As part of our Behind the Curtain webinar series, we’re committed to giving agency owners a transparent, unfiltered view of what drives M&A activity in home-based care. In this session, we welcomed Rich Tinsley, Chief Development Officer at Help at Home, to share how one of the nation’s largest personal care providers thinks about acquisitions, integration, and value. Hosted by Michael W. Lloyd and Cory Mertz of Mertz Taggart, the conversation covered everything from culture and compliance to rate stability, integration, and why some deals never make it past the finish line. The Help at Home Playbook Help at Home is a 50-year-old company founded in Chicago, now operating in 11 states with more than 60,000 clients and over 60,000 caregivers. The company focuses almost exclusively on personal care services in the home and has more than doubled in size over the last four years through a mix of organic and acquisition-driven growth. Tinsley emphasized Help at Home’s density-driven strategy: “We believe in density… we are one, two or three in every state that I mentioned. Probably one in 80% of them and then two or three in the others. That’s by design.” That density is designed to make Help at Home a stronger partner to states and payers, and to support higher-quality, more consistent care at the local level. What Makes a Deal Attractive? When evaluating acquisitions, Help at Home focuses on three core attributes: culture, compliance, and economics. 1. Culture: The First Gate Across small tuck-ins, mid-sized platforms, and larger transactions, culture is the starting point. “Culture is the number one thing we look at.” Help at Home is looking for owners who are caregiver- and client-focused, not just chasing short-term financial results. That shows up in the way sellers talk about why they started, why they’re exiting, and what they find hardest about the business. “We are very focused on customers and caregivers. We believe that our business is very, very hard… But the reality is the P&L… is pretty simple. The secret behind that is the culture and being caregiver and client focused.” When culture is weak at the top, Tinsley noted, it tends to bleed into compliance, operations, and even caregiver behavior. 2. Compliance: Intent and Discipline The second lens is compliance — both on the client side and the employee side: Regulatory adherence Hiring and onboarding Documentation and file quality Help at Home audits client and caregiver files and expects clear evidence that the organization is trying to do things the right way. “We want people to want to be compliant. We want them to do their best. We understand people make mistakes… but we want to make sure the quality is there.” Systematic caregiver pay issues or improper treatment of employees are particularly challenging because of the long-tail liability they create. 3. Economics: Performance and Sustainability Only after culture and compliance clear the bar does Help at Home focus on economic performance: Revenue and margin profile Rate environment Growth trajectory High margins can be attractive, but not if they’re clearly temporary or disconnected from caregiver wages: “When you start talking about 20 to 30% margins, those aren’t sustainable right long term… we’ll give you some credit for it… but we also will perform it at what we think is a longer window of what we think the rates really will be.” In other words, they’re buying the sustainable business, not a short-term spike. How Help at Home Evaluates States and Markets Beyond the individual agency, Help at Home pays close attention to state-level dynamics: Payer structure (managed care vs. traditional Medicaid) Historical rate behavior and predictability Support for home- and community-based services Labor environment and ability to recruit at viable wage levels “We like stability or at least a plan. It’s okay to have changes… we like that. But the more stable in the way it’s planned… that makes it hard or easier for us to get our density and do what we want to do.” Even when a first acquisition in a state is compelling, Help at Home wants to know whether it can double or triple its presence over time. Opportunistic entry — such as inheriting a smaller footprint in a new state as part of a larger deal — is common, but follow-on density still matters. Deal Flow, Filtering, and LOIs Help at Home evaluates far more deals than it closes, with a dedicated development team of six to seven professionals screening opportunities before they ever reach LOI. “We look at more deals than we can do. We look at more deals than we want to do, right? But you’re trying to find the right ones.” The team: Reviews each opportunity Brings it to Tinsley in weekly calls Runs multiple rounds of questions and analysis before issuing an LOI Pre-LOI work can take a week to several months, depending on how prepared and responsive the seller is. Internally, Help at Home also secures approvals at the same level that would ultimately sign off at closing, to minimize surprises later. On volume, Tinsley estimated: “Somewhere between 5 to one and 10 to one. It depends on the market.” Common Deal Snags — and What Actually Kills Deals Tinsley underscored that Help at Home does a lot of work up front and tries hard to avoid mid-process price reductions. When issues arise, the biggest recurring problems are: Undisclosed compliance issues uncovered in diligence Caregiver pay or employment missteps that carry tail risk Non-responsiveness and delays from sellers Operational decline once a sale decision is made “Selling your business is a full-time job… businesses that are declining or start to decline once they decide to sell, that sometimes is really hard for us to get over.” He summed it up bluntly: “Declining businesses are tough.” Help at Home will typically look for ways to solve around issues when a seller is reasonable — through structure (escrows, reps and warranties) and a practical view of risk. But if performance slides and information is slow or incomplete, the probability of closing drops quickly. Deal Structure Preferences: Cash Up Front, No Earnouts On structure, Help at Home’s position is clear: Tuck-ins: almost always 100% acquisition of the business Larger transactions: more flexibility on keeping owners involved or structuring payouts Earnouts: essentially off the table “We don’t do earnouts, right? They’re just hard… I find that earnouts, no one’s happy at the end.” That doesn’t mean sellers can’t stay involved in the business — especially in larger transactions — but it does mean Help at Home prefers clean economics at closing rather than long, subjective earnout tails. What Happens After the Sale? Integration and People For many owners, the biggest concern isn’t just price, but what happens to their team and legacy. Help at Home’s integration approach depends on size, market, and performance: Small in-market tuck-ins: often integrated in weeks, with a quick move to the Help at Home brand and centralized back-office functions. Larger or new-state platforms: integration is more gradual; dual branding can remain for a time, and the pace adapts to what’s working locally. Back-office functions like recruiting, billing, and collections are centralized to free up front-line leaders: “The first rule is don’t do any harm.” And on people, Tinsley was explicit: “I don’t have a barn full of good people.” Help at Home is acquiring clients, caregivers, and the teams who support them, not trying to replace them: “The assets that we buy are really clients and caregivers, right? I mean, that is the business.” For employees who want to stay and grow: “The runway here is really long because we’re growing and you can grow within our company.” The Current M&A Environment: Strong, But Different from 2021 From Tinsley’s vantage point, today’s home-based care M&A market is: Stronger than long-term historical norms Clearly below the peak valuations seen during and immediately after COVID “I think buyers have lowered their prices. I think sellers have lowered their expectations, but I still think there’s a gap.” He believes the COVID/post-COVID period may have been a “once in a lifetime” pricing environment for this sector, and that owners waiting for those multiples to return may be disappointed. Uncertainty around policies such as the 80/20 rule and other reimbursement changes is a bigger drag on deal volume than cuts themselves: “It’s not necessarily the cut. If we knew what the cut was… it’s easy for somebody to model that… When things are changing, that uncertainty just creates… it’s hard to pull the trigger.” Advice for Sellers: Preparation That Actually Matters Asked what owners should focus on 8–12 months before going to market, Tinsley cautioned against cosmetic, last-minute changes: “Last minute changes don’t tend to work, right?” Instead, he highlighted a few practical steps: Professional financials – ideally monthly, with clear visibility into revenue, pay rates, bill rates and margin. Clean records – organized client and caregiver files, compliance documents, and contracts ready to share. Integrated past acquisitions – if you’ve bought agencies, get them fully integrated (systems, reporting, processes) and let that stability show up in your numbers. Operational consistency – keep running the business like you’ll own it for years; buyers want to see stability, not a short-term pre-sale push followed by decline. “Being ready to sell and answering those questions is really important. It really speeds up the process.” Looking Ahead: Demand Isn’t Going Anywhere Despite policy shifts and reimbursement debates, Tinsley is confident about the long-term fundamentals of home- and community-based personal care: “My services aren’t going away… the demand for my services, the desire to have it in their home isn’t going away.” Help at Home’s strategy is built around that reality: dense local markets, strong culture, compliant operations, and disciplined acquisitions that can be integrated and grown over time. Final Thoughts Rich Tinsley’s session offered a clear view into how a scaled, strategic buyer in personal care services thinks about value, risk, and partnership. His emphasis on culture, compliance, sustainable economics, and preparation aligns closely with what we see across the broader M&A market in home-based care. Whether you’re actively preparing for a transaction or simply planning for the next 3–5 years, these are the levers buyers are looking at long before they ever submit an LOI. 👉 To watch the recording of the full webinar, visit: https://www.mertztaggart.com/behind-the-curtain Are you contemplating a sale of all or a portion of your healthcare services company? Arrange a confidential discussion with our M&A experts via info@mertztaggart.com.

