# Most Active Private Equity Firms in Home-Based Care M&A in 2026 > Private equity continues to drive the majority of home-based care M&A activity in 2026. Here is a working guide to the most active PE platforms and sponsors acquiring home care, home health, hospice, pediatric, and behavioral health agencies — and what each looks for. Source: https://www.hendonpartners.com/insights/most-active-home-care-private-equity-firms-2026 Author: Neli Gertner Published: 2026-04-27 Category: Buyer Landscape Tags: private-equity, buyers, M&A, home-care, home-health, hospice ---Private equity continues to drive the majority of home-based care M&A activity in 2026. Understanding who the active buyers are — and what each one is looking for — is one of the most useful pieces of context an agency owner can have when evaluating a sale. This guide is a practical overview of the most active PE participants in home-based care, organized by segment focus. Activity in this space is heavily concentrated through PE-backed portfolio platforms making add-on acquisitions, rather than direct sponsor acquisitions of individual agencies. We have included both layers. A note on scope: the firms below are active acquirers as of early 2026. Deal activity, fund cycles, and platform strategies shift regularly. Any sale process should be informed by current intelligence on which platforms are buying, in which geographies, at what scale, and at what valuations — not on a static list. --- ## How the PE Buyer Landscape Is Structured Three layers matter when thinking about PE in home-based care: 1. **Sponsors (the PE firms themselves)** — large-cap and mid-market healthcare-focused funds that invest in home-based care. 2. **Platforms (the operating companies the sponsors own)** — these are the home care, hospice, pediatric, or behavioral health businesses that execute the strategy. Most agency-level acquisitions happen at this layer as add-ons. 3. **Strategics with PE backing or financing** — established home-based care companies (some public, some private) that operate similarly to PE platforms in their acquisition behavior. When an agency owner gets approached by a "PE buyer," it is almost always one of the platform companies, not the sponsor directly. The sponsor sets strategy and funding capacity; the platform does the acquiring. --- ## Active Buyers in Non-Medical Home Care The non-medical home care segment has seen the most consolidation of any home-based care vertical. Active platforms include: - **Large-scale Medicaid HCBS personal care platforms** — multi-state operators focused on Medicaid waiver business - **Regional non-medical platforms** — building density in specific geographies - **Established national franchise systems** — many with PE backing supporting franchisee acquisitions or corporate roll-ups - **Mid-market regional platforms** with PE sponsorship targeting $1M+ EBITDA add-ons in their geographic footprint What they look for: defensible local market position, $500K+ EBITDA, scalable referral sources, clean operations, and geographic fit with existing density. --- ## Active Buyers in Medicare-Certified Home Health Medicare home health consolidation is dominated by a smaller number of large platforms: - **Public multi-state home health and hospice operators** — selective acquirers with broad geographic footprints - **Large pediatric and adult home health/hospice platforms** — combining service lines under a single corporate umbrella - **Public broad home and community health platforms** — diversified across home health, hospice, and community services - **Large nonprofit-affiliated organizations** — selective acquirers in targeted markets - **PE-backed personal care and home health platforms** active in select markets - **Regional Medicare home health platforms** owned by mid-market PE sponsors What they look for: strong star ratings, low LUPA rates, deficiency-free survey history, geographic fit, $1M+ EBITDA, and CON state positioning where applicable. --- ## Active Buyers in Hospice Hospice has been one of the most active M&A segments of the past five years. Active acquirers include: - **Public personal care and hospice operators** with growing hospice presence - **Large diversified home-based care platforms** expanding into adult hospice - **Public broad home and community health platforms** with established hospice operations - **PE-backed multi-state hospice platforms** consolidating across multiple regions - **Southeast-focused hospice platforms** with mid-market PE sponsorship - **Midwest-focused hospice platforms** with large-cap PE backing - **Large multi-state hospice and palliative platforms** with combined PE and health-system ownership - **Other regional hospice platforms** backed by mid-market PE sponsors - **Regional hospice operators** with PE financing supporting tuck-in acquisitions What they look for: average daily census growth trajectory, Medicare cap headroom, diversified referral sources, clean OIG/SFP profile, geographic density, and $750K+ EBITDA for add-ons. --- ## Active Buyers in Pediatric Home Health and PDN Pediatric is a smaller universe of active acquirers, with a few dominant platforms: - **National pediatric home health and PDN platforms** — the dominant consolidators in the segment - **PE-backed multi-state pediatric platforms** building density across multiple regions - **Regional pediatric platforms** backed by mid-market PE sponsors - **Large diversified home-based care companies** with significant pediatric capabilities embedded in broader platforms - **Children's hospital systems** acting as strategic acquirers in specific markets What they look for: pediatric-specific clinical capability (vent/trach, complex care), nurse retention infrastructure, authorized-hours fill rate, payer rate strength, and geographic concentration. --- ## Active