Acadia Healthcare Company, Inc. Q4 2025 results
Snapshot
Acadia Healthcare Company, Inc. reported $821M of revenue in Q4 2025, up 6.1% year over year, with diluted EPS of $-13.02 and an operating margin of -137.7%.
- Revenue
- $821M
- YoY growth
- +6.1%
- Diluted EPS
- $-13.02
- Operating margin
- -137.7%
What management said
- •I'm pleased to be with you today on my first earnings call since returning as CEO.
- •After a period of record expansion, the priority now is to shift our focus toward operational excellence and execution.
- •The environment is not without challenges, but there is a large opportunity to unlock the EBITDA and free cash flow potential within our existing facilities.
- •Relative to the startup losses included in our 2025 results, the incremental EBITDA opportunity represented by the new facilities opened from 2023 through 2026 exceeds $200 million.
- •Turning to our fourth quarter results, we reported revenue of $821.5 million, representing a 6.1% increase over the fourth quarter of last year.
- •Fourth quarter results included a $52.7 million adjustment to the company's reserve for professional and general liability, in line with the updated guidance that was provided on December 2, 2025.
- •Adjusted EBITDA was $608.9 million, near the upper end of our guidance range of $601 million-$611 million.
- •In the fourth quarter, same-facility revenue grew 4.4% year-over-year, driven by a 1.3% increase in revenue per patient day, and a 3.1% increase in patient days, an improvement over recent quarters.
- •On a same-facility basis, Adjusted EBITDA was $152 million in the fourth quarter.
- •We invested $93 million in CapEx in Q4, and a total of $572 million for the full year of 2025, nearly $50 million favorable to our prior guidance.
- •For the full year 2025, we added 1,089 beds, exceeding the high end of our guidance range.
- •During the fourth quarter, we also opened a new de novo in our CTC line of business, bringing the total to 15 new CTCs added to the full year of 2025.
What went well
- •Fourth quarter 2025 revenue of $821.5 million grew 6.1% over the prior-year quarter, and full-year 2025 revenue of $3.31 billion (up 5%) finished slightly above the upper end of guidance, reflecting improved volume.
- •Full-year Adjusted EBITDA of $608.9 million landed near the upper end of the $601 million-$611 million guidance range.
- •Fourth quarter same-facility patient days grew 3.1% and same-facility revenue grew 4.4%, an improvement over recent quarters with broad-based strength in both acute and specialty.
- •The company added 1,089 beds in 2025, exceeding the high end of guidance, including 778 beds from six new facilities and 15 new CTCs, and full-year CapEx of $572 million was nearly $50 million favorable to prior guidance.
- •Costs related to managing the government investigation fell to $12 million in Q4, down 69% sequentially.
- •The incremental EBITDA opportunity from facilities opened from 2023 through 2026 exceeds $200 million, expected to be realized within five years.
What went wrong
- •Fourth quarter Adjusted EBITDA of $99.8 million included a $52.7 million adjustment to the reserve for professional and general liability.
- •DSO was up about 6 days year-over-year, driven by slower payments tied to two states whose programs needed finalizing, plus denials.
- •New York's decision to no longer allow Medicaid patients to receive care in out-of-state facilities is expected to create a $25 million-$30 million annual EBITDA impact and an approximate 350 basis point headwind to 2026 same-facility growth, leading to closure of two leased Pennsylvania specialty facilities.
- •Q4 startup losses of $12.8 million rose from $11.2 million in Q4 2024, and some newer facilities have not ramped as quickly as expected.
Guidance changes
| Metric | Period | Previous | Current | Change |
|---|---|---|---|---|
| Full-year revenue | FY2026 | not previously provided | $3.37B-$3.45B | initiated |
| Full-year Adjusted EBITDA | FY2026 | not previously provided | $575M-$610M | initiated |
| Full-year Adjusted EPS | FY2026 | not previously provided | $1.30-$1.55 | initiated |
| Full-year startup losses | FY2026 | $56M in 2025 | $47M-$53M | expected to decline |
| Full-year CapEx | FY2026 | $572M in 2025 | $255M-$280M | declining |
| Q1 revenue | Q1 2026 | not previously provided | $820M-$830M | initiated |
| Q1 Adjusted EBITDA | Q1 2026 | not previously provided | $130M-$137M | initiated |
| Full-year same-facility volume growth | FY2026 | not previously provided | 0%-1% | initiated |
| Full-year PLGL expense | FY2026 | in line with prior guidance | $100M-$110M | initiated |
Performance breakdown
| Metric | YoY change | Reason |
|---|---|---|
| Q4 revenue | +6.1% to $821.5M | improved volume with same-facility revenue up 4.4% |
| Full-year 2025 revenue | +5% to $3.31B | improved volume, finishing slightly above the upper end of guidance |
| Q4 same-facility revenue | +4.4% | 1.3% increase in revenue per patient day and 3.1% increase in patient days |
| Q4 Adjusted EBITDA | to $99.8M | included a $52.7M professional and general liability reserve adjustment |
| Beds added in 2025 | 1,089 beds | exceeded the high end of guidance, including 778 beds from six new facilities; offset by 382 beds from five closed facilities |
Earnings call themes & trends
| Topic | Previous mention | Current period | Trend |
|---|---|---|---|
| Leadership transition | prior CEO Chris Hunter regime | Debbie Osteen returned as CEO focused on stability, execution, accountability and right-sizing corporate and field structure | transition to new leadership |
| Professional and general liability (PLGL) | significant headwind in 2025; Q4 included $52.7M reserve adjustment | 2026 PLGL expense expected $100M-$110M, in line with prior guidance; claims consistent with December expectations | stabilizing but elevated |
| New facility ramp | record expansion, some facilities not ramping as quickly as expected | evaluating each facility individually, building standardized opening approach; $200M+ incremental EBITDA opportunity within 5 years | shifting to operational excellence |
| Capital discipline | $572M CapEx in 2025 | CapEx declining to $255M-$280M in 2026 with expected positive free cash flow | declining spend |
| New York Medicaid / Pennsylvania | previewed in January | $25M-$30M annual EBITDA impact, two leased Pennsylvania facilities closed, backfilling occupancy | headwind being managed |
Q&A summary
What is the status of the value creation review with outside advisors?
It is not on hold; the immediate focus is on 2026 performance and addressing 2025 issues, with service lines being evaluated for value, while looking at both short- and long-term value creation as an ongoing process.
What is the time frame to realize the $200 million of incremental EBITDA from development activity?
The pace is not formally defined but is expected to be within five years, calculated facility-by-facility based on increasing occupancy at beds added since 2023 plus 400-600 more this year.
How will you address managed Medicaid pressure on average length of stay?
There is always natural push and pull in reimbursement; length of stay is expected to stay stable on a same-store basis, though New York Medicaid will create an impact this year as those patients stayed longer, and the company consistently advocates for patients on authorizations.
How should we think about the cadence of CapEx beyond 2026?
A significant CapEx reduction in 2026 leads back to free cash flow growth; the company will evaluate high-demand opportunities, expansions within existing facilities, and possible M&A, while staying disciplined in the years after 2026.
Why was Q4 volume better, and what drove the upside to revenue?
Q4 came in slightly better than expectations on a broad-based basis with strength in both acute and specialty, and length of stay improved a little, which helped drive revenue upside.
What is the EBITDA drag from underperforming de novos in 2026 and will startup losses continue in 2027-2028?
Startup losses are expected to improve modestly in 2026 versus 2025, with a larger decline expected in 2027 since few substantial new beds or facilities open then; ramping of 2023-2025 facilities drives improved EBITDA and cash flow.