As part of our Behind the Curtain webinar series, we’re committed to giving agency owners a transparent, unfiltered view of what drives M&A activity in home-based care. In our most recent session, we welcomed Rich Keller, CEO of PurposeCare, to share his perspective on what strategic buyers value most—and how operators can position themselves for success in today’s market. Hosted by Michael Lloyd and Cory Mertz of Mertz Taggart, the conversation covered everything from payer dynamics and deal structure to what makes PurposeCare walk away from a deal. The PurposeCare Playbook Founded with a mission to deliver integrated, patient-centered care, PurposeCare is a rapidly growing provider operating across multiple states with a focus on the dual-eligible population. The company, backed by Lorient Capital, provides a combination of home care, home health, and primary care services to underserved populations. Keller emphasized PurposeCare’s focus on markets where they can build density and serve complex patients effectively. “We’re not just looking for one-off assets—we’re looking to create a care ecosystem,” he said. What Makes a Deal Attractive? When evaluating acquisitions, Keller outlined several important criteria: Trust is Key Keller emphasized the importance of shared values: “Culture matters… The most successful deals we’ve had have been when we established trust with the owners out of the gate.” Clean Operations and Scalable Infrastructure PurposeCare seeks companies with robust, compliant systems and scalable infrastructure already in place. Keller made clear: “Our ability to be successful in acquiring companies isn't just to acquire companies... the key to us is we're going to want to integrate that company into our business.” Strategic Market Selection and Payer Partnerships PurposeCare’s evaluation of payer mix goes beyond just reimbursement types—it’s deeply tied to the regulatory and market landscape in each state. Indiana, for example, stood out as a strong fit. He explained that while the state’s shift to managed care could be seen as a disruptor for some, PurposeCare views it as a strategic opportunity: “We think that that's actually not a bad thing for us, because it's a chance to partner with payers in a way that's a little bit more creative than you can do in just straight Medicaid.” By targeting markets where they can form deeper, more flexible payer relationships, PurposeCare positions itself to serve complex populations more effectively—especially dual-eligibles. This market-by-market approach is key to sustaining growth and integration across their care model. Walking Away from a Deal Keller was candid about the types of issues that can give buyers pause—or stop a transaction altogether: State-by-State Medicaid Complexity: “If you're in Medicaid, you've seen one state… So they're all different.” PurposeCare evaluates markets carefully and will walk away from those with regulatory uncertainty or payer dynamics that don’t align with their model. Leadership Uncertainty: “We like to work with founders. The owner helps us through a transition and allows us to learn from them and their leadership team.” Lack of a strong leadership team—or unclear expectations from the seller—can derail buyer confidence. Preparation Gaps: “Think about it through the eyes of the entity that wants to purchase you... What are they going to value? What are the skeletons in the closet? Get them out.” If an owner hasn’t addressed internal issues—operational, financial, or compliance-related—it’s likely to show up in due diligence. Sector-Specific Priorities PurposeCare evaluates acquisitions based on the specific home-based care sectors involved: Home Health Clinical quality and CMS ratings are top concerns. Consistent documentation and scalability are essential. Home Care Labor compliance and caregiver retention are critical. Integration potential with clinical services is highly valuable. Primary Care Integration Clinical governance and data-sharing capabilities are key considerations, especially for managing high-risk populations. Deal Structure Preferences Rather than generalizing about deal mechanics, Rich Keller emphasized the importance of minimizing disruption while integrating acquired agencies into the PurposeCare platform: “We try to do it in a manner that creates as little disruption as possible. But we're going to put a PurposeCare fingerprint on it.” He also underscored the importance of seller involvement during the transition, particularly when acquiring founder-led businesses: “We like to work with founders. The owner helps us through a transition and allows us to learn from them and their leadership team.” Advice for Sellers Keller’s advice to agency owners considering a transaction was both simple and strategic: “Know your numbers, know your team, and know what you want out of the deal.” He encouraged sellers to spend time preparing—cleaning up their books, investing in staff retention, and working with advisors who understand their business model and goals. “The more prepared you are, the smoother and more valuable the process will be,” he said. Looking Ahead: Growth Through Integration PurposeCare’s future growth strategy remains focused on high-need markets, emphasizing integrated care delivery. Keller articulated this forward-looking approach clearly: “How do we leverage our position in the home on the home care side and the personal care services space to get in front of changes in condition on a pre-acute basis and treat them on an acute basis, and really keep people out of the hospital?” Final Thoughts Rich Keller’s session offered a clear and compelling look into how strategic buyers approach acquisitions in the home-based care space. His emphasis on values, operational readiness, and long-term integration aligns with the themes we continue to see in the market. Whether you’re actively preparing for a transaction or just beginning to think about your future, Keller’s insights are a valuable resource for understanding how to stand out to the right buyer. 👉 To watch the recording of the full webinar, visit: https://www.mertztaggart.com/behind-the-curtain Are you contemplating a sale of all or a portion of your healthcare services company? Arrange a confidential discussion with our M&A experts via info@mertztaggart.com

By Kevin Taggart, CM&AP, Managing Partner | Mertz Taggart You’ve built something valuable. You know it. And apparently, so does the buyer who just reached out. Maybe it’s a name you recognize, a PE-backed strategic that is targeting your market. They’re complementary. They move fast. And somewhere in the conversation, they mention that working directly saves everyone the hassle of a process. Maybe even the fee. It sounds reasonable. It isn’t. We’ve been advising healthcare services owners on sell-side transactions for over a combined 36+ years and have closed more than 165 deals across multiple market cycles. The single most consistent finding: you cannot know what your company is worth until the market tells you. And the market can only tell you if you ask it. That’s true whether you’re running a $5 million company or a $50 million one. Two deals illustrate why. Deal 1: Same Buyer, Direct Offer to Final Close — $7.5M to $15M A behavioral health company was approached directly by a well-capitalized strategic buyer. The buyer knew the market, liked the company, and moved quickly. Their offer: $7.5 million. It wasn’t a bad offer. The seller liked the buyer and was tempted to move forward. Instead, they engaged us for a free valuation before signing anything. Our view: we believed we could do meaningfully better than $7.5 million in a competitive process. The seller agreed to test the market — and, importantly, asked us to keep that initial buyer in the process. They liked them and wanted them to have a fair shot at the deal. We ran a process. The same buyer came back to the table almost immediately, this time at $11.5 million — $4.0 million more than their original direct offer, a 53% increase — from the same buyer, on the same business, with the same diligence information. Nothing about the company had changed. What changed was that the buyer knew they were no longer the only one at the table. Then competition took over. In total, we received 15 offers from credible, well-capitalized buyers. The deal ultimately closed at $15 million — a $7.5 million increase, or 100% above the original direct offer, and $3.5 million more than the same preferred buyer’s revised number. The seller got the buyer they wanted to work with, at a price the market — not the buyer — set. Same buyer. Same company. Twice the price. That additional $7.5 million didn’t come from catching the buyer in a lie or finding hidden value in the financials. It came from the buyer knowing they weren’t the only one at the table. Deal 2: A Larger Business — From $37 Million to $52 Million An outpatient behavioral health business came to us with a strong, rapidly growing operation. A buyer had already approached the seller directly with an offer of $37 million — a serious number from a serious acquirer. We took the company to market. This was a competitive process, though more concentrated than most: we received 6 offers in total, all from legitimate, well-capitalized strategic