Buyers in Behavioral Health and ABA Behavioral health and ABA M&A have their own ecosystem, with significant PE activity: - **Large-cap PE-backed ABA platforms** consolidating multi-state autism therapy operations - **Multi-state ABA platforms** with mid-market PE backing - **Large publicly traded behavioral health strategics** active in inpatient and outpatient acquisitions - **Other large behavioral health strategics** — both publicly traded and PE-owned - **Mid-market PE-backed mental health outpatient platforms** acquiring practice groups What they look for: clinical model integrity, payer mix (commercial and Medicaid), staff retention, BCBA capacity in ABA, and geographic fit. --- ## Active Buyers in IDD and Behavioral Services Intellectual and developmental disability service providers have a distinct buyer set: - **Large national IDD platforms** owned by large-cap PE sponsors - **Public broad home and community health platforms** with established IDD operations - **Regional IDD platforms** with PE financing - **State-focused IDD providers** with mid-market PE backing What they look for: state-by-state regulatory positioning, residential and day program licensing, workforce stability, and Medicaid waiver contract relationships. --- ## How to Use This Information Knowing the active buyer set is useful for several reasons: ### 1. Targeted Outreach in a Sale Process A well-run sale process targets a curated list of buyers most likely to value your specific business — not a mass-marketed auction. The right buyer for your agency depends on your segment, scale, geography, and operational profile. ### 2. Understanding Strategic Fit Each platform has a specific acquisition thesis: geographic expansion in certain states, service line additions, payer mix diversification, or scale build in a particular vertical. Agencies that fit the active thesis of multiple platforms attract competitive offers. Agencies that fit no current thesis sell harder, even when they are well-run. ### 3. Avoiding Premature Conversations Many agency owners receive direct outreach from PE platforms or business development teams. These outreach conversations are part of the platform's deal sourcing — they are not yet offers. Engaging with them outside of a structured advisor-led process typically produces lower outcomes than running a competitive process with multiple buyers. ### 4. Reading Multiples in Context Multiples reported in industry press are usually for the largest, most strategic transactions — not a representative sample. Understanding which buyers are paying which multiples, for which kinds of agencies, in which geographies, is the only way to anchor your own valuation expectations realistically. --- ## What This List Does Not Tell You **Which buyers are buying right now.** Platforms move in and out of acquisition mode based on integration capacity, fund timing, and strategic priorities. A platform that was the most active buyer in your segment 18 months ago may be in integration mode now. **Which buyers will pay the highest multiple for your specific agency.** That depends on geographic fit, service line fit, scale, payer mix, and the platform's current strategic gaps. **What current actual deal terms look like.** Multiples, structure (cash vs. rollover vs. earnout), and reps and warranties packages move with market conditions. A sale process built on current intelligence — which platforms are actively buying, where, at what scale, and at what current terms — is materially different from one built on a static buyer list. --- ## Strategic Implications for Sellers The PE buyer landscape in home-based care is concentrated, sophisticated, and well-capitalized. For agency owners evaluating a sale, the practical implications are: - **The highest outcomes come from competitive processes**, not direct response to inbound outreach - **Buyer fit matters as much as buyer count.** Three highly-aligned bidders typically produce a better outcome than fifteen marginally-aligned ones. - **Current intelligence on platform appetite and pricing** is one of the most important things an advisor brings to a sale process - **Your specific story should be matched to specific buyers**, not pitched generically If you would like to understand which active buyers are most likely to value your specific agency, [contact us for a confidential conversation](/contact-us). --- ## Frequently Asked Questions ### Who are the most active private equity buyers of home care agencies in 2026? Active sponsors include large-cap healthcare investors with established home-based care platforms, along with mid-market specialists focused on home care, hospice, pediatric, and behavioral health roll-ups. Activity is heavily concentrated through portfolio platforms rather than direct PE acquisitions. ### Do private equity firms buy small home care agencies? Generally no — direct PE acquisitions target platforms with $3M+ EBITDA. However, PE-backed portfolio companies actively acquire smaller add-on agencies down to $300K–$500K EBITDA, and these add-on transactions represent the majority of home care M&A volume. ### What multiples do private equity firms pay for home care agencies? Multiples range from 4× to 9×+ EBITDA depending on segment, scale, and quality. Platform acquisitions command higher multiples than add-ons. Hospice and pediatric typically trade at the high end; non-medical home care at the lower end; Medicare home health and behavioral health in the middle. ### What does private equity look for in a home care acquisition? Scale (or scalability), strong management depth, diversified payer mix, defensible clinical or operational capabilities, geographic density, regulatory and compliance cleanliness, and growth trajectory. Add-on acquisitions are evaluated primarily on geographic fit and integration ease.