Acadia Healthcare Company, Inc. Q1 2026 results
Snapshot
Acadia Healthcare Company, Inc. reported $829M of revenue in Q1 2026, up 7.6% year over year, with diluted EPS of $0.05 and an operating margin of 5.8%.
- Revenue
- $829M
- YoY growth
- +7.6%
- Diluted EPS
- $0.05
- Operating margin
- 5.8%
What management said
- •We delivered revenue at the high end of our guidance range and exceeded the top end of our Adjusted EBITDA and EPS range.
- •Our revenue growth was driven by our acute inpatient psychiatric facilities, with 14% growth compared to last year as we increased inpatient volumes by 6.2%.
- •The increase in volumes across Acadia reflects the continued strong demand for our services.
- •Our revenue growth and strong focus on operational improvements and efficiencies at every level of the organization drove Adjusted EBITDA to $144.2 million, $7.2 million above the high end of our guidance.
- •Our good start in quarter one is allowing us to raise our full-year Adjusted EBITDA guidance by $5 million at the midpoint.
- •Todd will walk through the financial results and our guidance in more detail.
- •These investments expand access to care and increase the number of patients we can serve each day.
- •The demand is there, and our goal is to meet that demand with high-quality patient care and ensure that we eliminate barriers for treatment through prompt response times.
- •As a result of this increased focus, this group's revenue and Adjusted EBITDA results in quarter one were ahead of our expectations.
- •We remain confident in this group delivering on $200 million of Adjusted EBITDA growth relative to 2025.
- •While we are reducing our capital investment by over $300 million compared to 2025, we are finalizing investments in these new JV facilities while also adding beds to existing facilities.
- •These tools help us make more informed operational decisions and deploy resources more effectively across facilities.
What went well
- •First quarter 2026 revenue of $828.8 million grew 7.6% year-over-year and came in at the high end of guidance, while same-facility revenue grew 7.3%.
- •Adjusted EBITDA of $144.2 million was $7.2 million above the high end of guidance and grew 7.5% over Q1 2025, prompting the company to raise its full-year Adjusted EBITDA guidance by $5 million at the midpoint.
- •The acute inpatient psychiatric business grew 14.2% with inpatient volumes up 6.2%, and same-facility admissions for acute were up over 20% in inquiries.
- •Facilities opened since 2023 delivered revenue and Adjusted EBITDA ahead of expectations, with startup losses of $12 million coming in $2 million better than the $14 million forecast.
- •Staff retention improved for the eighth consecutive quarter, and the specialty business outperformed by mitigating a portion of the expected Pennsylvania volume losses.
- •Free cash flow improved $148 million compared to Q1 2025, and the company collected $16 million from the sale of three closed facilities.
What went wrong
- •Bad debts and denials continued to worsen in Q1 versus prior expectations after appearing to stabilize in Q4, and this broad-based pressure was reflected in higher full-year assumptions.
- •CTC revenue growth slowed sequentially to 2.5% as severe winter weather forced closure of certain centers, costing roughly $3.7 million in Adjusted EBITDA.
- •Specialty facility revenue declined 6.5%, driven by the Pennsylvania challenges from New York's out-of-state Medicaid decision and 2025 specialty facility closures that created nearly a 6% headwind.
- •Free cash flow for the quarter was negative $15 million, and net leverage is expected to rise temporarily to approximately 4.4-4.5 times at the end of Q2.
Guidance changes
| Metric | Period | Previous | Current | Change |
|---|---|---|---|---|
| Full-year Adjusted EBITDA | FY2026 | $575M-$610M | $580M-$615M | raised $5M at midpoint |
| Full-year Adjusted EPS | FY2026 | $1.30-$1.55 | $1.35-$1.60 | raised $0.05 |
| Full-year revenue | FY2026 | $3.37B-$3.45B | $3.37B-$3.45B | unchanged |
| Q2 revenue | Q2 2026 | not previously provided | $835M-$850M | newly provided |
| Q2 Adjusted EBITDA | Q2 2026 | not previously provided | $142M-$152M | newly provided |
| Q2 Adjusted EPS | Q2 2026 | not previously provided | $0.30-$0.40 | newly provided |
| Full-year startup losses | FY2026 | $47M-$53M | $47M-$51M | lowered top end by $2M |
Performance breakdown
| Metric | YoY change | Reason |
|---|---|---|
| Total revenue | +7.6% to $828.8M | growth led by acute (+14.2%) and RTC (+6.3%) businesses, plus Ohio and Tennessee supplemental payments not in prior-year Q1 |
| Same-facility revenue | +7.3% | 5.6% increase in revenue per patient day and 1.6% increase in patient days |
| Adjusted EBITDA | +7.5% to $144.2M | strong acute performance, outperformance of new facilities opened since 2023, and better-than-planned cost efficiencies at corporate and facilities |
| Specialty revenue | -6.5% | Pennsylvania challenges from New York's out-of-state Medicaid decision and 2025 specialty facility closures |
| CTC revenue | +2.5% | growth slowed sequentially due to severe winter weather closing certain centers |
Earnings call themes & trends
| Topic | Previous mention | Current period | Trend |
|---|---|---|---|
| New facility ramp / startup losses | $14M Q1 forecast; facilities not ramping as quickly as expected | $12M actual, $2M better; each post-2023 facility now has a clear action plan | improving |
| Bad debts and denials | thought to be stabilizing in Q4 | ran a little hotter than expected, broad-based, factored into full-year guide | worsening |
| Staff retention | improving trend | improved for eighth consecutive quarter | improving |
| Pennsylvania / New York Medicaid headwind | $25M-$30M annual EBITDA impact expected | specialty mitigated a portion; backfilling via New Jersey, Maryland and Pennsylvania referrals | improving |
| Capital discipline | record expansion period | reducing capital investment over $300M vs 2025; CapEx of $255M-$280M for 2026 | declining spend |
Q&A summary
Can you elaborate on the correction plans for the underperforming de novos?
Plans focus on continued ramping of occupancy, access and communication with partners, and tailored service-line decisions including CON approval and licensure; each plan is tailored to the partner, market and facility.
What's new in payer behavior on denials, and how much of the AR days increase is from that?
Bad debts and denials continued worsening in Q1 versus expectations and are broad-based, not one specific payer; the company has game plans for revenue cycle management and reflected the pressure in full-year expectations.
How should we think about the seasonality and EBITDA contribution from Medicaid supplementals and ramping facilities in the back half?
Seasonality is fairly normal with some noise from 2025 volatility; back half driven by slightly higher supplementals (high single to low double digits, not $30M), ramping facilities overachieving, and cost efficiencies implemented at end of Q1.
Why was admission guidance increased but patient days left unchanged given payer pushback on length of stay?
The length-of-stay change is more a math exercise than a business change; closed specialty facilities and Pennsylvania challenges removed longer-stay beds while new acute beds with shorter stays were added, raising admissions while lowering average length of stay.
What is the G&A and organizational structure opportunity after your leadership review?
A middle layer of corporate management was eliminated to speed decision-making; the acute service line was restructured to reduce facilities and geography per division and a new operating group was created for JV and recently opened hospitals.
What is driving the strong same-store admissions and when do startup losses diminish?
Startup losses were $12M in Q1 ($2M better), with $15M expected in Q2 as the likely quarterly high; admissions growth is driven by new acute beds ramping, with acute inquiries up over 20% and strong RTC census.