and PE-backed buyers. Six was enough. As the process developed, one buyer came in at a number very close to where the original buyer was sitting. That competing offer did exactly what a competitive process is supposed to do — it reframed the floor. We were able to use that leverage to move the buyer the seller wanted to work with up, well past their original $37 million number. They came back at $52 million, $15 million higher than where they started. The deal closed at $52 million with the seller’s preferred buyer. If that seller had responded directly to the initial $37 million offer — a perfectly reasonable-sounding number from a real buyer — they would have left $15 million on the table. The buyer they ultimately sold to was the same buyer they would have sold to in the direct deal. The only difference was the presence of competition, and a credible alternative bid sitting next to the preferred buyer’s offer. Why the Spread Exists Buyers aren’t dishonest when they approach you directly. They’re doing their job. A direct deal is better for them — less competition, less process, less price pressure. What changes in a competitive process isn’t the buyer’s character. It’s their behavior. When a serious buyer knows another serious buyer is in the room, they move. The preferred buyer in Deal 1 didn’t go from $7.5 million to $11.5 million because they suddenly saw new value — they moved because they had to in order to stay in the deal. The preferred buyer in Deal 2 went from $37 million to $52 million for the same reason. Neither would have gotten there on their own. That spread — $7.5 million versus $15 million on the smaller deal, $37 million versus $52 million on the larger one, in each case among qualified buyers looking at identical information — doesn’t close because one buyer is more honest than another. It closes because of competition. One more thing these deals illustrate: never tell a buyer what you think your company is worth. If the Deal 1 sellers had volunteered that they thought $7.5 million was fair, they would have created a ceiling — and that ceiling would have cost them $7.5 million. If the Option 2 sellers had anchored to $37 million, they would have left $15 million behind. It’s Not Just Price Going direct doesn’t only cost you in headline value. In a competitive process, buyers sharpen their terms too — faster timelines, cleaner deal structure, less holdback, lower earnouts, shorter performance windows. When there’s no competition, there’s no urgency to be accommodating. In both Deal 1 and Deal 2, the seller ended up working with a buyer they liked — in Deal 1, the same buyer who originally approached them. The competitive process didn’t cost them their preferred partner. It just made sure that partner paid market price. We’ve written more broadly about the risks of going direct here. The mechanics aren’t complicated. What’s harder to internalize — until you see a real deal — is how much you’re leaving behind. A motivated buyer negotiating with a seller who has no alternatives will pay what they have to. Not what they could. Frequently Asked Questions If a buyer approaches me directly, should I respond? You can have an initial conversation, but don’t share financials, don’t name a price, and don’t sign anything until you’ve spoken with an advisor. Engaging directly without running a process almost always means leaving money on the table. Does a competitive process work even if I already know who I want to sell to? Yes. Competition changes buyer behavior regardless of your preference. In both deals above, the sellers’ eventual buyers paid significantly more because they knew others were at the table — not because they were the only option. In Deal 1, the seller’s preferred buyer paid twice their original direct offer. In Deal 2, the seller’s preferred buyer paid $15 million more. What if the buyer says the offer expires if I hire an advisor? That’s a pressure tactic. A buyer who walks away because you ran a process was never going to give you their best number to begin with.

By Michael W. Lloyd | Originally published January 20, 2023 | Updated May 7, 2026 At a Glance You do not need to be actively considering a sale to benefit from a relationship with an M&A advisory firm. For home care, home health, and hospice agency owners, an experienced advisor can provide valuation guidance, exit planning support, marketplace intelligence, and industry knowledge well before you are ready to go to market. Understanding these areas early can help you make better operational decisions today and position your agency for a stronger outcome whenever you do decide to sell. For many agency owners, selling their home care or hospice agency will be the most important financial decision of their life. It’s not only a difficult decision because of its emotional ties, but also tough to know when to sell or to let go. Confidentiality is paramount. And the complexity and uncertainty surrounding the idea of selling often lead agency owners to ignore or postpone it entirely. The good news is that an M&A advisor can add value well before you are ready to sell your agency, or even if you are not considering a sale at all. Here are some of the benefits an agency owner can get from engaging with a specialized M&A advisory firm early. Valuation Guidance and Exit Planning One of the most practical things an M&A advisory firm can do is help you understand what your agency is worth today and what you can do to increase that value over time. There are three widely accepted valuation methodologies that professional firms typically employ: discounted cash flows (DCF), comparable company analysis, and precedent transactions. To truly understand the value of a home care, home health, or hospice agency, that analysis requires specialized knowledge of these sectors. When seeking valuation guidance, choose an advisory firm with experience in these verticals. An even better selection is a firm that has both valued agencies and participated in actual transactions in the marketplace. Some of the questions a specialized M&A firm can help you answer: Which valuation methodology is most appropriate for my agency? How much is my agency worth today? What operational changes should I make now that will ultimately increase value? What are the high-risk elements that caution buyers the most? Education on the M&A Process Many agency owners have never been through a transaction before. Learning what a well-run, professionally managed M&A process looks like, and what it requires of every stakeholder, can remove a great deal of uncertainty. Common questions an advisor can walk you through include: How long will the process take from beginning to end? How much additional work will be required from the owner and potentially from key employees brought into the circle of trust? How can confidentiality be managed so that key stakeholders do not find out before you are ready? What type of information does an M&A firm need to build the materials for an effective, competitive process? → Related: 7 Common Challenges Home-Based Care Owners Face When Selling Their Agency M&A Marketplace Updates M&A advisors live and breathe transactions. Their wealth of information can be invaluable to an agency owner seeking to understand market dynamics. A firm that specializes in care-at-home can provide insight on questions like: What makes an agency an attractive acquisition target? Who are the most acquisitive buyers in today’s market? Which geographies are attractive to which buyers? What are the current market terms for negotiated areas of a purchase agreement?\ This kind of intelligence is hard to come by on your own. Even if a sale is years away, understanding the buyer landscape and deal terms can shape how you run and grow your agency in the meantime. Industry Knowledge An M&A advisory firm that specializes in home care, home health, and hospice has a deep body of knowledge on the industry and can provide insights on operating margins (including gross profit and adjusted EBITDA margins), innovative ideas being adopted across the sector, standard solutions to operational problems you may be facing, and introductions to other industry advisors who could assist you. The above is a brief summary of some of the benefits an agency owner can get from engaging with a specialized and professional M&A advisory firm, regardless of their exit timeline. The earlier you start the conversation, the more prepared you will be when the time comes. → Related: Considerations When Choosing a Home-Based Care M&A Advisor Key Takeaways • You do not need to be ready to sell to benefit from engaging an M&A advisory firm. • Valuation guidance can help you understand what your agency is worth and what drives that value. • Learning the M&A process early removes uncertainty and helps you plan. • Marketplace intelligence gives you insight into buyer activity, deal terms, and regional demand. • Choose an advisory firm with specialized experience in home care, home health, and hospice. Start the Conversation Early Mertz Taggart has been advising healthcare services owners for over twenty years. Whether you are actively considering a sale or simply want to understand your options, we welcome a confidential conversation. Contact us to get started.

