice agencies transacted in the 6.0× to 9.0× EBITDA range, with platform-quality assets exceeding 9×. Smaller agencies (sub-$1M EBITDA) transacted at 4.5× to 6.5×. Premium drivers continued to include average daily census growth, Medicare cap headroom, diversified referral sources, clean compliance, and geographic density.
Hospice buyers continued to differentiate aggressively between agencies with clean compliance profiles (premium pricing) and agencies with any material concerns (steep discounts or process termination).
Medicare-certified home health activity in Q1 2026 was steady but selective.
Quality Medicare-certified home health agencies transacted in the 5.5× to 8.0× EBITDA range, with platform-quality assets exceeding 8×. CON state assets and assets with strong star ratings, low LUPA rates, and clean survey histories commanded the upper end of the range.
Private pay non-skilled home care saw steady add-on activity in Q1 2026.
Quality private pay agencies transacted in the 4.5× to 6.5× EBITDA range, with larger platform-quality assets exceeding 6.5×. Premium markets (Naples, Palm Beach, parts of California) supported higher multiples for the right operators.
Pediatric continued to attract premium PE interest in Q1 2026.
Quality pediatric platforms transacted in the 6.0× to 9.0× EBITDA range, with platform-quality assets approaching or exceeding 9×.
Behavioral health and ABA activity remained at stable levels in Q1 2026, with continued post-2022 multiple discipline.
Quality ABA platforms transacted in the 5.0× to 8.0× EBITDA range, with multi-state platforms with strong commercial mix and clinical model integrity at the upper end. Mental health outpatient platforms transacted in similar ranges depending on payer mix and clinical model.
IDD services M&A continued at modest activity levels in Q1 2026, with continued caution from buyers around 80/20 rule implementation and Medicaid HCBS rate adequacy.
Quality IDD platforms transacted in the 5.0× to 7.0× range, with state-specific dynamics affecting individual transaction outcomes.
Healthcare staffing M&A continued at modest activity levels relative to the 2021–2022 peak. Multiples have normalized substantially.
Quality healthcare staffing platforms transacted in the 4.0× to 6.5× EBITDA range, with home care staffing toward the upper end and broader allied/travel staffing at the lower end.
The CMS Medicaid Access Rule continued to shape diligence on Medicaid HCBS-exposed agencies. Buyers in Q1 2026 increasingly required compensation ratio documentation, state-specific implementation analysis, and credible paths-to-compliance from sellers.
MA penetration impact on home health valuations remained one of the most consequential variables in Q1 2026 transactions. Agencies with strong MA contract portfolios and value-based positioning defended premium multiples; agencies with low-rate MA exposure faced compression.
Across all segments, workforce stability metrics — caregiver, nurse, BCBA, clinical leadership retention — drove an increasing share of valuation differentiation in Q1 2026. Buyers paid clear premiums for agencies with documented retention infrastructure.
Hospice SFP risk, ABA audit exposure, EVV compliance, and general regulatory cleanliness all continued to drive bifurcated outcomes — premium for clean operators, deep discount for operators with material concerns.
Buyer preference for concentrated metro density over geographic sprawl continued to strengthen in Q1 2026, with multi-region operators receiving discounts vs. similarly-sized concentrated operators.
Our base case for the remainder of 2026:
The market in 2026 rewards sellers with clean operations, documented quality, defensible payer mix, strong workforce metrics, and disciplined sale process execution. Sellers who go to market unprepared continue to leave value on the table.
Q1 2026 reflected a stable, selectively active home-based care M&A market. Quality assets attracted competitive interest at premium multiples; average assets transacted at lower multiples; the gap between the two continued to widen.
If you would like to discuss what current market conditions mean for your specific agency, contact us for a confidential conversation.
Q2 2026 Home-Based Care M&A Report: Transactions, Multiples, and Buyer Trends
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