# Home Health and Hospice M&A Activity Report: Q1 2026 > Home-based care M&A activity in Q1 2026 reflected stabilized buyer interest, modest sequential improvement in deal volume, and continued segmentation between premium-quality assets attracting competitive bids and average assets pricing at lower multiples. Here is our quarterly read of the market. Source: https://www.hendonpartners.com/insights/home-health-hospice-ma-q1-2026-report Author: Neli Gertner Published: 2026-04-15 Category: Market Intelligence Tags: quarterly-report, home-health, hospice, M&A-trends, 2026 ---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. --- ## Overall Market Conditions in Q1 2026 **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 Hospice continued to lead home-based care M&A by both volume and multiple strength in Q1 2026. ### Activity Themes - Continued PE platform consolidation - Active acquisition by Bristol, Compassus, Agape, St. Croix, Three Oaks, Traditions, and other established platforms - Selective new platform investments - Continued post-CON-repeal entry activity in Florida ### Multiple Ranges 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. ### Diligence Themes - Special Focus Program (SFP) profile and risk - Medicare cap utilization and headroom - General inpatient (GIP) utilization patterns - Length of stay distribution and live discharge rates - Referral source diversification and concentration - OIG and audit history 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 Medicare-certified home health activity in Q1 2026 was steady but selective. ### Activity Themes - Active PE-backed platform consolidation continued - Strategic acquirer activity in select markets - CON state premiums continued for quality assets - Medicare Advantage penetration impact on valuations remained meaningful ### Multiple Ranges 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. ### Diligence Themes - Medicare Advantage payer mix and rate quality - Star ratings (Patient Survey and Quality of Patient Care) - LUPA rates and PDGM management - OASIS accuracy and survey history - Value-based care contracting position - HHCAHPS performance --- ## Private Pay Non-Skilled Home Care Private pay non-skilled home care saw steady add-on activity in Q1 2026. ### Activity Themes - Continued add-on acquisitions by PE-backed platforms - Active franchise system consolidation - Selective new geographic platform builds - Family office and independent sponsor activity at the lower middle market ### Multiple Ranges 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. ### Diligence Themes - Caregiver retention metrics - Geographic density and metro concentration - Referral source diversification - Per-hour billable rate trajectory - Wage cost trajectory and margin defensibility --- ## Pediatric Home Health and PDN Pediatric continued to attract premium PE interest in Q1 2026. ### Activity Themes - Active acquisition by established pediatric platforms - Selective new pediatric platform investment - Continued buyer focus on workforce-driven valuation premium ### Multiple Ranges Quality pediatric platforms transacted in the 6.0× to 9.0× EBITDA range, with platform-quality assets approaching or exceeding 9×. ### Diligence Themes - BCBA/RN recruiting and retention infrastructure - Authorized hours fill rate - Payer mix (EPSDT, MCO, commercial, TRICARE) - Geographic density - Service line breadth (PDN, therapy, complex care coordination) --- ## Behavioral Health and ABA Behavioral health and ABA activity remained at stable levels in Q1 2026, with continued post-2022 multiple discipline. ### Activity Themes - Continued ABA platform consolidation - Mental health outpatient platform building - SUD treatment center selective activity - Payer mix and clinical model integrity central to valuations ### Multiple Ranges 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 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. ### Multiple Ranges Quality IDD platforms transacted in the 5.0× to 7.0× range, with state-specific dynamics affecting individual transaction outcomes. --- ## Healthcare Staffing Healthcare staffing M&A continued at modest activity levels relative to the 2021–2022 peak. Multiples have normalized substantially. ### Multiple Ranges 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. --- ## Cross-Cutting Themes ### 80/20 Rule Implementation 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. ### Medicare Advantage Dynamics 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. ### Workforce Premium 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. ### Compliance Sensitivity 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. ### Geographic Concentration 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. --- ## Outlook for the Rest of 2026 Our base case for the remainder of 2026: - **Volume stable to modestly higher** than Q1 levels - **Multiples stable** with continued bifurcation between premium and average assets - **Continued PE add-on dominance** in transaction count - **Selective new platform investment** in attractive verticals (pediatric, hospice, behavioral health) - **80/20 rule and MA dynamics** continuing to shape diligence - **Workforce metrics** continuing to drive valuation differentiation - **Continued post-CON-repeal activity** in Florida hospice and selective other state regulatory shifts 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. --- ## Bottom Line 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](/contact-us). --- ## Frequently Asked Questions ### What was home health M&A activity like in Q1 2026? Q1 2026 saw stabilized home health M&A activity at modestly higher levels than Q4 2025, with continued buyer selectivity. Quality assets in attractive geographies attracted competitive bids; average assets transacted at the lower end of typical multiple ranges. ### How are hospice M&A multiples trending in 2026? Hospice multiples remained strong in Q1 2026, with quality platforms transacting in the 6.0× to 9.0× range and select platform-quality assets exceeding 9×. Buyer focus on Special Focus Program (SFP) avoidance, Medicare cap headroom, and clinical compliance continued to differentiate premium pricing. ### What sub-segments saw the most activity in Q1 2026? Hospice continued to lead by volume and multiple strength, followed by pediatric PDN. Private pay non-skilled home care saw steady add-on activity. Medicare-certified home health was selective, with quality assets transacting and average assets pricing more cautiously. ### What is the outlook for home-based care M&A through the rest of 2026? Activity is expected to remain at current levels or modestly increase through 2026, with continued buyer selectivity. The 80/20 rule, Medicare Advantage penetration, and regulatory implementation timelines will continue to shape pricing and segment dynamics.