Behavioral Health M&A Executive Summary: A Year of Resilience and Reality Checks A total of 42 closed transactions — 34 traditional M&A deals and 8 growth deals — were reported in Q1 2026. Traditional M&A volume increased from 29 closed deals in Q4 2025, though it remained below the 40 deals closed in Q1 2025. The 8 growth deals carried a combined disclosed value of approximately $535.7 million, led by major financing rounds for Talkiatry and Grow Therapy, signaling continued institutional conviction in scaled virtual behavioral health platforms. "Q1 was a solid start to the year — not a blowout, but active. Traditional deal volume bounced back from Q4, and what stands out to me is how concentrated the mental health activity is becoming around platform builders. Beacon Behavioral closed four add-ons in a single quarter, and you're seeing the same pattern across ABA. On the growth side, Talkiatry and Grow Therapy together raised $360 million. That's a signal that institutional capital still has a lot of appetite for virtual and tech-enabled delivery models at scale." — Mertz Taggart Managing Partner Kevin Taggart said. Mental health led all sub-sectors with 19 closed traditional M&A deals, followed by Autism/IDD with 10 and Addiction Treatment with 5. PE-backed strategics and platform builders drove the bulk of transaction volume, consistent with the consolidation patterns seen throughout 2025. Addiction Treatment M&A Five addiction treatment deals closed in Q1 2026, down from 7 in Q4 2025 and 8 in Q1 2025. The subdued volume reflects ongoing caution among SUD-focused buyers, many of whom continue to work through platform integrations before resuming add-on activity. "SUD deal flow has been building momentum, and the buyers we're talking to are increasingly motivated to get back into the space. Some platforms that were focused on integration over the past couple of years are starting to look at add-ons again, and we're seeing new entrants with capital ready to deploy. For a quality addiction treatment provider considering a sale, I think the timing is actually quite good — there's demand out there and it's growing." — Taggart said. The most notable deal of the quarter was Mayfair Group's acquisition of Praesum Healthcare, a Florida-based multi-state addiction treatment platform operating more than 30 centers across the Eastern U.S. under brands including Sunrise Detox, The Counseling Center, and Evolve Recovery Center. Praesum had filed for Chapter 11 bankruptcy in August 2025 and was acquired out of the bankruptcy auction for $18.5 million. Additional Q1 addiction treatment transactions: ● Lee Equity Partners-backed Bradford Health Services acquired Parkdale Center, expanding its inpatient SUD footprint. ● Victory Recovery Partners acquired Realization Center, an addiction treatment provider with locations in Manhattan and Brooklyn, continuing its multi-specialty behavioral health rollup in the Northeast. ● Xolani acquired Welwynn Outpatient Center in the outpatient SUD space. ● Doctor Staffers LLC acquired TAKS Care Group. Mental Health M&A Nineteen mental health deals closed in Q1 2026, down from 24 in Q1 2025 and roughly in line with the 18 closed in Q4 2025. The sub-sector continues to account for the majority of BH transaction volume, driven by active PE-backed platform builders and a growing number of nonprofit strategic combinations. Latticework Capital-backed Beacon Behavioral Partners was the most active acquirer in the quarter, closing four add-ons: Carolina Psychiatry, SunCoast Psychiatry, Novus Neurology, Psychiatry, & TMS, and one yet to be named acquisition — all in outpatient psychiatry. Mertz Taggart provided exclusive sell-side advisory services in the acquisition of an outpatient mental health platform. The parties have requested confidentiality. Other notable closed mental health transactions: ● Goldman Sachs Asset Management formed a new platform with LearnWell, a provider of behavioral health services for students in hospital and therapeutic day school settings. ● Cerebral acquired Get Inflow, a digital ADHD-focused platform, continuing its build-out of condition-specific virtual care offerings. ● Quantum Health acquired CirrusMD, adding text-based virtual care to its navigation platform. ● Harbor Health acquired Rippl Care, a dementia-focused behavioral health provider. ● Nocd acquired Rebound Health, expanding its OCD-focused digital platform. ● Victory Recovery Partners acquired North Shore Relationship Center, a group therapy practice in Port Jefferson, New York. ● Chimes International acquired Family Focus, a community-based mental health and social services provider. ● Omni Family of Services acquired Justiceworks Youthcare, a youth-focused mental health provider. ● New View Alliance (formerly Gateway-Longview) acquired New Directions Youth and Family Services, continuing its nonprofit consolidation strategy in children's behavioral health. ● Proficio Therapy Services acquired Child's Play Therapy Services, a pediatric outpatient practice. ● WVU Medicine Wheeling Hospital acquired Orchard Park Hospital, an inpatient psychiatric facility. Also announced — but not yet closed — was Universal Health Services' (UHS) agreement to acquire Talkspace for approximately $835 million. Talkspace operates a nationwide virtual behavioral health platform with roughly 6,000 licensed professionals and generated $229 million in revenue in 2025 and $6.03 million in EBITDA, which translates to an eye-popping approximately 138x multiple . Expected to close in Q3 2026, the deal reflects the broader thesis that large health systems are moving to integrate virtual outpatient behavioral health capacity with their existing inpatient infrastructure. Also announced was Spring Health's agreement to acquire Alma, a mental health marketplace that would significantly expand Spring Health's provider network. On the growth side, mental health attracted six of the quarter's eight venture rounds. Talkiatry raised a $210 million Series D led by Perceptive Advisors — bringing total funding to over $400 million — to expand its employed-psychiatrist model, which now includes more than 800 full-time W-2 psychiatrists in-network with over 100 insurers. Grow Therapy raised a $150 million Series D led by TCV and Goldman Sachs Alternatives at a reported $3 billion valuation. Salma Health raised $80 million from ARCH Venture Partners. Smaller rounds were completed by Somethings ($19.2M), Jimini Health ($17M), and Coral Care ($13M). Autism and Intellectual/Developmental Disabilities M&A Ten Autism/I/DD deals closed in Q1 2026, up from 7 in Q4 2025 and below the 12 closed in Q1 2025. New PE platform formations and continued ABA consolidation remained the primary drivers. "ABA and I/DD continue to attract serious buyer interest — three new PE platforms launched in the space in Q1 alone, which tells you something about where institutional capital is placing its bets. Buyers are doing their diligence carefully, but well-run practices with solid clinical outcomes and clean financials are still generating competitive processes. We're also seeing growing interest in HCBS and community-based I/DD models as buyers look to build out the full continuum." — Taggart said. Three new PE platforms were formed in the space during Q1. Momentum Health Partners launched with the acquisition of Advanced Autism Center for Treatment (AACT). Aquitaine Capital formed a new platform with KidsChoice, an ABA and behavioral therapy provider. Elysium Management LLC formed a platform with InBloom Autism Services (formerly Behavior Development Group), a multi-state ABA provider. Centerbridge Partners, Vistria Group, and Madison Dearborn-backed Sevita (formerly The Mentor Network) completed the acquisition of RES-Care Community Living, a significant I/DD and home- and community-based services combination that expands Sevita's national HCBS and supported living footprint. Additional Q1 Autism/I/DD transactions: ● General Atlantic-backed ACES acquired Ally Pediatric Therapy, continuing its ABA and pediatric therapy expansion. ● Center for Social Dynamics acquired Behavior Change Institute (BCI). ● Renovus Capital Partners-backed Behavioral Framework acquired Autism ETC. ● Step Forward ABA acquired MySpot (NC and VA locations). ● The Verland Foundation acquired Triad Behavior Support Services, a nonprofit I/DD strategic combination. ● NCG Care acquired community-based operations from Broadstep Behavioral Health. On the growth side, Answersnow raised $40 million from HealthQuest Capital to expand its telehealth-based ABA platform, and Avela Health raised $6.5 million from Artemis Fund. If you are interested in downloading the PDF version of the Q1 2026 Behavioral Health M&A Report, click the download link below:

