What Is My Hospice Business Worth in 2026?

Hospice businesses sell for 5.0x-8.0x EBITDA in 2026, with scaled agencies ($3M+ EBITDA, ADC above 100, and clean quality metrics) commanding the top end of that range. Smaller agencies typically trade at 4.0x-6.0x EBITDA. Active buyers include Addus HomeCare, Humana's CenterWell, Enhabit, BrightSpring Health, Amedisys, AccentCare, Chapters Health, Compassus, Traditions Health, and St. Croix Hospice, plus PE-backed platforms from Webster Equity, Clayton Dubilier & Rice, KKR, Bain Capital, and TPG.

Who this is for: Hospice owners with $1M+ in EBITDA evaluating a sale in the next 12-24 months, or owners who want a defensible valuation before talking to buyers.

How is a hospice business valued?

Hospice valuations in 2026 are built on EBITDA multiples, not revenue multiples. I start every engagement by normalizing the P&L — adding back owner compensation above market, personal expenses, one-time regulatory consulting fees, and any non-recurring items. From there, buyers apply a multiple that is driven by four specific things: ADC stability over the trailing 24 months, CAHPS/HIS quality scores, Medicare cap utilization, and the referral source concentration. An agency with a diversified referral base (no single source above 20%) and clean cap history will clear 7.0x-8.0x. An agency with concentration risk or cap issues typically lands at 4.0x-5.0x. Buyers also run a per-patient census check — they want to see roughly $7,500-$9,500 in EBITDA per daily census slot. If your per-ADC EBITDA is below that range, they will dig into labor costs, GIP utilization, and routine home care mix.

What are current hospice valuation multiples?

In the first quarter of 2026, I'm seeing three distinct valuation tiers. Tier one is scaled platforms with $3M+ EBITDA, ADC above 100, and clean quality metrics — these are clearing 7.0x-8.0x EBITDA, and in a few competitive processes I've run, 8.5x. Tier two is mid-sized agencies with $1M-$3M EBITDA — the market on these is 5.5x-7.0x EBITDA depending on growth trajectory and payor mix. Tier three is smaller agencies under $1M EBITDA, where buyers are typically regional roll-ups or first-time acquirers. Those deals clear 4.0x-5.5x EBITDA. The big shift I've watched over the past 18 months is that buyers have gotten much more disciplined about cap utilization. If you're running above 90% of the aggregate Medicare cap, expect a meaningful discount or a holdback structure. If you're below 80% with room to grow, that's a tailwind in pricing. For deeper context on where multiples are heading, see my analysis on hospice valuation trends.

Who is buying hospice businesses in 2026?

The buyer universe is broader than most owners realize. Strategic acquirers include Addus HomeCare (public, aggressive acquirer of Medicare-certified hospice), Humana's CenterWell, Enhabit Home Health & Hospice, BrightSpring Health Services, AccentCare (Webster Equity-backed), Amedisys (Optum), Compassus (Clayton Dubilier & Rice and TowerBrook), Chapters Health System, Traditions Health, and St. Croix Hospice. PE-backed platforms are extremely active — KKR, Bain Capital, TPG, Webster Equity, and The Vistria Group all have hospice plays running right now. Regional buyers matter too: independent hospices with $5M-$15M revenue often sell to other regional operators looking to hit scale before their own exit. In 2026, I'm seeing multi-bidder processes on any agency with $1M+ EBITDA and clean compliance — the demand-supply dynamic is still heavily favoring sellers in this space.

What makes a hospice business worth more?

Five things consistently move the multiple up. First, quality scores — agencies in the top quartile of CAHPS Hospice Survey and HIS measures get a premium because the data is public and buyers know it drives referral retention. Second, diversified referral sources. If your largest referral source is under 20% of admissions, you price like a higher-quality asset. Third, a routine home care mix that's balanced — buyers get nervous when GIP and continuous care are consistently above industry averages because it invites audit exposure. Fourth, clean survey and ADR history — no immediate jeopardy findings, no major UPIC audits, no cap overpayment history. Fifth, management depth. If the selling owner is also the Executive Director and clinical lead, buyers will either discount the offer or require a long transition. An agency with a capable ED, DCS, and clinical managers in place transitions at a premium because buyer integration risk drops.

What Hurts Hospice Valuations

The biggest multiple killers I see are cap overpayment history, survey deficiencies, and referral concentration. An agency with a prior cap liability — even if repaid — will typically see a 1.0x-1.5x multiple discount because buyers price in the risk of recurrence. Survey history matters almost as much: any immediate jeopardy finding in the past three years is effectively a deal-breaker for strategic buyers and forces a sale to a specialized turnaround buyer at a meaningful discount. Referral concentration above 30% from a single source (a hospital system, nursing home chain, or ALF group) will take 0.5x-1.0x off the multiple because buyers worry about what happens if that relationship shifts. For a broader look at compliance-driven value drivers, my home health care valuation guide covers many of the same regulatory issues.

How Long Does It Take to Sell a Hospice Business?

From engagement to close, a well-prepared hospice sale runs 6-12 months. I budget roughly 30-45 days for diligence prep and CIM creation, 45-60 days for buyer outreach and first-round bids, 30-45 days to select a buyer and sign an LOI, and 90-120 days for confirmatory diligence, CHOW filings with CMS, and closing mechanics. The CHOW timeline is the biggest wildcard — Medicare CHOW approvals have gotten slower in the past two years, and I tell sellers to assume 120-150 days for that alone in high-volume regions.

I tell every hospice owner the same thing in the first meeting: your CAHPS scores and your cap compliance history matter more than your top-line revenue. I sold an agency last year with an ADC of 65 for a higher multiple than a larger competitor because their Family Evaluation of Hospice Care scores were in the 90th percentile and they had a clean five-year survey history. Buyers pay for quality metrics because they translate directly into referral defensibility.