Acadia Healthcare Company (ACHC) Q4 2025 earnings summary

Executive summary

• Leadership transition with Debbie Osteen returning as CEO in February 2026, emphasizing stability, operational discipline, and execution focus.

• Fourth quarter 2025 revenue grew 6.1% year-over-year to $821.5 million, exceeding guidance, with same facility revenue up 4.4% driven by higher patient days and revenue per patient day.

• Net loss per diluted share was $(13.02) due to a $996.2 million non-cash goodwill impairment; adjusted net income per diluted share was $0.07, down from $0.64 in the prior year.

• Strategic priorities include quality management, leadership depth, standardized approaches to new facility openings, and a shift from rapid expansion to operational excellence and unlocking EBITDA and free cash flow potential.

• Continued expansion through joint ventures with major health systems, with over 2,500 beds added in three years and 15 new CTCs opened in 2025, expanding reach to 178 centers across 33 states.

Financial highlights

• Q4 2025 revenue was $821.5 million, up 6.1% year-over-year; adjusted EBITDA was $99.8 million, impacted by a $52.7 million PLGL reserve adjustment and legal settlements.

• Full-year 2025 revenue reached $3.31 billion, a 5% increase, slightly above guidance; adjusted EBITDA was $608.9 million, down from $709.0 million in 2024.

• Full-year net loss per diluted share was $(12.16), compared to net income of $2.78 in 2024, primarily due to impairment and legal settlement charges.

• Startup losses for new facilities were $12.8 million in Q4; $3.6 million in net operating costs from closed facilities.

• CapEx totaled $572 million for 2025, $93 million in Q4, both favorable to guidance; cash and equivalents at year-end: $133.2 million; $595 million available on $1B revolver; net leverage ~4x adjusted EBITDA.

Outlook and guidance

• 2026 revenue expected between $3.37B and $3.45B; adjusted EBITDA $575M–$610M; adjusted EPS $1.30–$1.55.

• Q1 2026 revenue guidance: $820M–$830M; adjusted EBITDA: $130M–$137M; adjusted EPS: $0.25–$0.30.

• Same-facility volume growth projected at 0–1%, with 630 beds added to same-store in Q1 and 400–600 new beds expected in 2026, mainly via joint ventures.

• 2–3% increase in same-facility revenue per patient day expected; $34M non-recurring 2025 revenue from Tennessee Medicaid will not repeat.

• Startup losses forecasted at $47M–$53M, down from $56M in 2025; 60% of losses expected in H1; New York Medicaid policy change to reduce EBITDA by $25M–$30M in 2026.

• CapEx to decline to $255M–$280M in 2026; positive free cash flow anticipated.