By Michael W. Lloyd | Originally published March 7, 2023 | Updated May 7, 2026 At a Glance Selling a care-at-home agency is one of the most consequential decisions an owner can make. After 160+ completed healthcare M&A transactions, Mertz Taggart recommends every home care, home health, or hospice owner address five areas before going to market: clarifying exit goals, reducing owner dependency, defining the ideal buyer profile, engaging an experienced M&A advisory firm, and organizing diligence-ready information. Getting these right can significantly affect both the value you receive and the outcome for your employees and patients. For many agency owners, exiting their business can feel like stepping away from something deeply personal. It’s an emotional decision, but also one that rewards careful planning and sophistication to obtain the best outcome. The list of things to consider before a sale is long. But after guiding owners through many successful healthcare services M&A transactions across home care, home health, and hospice, we have narrowed it down to the five that matter most. These are the areas where preparation consistently separates the owners who get the outcome they want from those who leave value on the table. 1. Outline the Goals and Objectives of Your Exit Strategy Before anything else, get clear on what matters most to you and rank those priorities. The financial outcome is important, but it is rarely the only thing owners care about. Consider: How much will I receive after taxes? Will the legacy of the business be maintained? Will my employees still have jobs, and will company culture remain? Do I want to stay with the business for a period beyond a standard transition? Documenting these priorities early gives you a framework for evaluating every offer and every buyer that comes to the table. 2. Distance Yourself from the Agency’s Day-to-Day Operations Care-at-home investors are highly sensitive to transition risk. In the words of Cory Mertz, Managing Partner: they worry about "risk that the business will deteriorate after a closing," and after the owner has received a substantial payout. Delegating responsibilities is challenging. But separating yourself from the agency’s day-to-day operations adds flexibility to your options upon exit and can meaningfully increase the value a buyer is willing to pay. A business that runs well without its founder carries less risk for a new owner. 3. Define Your Ideal Buyer or Investor Profile Choosing the right buyer or investor to partner with, rather than simply selecting the highest offer, can make or break the outcome. A buyer who has direct experience with home care, home health, or hospice transactions, plenty of cash on hand, and a healthy credit line will have a higher certainty of closing the deal. The right buyer will also strive to maintain or improve the service quality while caring for your employees. Fit matters as much as price. 4. Engage a Professional, Industry-Experienced M&A Advisory Firm An M&A advisory firm that specializes in home care, home health, and hospice will guide and prepare you for a sale that can maximize value while fulfilling your goals and objectives. Finding the right buyer and compelling them to make their highest offer requires a well-run, competitive M&A process. Preparing the marketing materials, financial model, and information for due diligence is exceptionally time-consuming and taxing. An advisory firm provides the additional bandwidth to prepare all of it while you keep growing your agency. And there is an important distinction worth noting: an M&A advisory firm acts as a strategic partner through every phase of the process, which is different from a broker who may simply list your business and wait for interest. → Related: How to Choose a Home Care M&A Advisor 5. Ensure Easy Access to Critical Diligence Information Even with an advisory firm handling the heavy lifting, you will need to provide the raw information: accurate financials, operational metrics, licenses, contracts, and compliance records. Buyers and their teams will scrutinize every detail. Assuring this data is clean, accurate, and accessible will put you ahead from day one. It signals professionalism and reduces the risk of delays or price adjustments during due diligence. → Related: What Strategic Buyers Really Look For in Home Care M&A Considering the five items above will better prepare every care-at-home agency owner to plan and execute a successful exit strategy. Key Takeaways: • Define and rank your exit goals before engaging with any buyer. • Reduce owner dependency to lower transition risk and increase value. • Evaluate buyers on fit, experience, and financial capacity, not just price. • Choose an M&A advisory firm with deep healthcare transaction experience. • Organize your financials, licenses, and operational data before going to market. Ready to Start Planning Your Exit? Mertz Taggart has guided owners through healthcare services M&A transactions across home care, home health, and hospice for over twenty years. If you are considering a sale of all or a portion of your agency, we welcome a confidential conversation about your goals and timeline. Contact us to get started.

By Cory Mertz, Managing Partner, Mertz Taggart At a Glance Maximizing the value of your home health, hospice, or home care agency comes down to two things: building value over time and capturing it through a disciplined sale process. Value is determined by the equation Enterprise Value = Adjusted EBITDA x Multiple, where the multiple reflects buyer-perceived risk. Owners who grow revenue, manage margins to the EBITDA sweet spot, diversify referral sources, and separate themselves from day-to-day operations can significantly increase what their agency commands. Equally important is how you go to market: a confidential competitive bid process with A-list buyers consistently delivers stronger outcomes than negotiating with a single buyer. You spend years, sometimes decades, building something valuable. But how you go about selling it can make all the difference between a good outcome and a great one. I break maximizing value into two distinct phases: building value and capturing value. Most owners are already doing the first part every day. It is the second part, the sale process itself, that does not get talked about nearly enough. What Is the Valuation Equation for a Home Health or Hospice Agency? The fundamental valuation equation is straightforward: Enterprise Value = Adjusted EBITDA x Multiple. Adjusted EBITDA is the normalized cash flow your agency produces, as if the buyer already owned it, before any synergies. The multiple is an inverse measure of risk. The lower the perceived risk that cash flow will decline after a sale, the higher the multiple a buyer will pay. I like to break this down further: Revenue x EBITDA Margin x Multiple. Each of those three levers can be improved independently, and the compounding effect can be significant. A Real-World Example: From $7.5M to $14M I met a Medicare Home Health agency owner at a conference in 2018. His magic number was $10 million. When we evaluated the agency, it was doing about $8.5 million in revenue with a 16% EBITDA margin. At a conservative 5.5x multiple (at that time), that put guidance around $7.5 million. Not quite there. We agreed he had some work to do. He focused on facility referrals, prepared for PDGM, and growing the business. By late 2020, he had taken revenue to $10 million and improved margins to 20%. The market had also strengthened. He ultimately received a 7x multiple and $14 million in enterprise value, 87% more than the original guidance. That happened by moving all three levers: revenue, margin, and multiple. → Related: It’s All About the Multiple (…Or Is It?) Why Does the Type of Financial Consideration Matter? Not all enterprise value is created equal. Cash at close is what matters most. Any other form of consideration, whether it is seller financing, an earn-out, or a contingent payment, needs to be discounted. Sometimes significantly. Most transactions include a holdback, typically held in escrow with the seller's name on it. The buyer has to make a formal indemnification claim and prove damages to access any of that money, which makes it relatively secure. Where sellers run into trouble is with cash-strapped buyers who want to structure holdbacks as seller notes, request seller financing, or rely heavily on earn-outs. An earn-out or contingent payment, in my opinion, should be considered icing on the cake. If the business falls off post-close, you may never see that money. What Are the Most Common Ways to Build Value? Grow the Business Revenue growth directly increases the EBITDA numerator and also drives a higher multiple. Bigger companies command higher multiples because they have the infrastructure to absorb setbacks. Publicly traded home health companies have traded at multiples ranging from the mid-teens to the mid-30s. A smaller agency with concentrated risk will trade for far less. Growing the company addresses both sides of that gap. Manage Your Margins Start measuring gross margin and net margin if you are not already. Gross margin is what remains after the cost of care: clinicians, caregivers, mileage, supplies. Net margin is what remains after overhead. Target margin ranges that buyers find attractive: Sector Gross Margin EBITDA Margin Home Health 45-50% 15-25% Hospice 45-55% 15-25% Home Care Lower than HH/hospice* 10-20% Diversify Referral Sources and Clients A company with a hundred referral sources will typically command a higher multiple than one with ten. On the home care side, an agency with many lower-hour clients is generally more attractive than one relying on a handful of 24/7 cases. Concentration is risk, and buyers price risk into the multiple. Separate Yourself from Marketing and Day-to-Day Leadership This is one of the biggest drivers of the multiple. If the owner is the primary marketer and operator, buyers see significant transition risk. Even if they convince you to stay on after the sale, your motivation as a former owner is different. The more the business can run without you, the higher a buyer will pay for it. Build a Transition-Proof Business Make sure your key employees and managers are aligned and motivated to stay. Stay bonuses, even modest ones relative to the overall transaction, give buyers comfort that the team will remain intact. Bringing one or two key people into your circle of trust, and giving the buyer the chance to meet them, can go a long way toward de-risking the deal. Consider an Acquisition An acquisition can move all three levers at once. Revenue grows when you add patients and clinicians. Margins often improve when you eliminate redundant overhead, especially in your own market or a contiguous one. And a bigger company commands a higher multiple. It is a big undertaking, but it checks all the boxes. → Related: Your Company Might Be Great. That Doesn’t Mean It’s Valuable. How Do You Capture Maximum Value When Selling? Building value is what you do over years. Capturing value is what happens in the final five to eight months. This is the part most owners do not spend