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.

• Full-year 2025 revenue reached $3.31 billion, with adjusted EBITDA of $608.9 million and adjusted EPS of $2.00; net loss per diluted share was $(12.16) due to a $996.2 million non-cash goodwill impairment.

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

• Over 2,500 beds added since 2023, with 1,089 licensed beds added in 2025, including 778 from new facilities and 15 new CTCs; expansion continues through joint ventures.

• Emphasis on data-driven quality improvement, transparency in patient outcomes, and expansion of quality dashboards across more programs in 2026.

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 grew 5% to $3.31 billion, with adjusted EBITDA of $608.9 million; net loss driven by a $996.2 million non-cash goodwill impairment.

• Adjusted net income for 2025 was $182.7 million ($2.00 per diluted share), down from $304.1 million ($3.30 per share) in 2024.

• CapEx totaled $572 million for 2025, $93 million in Q4, both favorable to guidance; cash and equivalents at year-end: $133.2 million, with $595 million available on a $1B revolver.

• Net leverage ratio at year-end: ~4x adjusted EBITDA; gross debt at year-end 2025 was $2,561 million, with net debt of $2,428 million.

Outlook and guidance

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

• Q1 2026 guidance: revenue $820–$830 million, adjusted EBITDA $130–$137 million, 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 net new beds expected in 2026.

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

• Startup losses forecasted at $47–$53 million, down from $56 million in 2025; 60% of losses expected in H1.

• New York Medicaid policy change to reduce EBITDA by $25–$30 million in 2026.

• CapEx to decline to $255–$280 million in 2026; positive free cash flow anticipated; operating cash flow projected at $280–$320 million.

• 2026 net leverage ratio expected between 3.9x and 4.2x adjusted EBITDA.