enough time on, and it is where the process can make a dramatic difference in your outcome. Who Are the A-List Buyers? A-list buyers check three boxes: they have cash (or easy access to credit), they operate in your industry or an adjacent one, and they have done deals before. In practice, this means publicly traded companies and financially backed strategic buyers, companies backed by private equity or family offices. There are roughly 50 to 60 A-list buyers across the country in the home-based care space. Why Does a Competitive Process Matter? You want to avoid a monopsony, which simply means dealing with only one buyer. When multiple qualified buyers are competing for your agency, you get better pricing, better terms, and more leverage throughout the process. The process works like this: reach out to all A-list buyers confidentially with a teaser document that includes an executive summary and high-level financials but not enough to identify the agency. Interested buyers sign a non-disclosure agreement. Then you provide a Confidential Information Memorandum, typically a 25- to 60-page deck covering the agency's history, financials, patient metrics, key employees (no names), and referral information (no names). That document also includes a process letter, which tells buyers this is a competitive process, sets an offer deadline (usually four to five weeks), and spells out what the letter of intent needs to include. What Should You Look for When Meeting Buyers? Once the serious buyers emerge, meet them face to face if possible. Schedule meetings back to back. This gives them a chance to ask detailed questions and gives you an opportunity to gauge which buyer is truly the best fit. It also reinforces that this is a competitive process. During these meetings, be upfront about any potential issues. You do not want a buyer discovering something in due diligence that you could have disclosed earlier. Getting everything on the table builds trust and reduces the risk of renegotiation down the road. Beware the uninformed buyer. Buyers who are not experts in the industry will find things late in the process that can upset the deal. Buyers who approach sellers directly and make offers based on very little information are especially concerning. You want buyers who know the industry cold. → Related: How to Sell Your Home Care Agency: 3 Proven Exit Strategies from Private Equity How Do You Get to the Closing Table Without Renegotiating? Once you select a buyer and sign a letter of intent, you enter an exclusivity period, typically 60 to 120 days. You are locked in with that buyer. Everything you can do before signing the LOI to eliminate blind spots will pay off during this phase. Having backup offers from the competitive process keeps the selected buyer honest. You do not need to mention it in an unprofessional way, but a subtle reminder that other conversations took place goes a long way. Bring one or two key employees into the circle of trust. Due diligence is a lot of work, and you need to keep running the company at the same time. A trusted employee with access to the data you need can take a significant burden off your shoulders. Incentivize them with a stay bonus so they are motivated to stick around through the close and beyond. Be ready to produce standard diligence information quickly. Time kills all deals. Due diligence checklists can run anywhere from 100 to 300 line items, so it’s important to know where everything is before that checklist arrives. Most importantly, maintain strong admissions and hours through the process. If the business starts to fall off, even a little, buyers may question the value. The best deals grow through diligence, and that gives sellers maximum leverage when negotiating the final purchase agreement. Key Takeaways Value is determined by Enterprise Value = Adjusted EBITDA x Multiple. All three levers (revenue, margin, multiple) can be improved independently. Target EBITDA margins of 15-25% for home health and hospice, 10-20% for home care. Margins outside these ranges can raise questions with buyers. Cash at close is what matters. Earn-outs, seller notes, and contingent payments should be considered icing on the cake. Owner dependence is one of the biggest risks buyers price into the multiple. Separate yourself from marketing and day-to-day leadership. A confidential competitive bid process with A-list buyers consistently outperforms negotiating with a single buyer. Time kills all deals. Have your diligence materials organized and maintain strong admissions throughout the process. Ready to Talk About Your Exit? Mertz Taggart has spent over twenty years advising home health, hospice, home care, and behavioral health owners through the sale process. If you are contemplating an eventual sale, or if you just want to understand where your agency stands today, we are happy to have a confidential conversation.

By: Bruce Vanderlaan While this has been a pretty volatile year in the M&A world, demand for small- to mid-sized home-based care agencies remains high. You can tell by the sheer volume of calls and emails you have been getting from “advisors” who tell you they have a buyer for you, or they can get you what looks like a very attractive multiple. In this environment, potential sellers need to be keenly aware of the “broker bait-and-switch” that is becoming more common in the home health, home care, and hospice industries. At the very least, those reaching out to you with promises of “interested buyers” or high multiples (all without knowing anything more than your website) should, at the very least, be cautiously received. Here is how the broker bait-and-switch usually goes: ● An M&A ‘broker’ approaches a seller with the promise of an interested buyer, multiple interested buyers, or even a specific buyer looking to pay a steep price for that seller’s agency ● To find out who the buyer is, the broker forces the seller to enter into an agreement of some kind ● After the seller enters that agreement, they will likely be forced to pay a fee to that broker down the line when an acquisition takes place with whomever they bring to the table There are multiple problems with this process. First, it’s highly unlikely the broker actually has a specific buyer who has already made contact. In this equation, the promise of that specific buyer is the “bait.” Once the seller has entered into the agreement, the broker can turn around and play the same game with potential buyers. That’s the “switch". The broker will notify a group of buyers that it has an interested seller, blasting out an advertisement of sorts of an interested seller. Sellers — and buyers, for that matter — are likely to find this sort of process expensive, confusing, burdensome, and unprofessional. It leaves owners dissatisfied and fatigued after selling their agency, a chance they may only get once. Essentially, the broker is intent on making a fee, regardless of who pays it. Many of these brokers are simply “transaction” brokers. Meaning, they represent the transaction, not you, and not the buyer. A legitimate M&A advisory firm will put significant effort into maximizing value for the seller, and the results can be significant. There is a lot of work that goes into going to market the right way, ensuring that the agency is ready for due diligence and that the transaction has a high likelihood of closing. Finding Buyers is the Easy Part To avoid succumbing to this trick, the first thing that sellers need to understand is that the pressure is not nearly as high as the broker makes it seem. After all, there is always strong interest in the M&A marketplace for quality agencies. There are plenty of strategic buyers and PE firms regularly looking for quality home health, home care, and hospice assets. The allure of an “interested buyer” should generally be ignored when no details are given. In fact, having “one” interested buyer is almost never in a seller’s best interest. When an owner is looking to sell, they should expect a transparent and competitive process from the outset. An experienced M&A advisory firm or investment banker should lead that process and engage with multiple buyers in order to get the best price and terms for the agency at the end of negotiations. That also allows the seller — and not the broker, who may just be looking for a fee via the broker bait-and-switch — to choose the best buyer. That choice will involve price, cultural alignment, certainty to close, post-closing obligations, and a host of other factors. Without backup offers, buyers are hardly likely to raise their offers or make compromises on other seller wishes. They are also more likely to negotiate on the basis of what is ‘reasonable’ versus what is ‘market’, determined by a professional, competitive, process. How to navigate the process Sellers should not enter into vague agreements, no matter how eager they are to negotiate with so-called “interested buyers.” In order to ensure the process goes smoothly, they need to ask the right questions to the broker: ● Who is the buyer? ● Did the buyer ask you to contact us, specifically? ● Why is my company strategically interesting to them? ● How did the buyer determine the price or multiple? ● Is the buyer paying your fee? If the broker cannot or will not answer the above questions, sellers should reevaluate the situation before agreeing to anything. If it seems too good to be true… The vast majority of the time, a respectable M&A advisor should not have any problem answering those questions from the start. If they do, they likely do not have the sellers’ best interests in mind. Instead, they are likely looking to capitalize on their fees, and not much else. This is likely going to be one of the most major life decisions an agency owner makes, and it usually only happens once. It makes sense to be cautious and informed. My rule, that it took me a lot of pain to learn, is that if I am being pressured to make a decision, the answer has to be “no.”

Introduction The Veterans Administration (VA) has long been considered a ‘payer of last resort’ for home care providers, offering below-market rates and slow pay for services to our veteran community that deserves better. As a result, this business line has often been viewed as important, but not desirable for home care operators, resulting in low M&A interest from industry consolidators. That changed in 2018 with the passage of the VA Mission Act of 2018 . This federal law aimed to enhance veterans' access to healthcare services within the VA system and through community care providers. Of particular interest to home-based care providers, the act replaced the Veterans Choice Program with the new Community Care Program . Community Care Program The new Community Care Program expanded the eligibility criteria for veterans, provided more stable funding, improved the program’s long-term sustainability, and standardized and streamlined access requirements to receive care. Additionally, the Act established the Community Care Network (CCN), which serves as the contract vehicle for the VA to “purchase” community care from community healthcare providers for veterans. The CCN established agreements with two third-party administrators (TPA), Optum Public Sector Solutions, Inc. (Optum), part of UnitedHealth Group, Inc. and TriWest Health Care Alliance (TriWest) and divided the country into five different regions: The TPAs are responsible for developing and administering the CCN within their assigned geography. Their scope of work includes the following: Provider Network Management: Establish and maintain networks of community healthcare providers, such as home care or home health providers. Appointment Scheduling: Help coordinate appointment scheduling for veterans. Claims Processing: Handle claims processing and payment from community healthcare providers. Authorization and Coordination : Assist in obtaining authorizations for medical services that veterans need from community providers and ensure necessary documentation is in place. Quality Assurance : Monitor the quality of care. Communication : Facilitate communication between the VA, veterans, and community healthcare providers. In order for a home-based care provider to provide services to veterans and get reimbursed for it, it needs to: Establish a contract with a TPA : This involves executing an agreement and going through certain credentialing. Build relationships with local VA representatives: This should be in the form of high-quality and timely care. Billing: Submit proper billing through established protocols and online portals Receive payment or follow up on unpaid claims: As with any payer, providers will need to follow up with TPAs on unpaid claims, but the majority of the time this will be due to minor and easy-to-fix issues Attractive Reimbursement In addition to the improved and more efficient Community Care Program, the VA also has attractive reimbursement rates for home-based care services: Personal Care Services: The rates for personal care services depend on the state/city/market serviced, but the majority will be in the low $30’s/hr. Home Health and Hospice Services: VA will reimburse at Medicare rates. Investor Interest Investors have caught wind of the improvements in the VA healthcare ecosystem and have developed a strong interest in home-based care providers that service veterans. Below are some of the reasons for the renewed investor interest: Payor Diversification : Increasing the number of payors reduces the risk that a certain payor will lower rates, stop reimbursement, change material terms in agreements, etc. High Reimbursement Rates: Current reimbursement rates are on the high end for home-based services. Uncertainty Other Payors: Private Pay: Concerns with the state of the economy could inhibit clients’ ability to pay high rates Medicaid: CMS’s proposed Medicaid Access Rule requiring providers to pass 80% of reimbursement to direct care workers jeopardizes the feasibility of the different state programs. Medicare: Looming proposed rate cuts increase risk Value-based Care Opportunities: An additional payor means an opportunity to care for more individuals, have more leverage when negotiating contracts, and capture higher-margin health services. “We are hearing more from strategic buyers interested in adding VA to their existing Medicaid home and community-based services business,” Mertz Taggart Managing Partner Cory Mertz said. “It’s a perfect complement to that business line. The models are very similar, payer diversity reduces risk, especially in light of the proposed 80/20 rule, and the current reimbursement rates are strong.” M&A Market For Home-Based Care Providers Servicing Veterans The strong investor interest in home-based care providers that service veterans and receive reimbursement through TPAs has increased the demand and value of these assets. Resources: VA Community Care Network VA Mission Act of 2018 VA Disability Calculator VA Disability Appeals Additional Veteran Resources As part of our commitment to supporting veterans and their families, we are pleased to share some valuable resources provided by Hill & Ponton , a law firm dedicated to advocating for veterans who have been denied benefits by the VA. These resources are designed to assist veterans in navigating the challenges they face, particularly in relation to mental and physical health issues. PTSD Guide :  A comprehensive resource tailored to assist veterans coping with post-traumatic stress disorder. 2024 Disability Calculator :  An up-to-date practical tool for evaluating disability compensation eligibility. Toxic Exposure Map :  A helpful tool designed to help veterans navigate potential exposure risks. Blue Water Navy Map :  An interactive Vietnam map for navigating exposure to Agent Orange. We believe these resources will be highly beneficial to our readers, offering practical tools and information to better manage the challenges that veterans often face.

By Michael Lloyd The convergence of unique market factors has created an opportunity for owners of home-based care businesses in the lower middle market. The major contributing factors in the market are rising interest rates [ML1], which are causing private equity to delay their exits on platform investments, and a scarcity of quality assets currently on the market. In other words, large private equity-owned businesses cannot fetch the terms and values they want in the 100M+ market due to interest rates, so they are forced to continue investing in their businesses by acquiring assets that fit their strategy. “The top has come off the higher end of the market, forcing private equity portfolio companies to delay their exits for now. In terms of multiples, these larger companies that would have sold a couple years ago in the mid- to high-teens are not commanding that right now. Transactions that size tend to be more highly leveraged, which will ultimately weigh down valuation,” Mertz Taggart Managing Partner Cory Mertz said. “But private equity has a mandate to spend the piles of cash they are sitting on, so that’s what their portfolio companies are doing right now. Or at least they are trying to.” The issue for these strategic buyers and opportunity for owners (sellers) lies in the availability or lack thereof of quality assets currently on the market. Although home-based care M&A ticked up in Q2(see report) , Q1(see report) recorded near-historic lows for completed transactions, and it appears Q3 will follow suit. “Transaction volume right now is, for the most part, a function of quality opportunities in the marketplace,” Mertz added. Healthy businesses with EBITDA numbers between $1 million-$10 million have benefited from these conditions. In a market where assets are more readily available, these companies may not garner the same level of interest or demand as they are currently getting. Consistently, in a competitive process, owners are capitalizing on this demand by exceeding valuation expectations. While values hold firm, the buyers are increasingly disciplined in diligence due to the general sense of uncertainty and historically high values. It is essential that owners are stringent with compliance and manage margins to capitalize on the values being offered. “We will almost always recommend our clients perform some level of a compliance audit and quality of earnings before going to market,” Mertz said. “It costs money, so it can be a tough pill to swallow for owners, but it will give them insight into how the buyer will ultimately size up the company. It’s better to know that before jumping into a months-long sale process.”

The healthcare mergers and acquisitions (M&A) marketplace is undergoing a dynamic transformation, driven by shifting industry trends, heightened scrutiny on asset quality, and the strategic pursuit of value-based care. These developments were the focus of our recent webinar series, Home Health & Hospice M&A – Webinar Series , where industry experts shared actionable insights and strategies to navigate today’s M&A environment effectively. Hosted by Jennifer Maxwell , the discussion featured insights from Cory Mertz , managing partner at Mertz Taggart, and Jay Duty , COO at Maxwell Healthcare Associates. The session provided a comprehensive exploration of the latest M&A trends, challenges, and forward-looking opportunities in home health and hospice care. Here are the key takeaways that can shape your approach to M&A in this evolving marketplace. Emerging Trends Shaping Healthcare M&A A Post-Pandemic Reset The COVID-19 pandemic significantly altered the M&A landscape. After a slowdown during the early stages of the pandemic, a surge in transactions followed, fueled by low interest rates and government stimulus. However, rising inflation and higher borrowing costs have shifted priorities. Buyers are now more discerning, focusing on assets with robust financial and operational performance. Increased Demand for Quality Assets Today’s buyers prioritize quality over quantity. Clinical and operational efficiency, data-driven insights, and a clear demonstration of value are critical factors. Sellers must prepare thoroughly, ensuring their businesses meet these elevated standards to stand out in a competitive market. Strategic Considerations for M&A Success Adapting to Consolidation Trends The move toward value-based care is a driving force behind healthcare consolidation. Strategic buyers aim to enhance existing operations and expand service lines through acquisitions that align with their long-term objectives. Optimizing Margins and Metrics Private equity firms are continuing to target high-quality assets with strong margins and scalable operations. As competition intensifies, sellers must ensure their business metrics and processes are optimized to attract top-tier interest. Preparing for Market Success Proactive Operational and Financial Planning Preparation is paramount in today’s M&A environment. Conducting thorough operational assessments, optimizing revenue cycle management, and addressing inefficiencies are critical steps for enhancing valuation. Sellers who invest in readiness build buyer confidence and mitigate transaction risks. Early Exit Strategy Development Successful exits don’t happen overnight. Engaging with M&A advisors and consulting firms well before a potential sale can provide actionable guidance to improve operational metrics and unlock hidden value. Understanding your business’s unique strengths ensures a stronger position during negotiations. Opportunities on the Horizon Data and Technology as Growth Enablers Data collection and analysis are increasingly pivotal. Organizations leveraging patient outcome data can strengthen relationships with payers, ACOs, and Medicare Advantage plans while improving operational efficiency. Service Integration for Value-Based Care Innovative service offerings, such as infusion therapy and physician-at-home care, are becoming essential to building comprehensive care portfolios. Integrating these services into value-based care contracts enhances profitability and market appeal. Key Takeaways for Sellers Plan Ahead : Begin preparing for a sale early. Building operational readiness and addressing inefficiencies takes time but delivers substantial returns. Leverage Expert Guidance : Engage M&A advisors and consultants to maximize asset value and navigate the transaction process effectively. Understand Your Unique Value Proposition : Clearly articulate your market position and competitive advantages to stand out during buyer evaluations. Optimize Financial and Operational Metrics : Ensure strong EBITDA margins and operational efficiencies to attract premium valuations. Looking Ahead With interest rates stabilizing and private equity poised for increased activity, the healthcare M&A marketplace is on the brink of renewed momentum. Organizations that prioritize preparation, operational efficiency, and strategic alignment with market trends will be best positioned to thrive in this competitive landscape. If you are interested in watching the entire Navigating the M&A Landscape: Key Trends and the Role of Advisors webinar, you can find it on our YouTube channel! If you are contemplating an eventual sale of your home-based care agency, feel free to contact us at info@mertztaggart.com to arrange a confidential discussion about your exit strategy!

Home-based care M&A activity held steady in Q1 2026, with 22 transactions closed during the quarter — continuing the momentum from last year's rebound . Seven additional deals were announced but not yet closed as of quarter-end, signaling a healthy pipeline heading into the second quarter. Hospice led all sub-sectors with 10 closed transactions, followed by home care at 9 and home health at 6. Cory Mertz , managing partner at Mertz Taggart, noted: "Q1 2026 was an encouraging start to the year. We're seeing more sponsors reach the point where they need to transact — some of these platforms have been held for five, six, seven years, and the pressure to return capital to LPs is real. The clock is ticking on a lot of these funds, and buyers are active. We expect deal volume to continue building through Q2 and into the back half of the year." Home-Based Care M&A Note: Total industry transactions do not necessarily equal the sum of the sub-industries, as many transactions include more than one sub-industry. The 22 closed transactions in Q1 2026 were driven by sponsor-backed activity across all three sub-sectors. Home care and hospice each contributed double-digit deal counts on a combined basis, while home health showed modest improvement from the multi-quarter lows seen through much of 2024 and early 2025. Cory Mertz added: "The announced deals this quarter tell the real story. Elara Caring, Enhabit, TEAM Services, Aveanna/Family First — these are meaningful transactions that reflect growing conviction from both buyers and sellers." Home Health M&A   Home health activity improved in Q1 2026, with 6 total transactions — including 1 new platform and 5 sponsor-backed add-ons — up from 3 in Q4 2025 and the best quarter for the sub-sector in over a year. The quarter's headline deal was the announced acquisition of Enhabit Home Health & Hospice  by Kinderhook Industries  for $1.1 billion, representing a 10.2x EBITDA multiple on $108 million of EBITDA and $1.06 billion in revenue. Enhabit had been publicly traded since spinning out of Encompass Health in 2022 and had spent much of its time as a standalone company navigating reimbursement headwinds and investor skepticism about Medicare home health. The Kinderhook deal delivers a 24% premium to Enhabit's share price at announcement and nearly 34% to the 60-day average — the kind of outcome that speaks for itself. Cory Mertz offered this perspective: "The Enhabit deal is a good reminder of why we don't lead with multiples. Shareholders received a 24% premium to market and nearly 34% to the 60-day average — real value by any measure. But if you just read '10.2x EBITDA' in a headline, it sounds unremarkable. The multiple is an output, not the goal. For Enhabit's board, the goal was maximizing value for shareholders and getting the company out from under the quarterly earnings spotlight — both of which this transaction accomplished." Also announced — but not yet closed — was Ares Management's  (alongside DaVita ) strategic investment in Elara Caring , the large national home health, hospice and personal care platform formed in 2018 from the three-way merger of Great Lakes Caring, National Home Health Care and Jordan Health Services. Blue Wolf Capital had held the asset for nearly eight years — an unusually long hold period by private equity standards — navigating a difficult regulatory environment, a $4.2 million DOJ settlement in 2024, and a home health reimbursement landscape that kept many large-platform exits on hold. DaVita disclosed an approximately $200 million minority investment alongside a majority investment from Ares, with Elara continuing to operate as an independent company. The strategic rationale centers on co-developing a kidney-specific in-home care model, leveraging DaVita's clinical expertise to reduce preventable hospitalizations and lower total cost of care for patients with kidney disease. Among closed deals, Choice Health at Home  added Cyfair Healthcare  in Texas and Alliant Home Health  in back-to-back transactions, extending its multi-state footprint. Residential Healthcare Group  acquired Covenant Home Health  to deepen its presence in eastern Pennsylvania, and Superior Health Holdings  closed on Pulse Home Health & Hospice . Also announced was Aveanna Healthcare's  agreement to acquire Family First Homecare  for $175.5 million. Family First is a pediatric home care provider focused on skilled private duty nursing, operating 27 locations across seven states including Florida and Texas. The deal expands Aveanna's specialized pediatric footprint and reinforces its strategy of building scale in medically complex, high-cost patient populations. Hospice M&A Hospice maintained its position as the most active sub-sector in Q1 2026, with 10 closed transactions — including 5 sponsor-backed strategic add-ons. This is consistent with the record activity seen in Q4 2025 and confirms hospice as the preferred target for both strategic and financial buyers in the current environment. Notable transactions include Uplift Hospice's  purchase of Autumn View Hospice  in Georgia, continuing the platform's active acquisition streak. On the not-for-profit side, Chapters Health System  announced another transaction in its acquisition of HouseCall Providers , a Portland, Oregon-based organization offering home health, hospice and palliative care services across the Pacific Northwest. Hospice of Southern Maine  announced the pending acquisition of Andwell Health Partners , and VNA of Texas  completed the acquisition of Faith Presbyterian Hospice . Heart to Heart Hospice  continued its add-on pace with the acquisition of a former Cura-HPC  location in Oklahoma City. Kara Health  launched a joint venture with Loma Linda University Health  to form Loma Linda University Hospice , expanding Kara's health system partnership model into the Inland Empire region of California. Cory Mertz noted: "Hospice M&A has been on a run, and we don't think it's over. The activity we saw in Q4 2025 and Q1 2026 is being driven by real demand from buyers and growing willingness from owners to engage. A few precedent platform transactions were received well in 2025, and that fuels more PE interest in the space — which drives demand for all hospice agencies, large and small. For hospice operators who are thinking about a sale in the next one to three years, the current environment rewards preparation — particularly around billing compliance and documentation." Home Care M&A Non-medical home care contributed 9 closed transactions in Q1 2026, including 5 sponsor-backed strategic add-ons and 1 new platform. While slightly below the elevated levels seen in Q1 and Q2 2025, activity remained healthy and the announced deal pipeline points to continued momentum. The quarter's most notable announced transaction was General Atlantic's  acquisition of TEAM Services Group , one of the largest Medicaid-focused home and community-based services providers in the country, from Alpine Investors , which had built the platform through more than a decade of aggressive add-on activity since forming the company in 2015. The deal, backed by $1.38 billion in financing, closed in early Q2 — but its announcement during the quarter is a meaningful signal of continued large-platform appetite in the home care space. Among closed deals, Care Advantage  acquired the Delaware locations of Neighborly Home Care , HouseWorks HomeCare  added A Caring Experience Nursing Services  in the Northeast, and PurposeCare  added Freedom Home Care  to its expanding portfolio. Choice Health at Home  continued its aggressive add-on pace, closing on Florida-based Senior Nannies Home Care Services  in addition to its home health transactions this quarter. Q1 also saw two home care franchise networks change hands: Main Post Partners  established a new platform with the acquisition of HomeWell Franchising , and Dovida , a global home care provider operating across six international markets, made its U.S. market entry with the acquisition of A Place At Home , a franchise network with approximately 55 locations across 27 states. Cory Mertz noted: "Home care is still very much in play. We have a number of sponsor-backed platforms that have been building for several years and are getting close to exit-ready, and buyers — including some we haven't seen active in a while — are showing renewed interest." If you are interested, you can also download the .PDF version of the Q1 2026 Home-Based Care M&A Report via the following link: