Aveanna Healthcare Raises 2026 Outlook After Family First Deal, Eyes 7%-10% Growth

Key Points

• Aveanna raised its 2026 guidance after closing the Family First Homecare acquisition, now expecting revenue of $2.63 billion to $2.65 billion and adjusted EBITDA of $338 million to $342 million. Management said the boost was driven entirely by the timing of the deal.
• The Family First acquisition expands Aveanna’s Private Duty Nursing footprint, especially in Florida, while adding or expanding operations in several other states. The deal strengthens the company’s presence in a key managed care market.
• Executives reaffirmed a long-term growth target of 7% to 10%, supported by 6% to 8% organic and value-based growth plus 1% to 2% from acquisitions. Aveanna also highlighted improved leverage, falling to under 3.8x from just above 11x at the end of 2022.

Aveanna Healthcare NASDAQ: AVAH executives outlined the company’s growth strategy, updated 2026 guidance and discussed its newly closed Family First Homecare acquisition during a presentation at William Blair’s Growth Stock Conference.

President and CEO Jeff Shaner described Aveanna as a national provider of home care services for pediatric, adult and geriatric patients, with a platform spanning Private Duty Services, Home Health & Hospice and Medical Solutions. He said the company has undergone “three years of strategic transformation” since management stepped into current roles in early 2023, focused on rebuilding the organization after COVID-19 and expanding preferred payer and government affairs strategies.

Shaner said Aveanna has produced nearly a 10% revenue compound annual growth rate over the past six years, with most of that growth organic. He also pointed to a reduction in leverage from just above 11 times at the end of 2022 to under 3.8 times at the end of the first quarter of 2026.

Family First Acquisition Leads to Guidance Increase

Aveanna announced the closing of its acquisition of Family First Homecare, which Shaner said strengthens the company’s Private Duty Nursing presence, particularly in Florida. He said about 70% of Family First’s revenue was generated in Florida, which he described as an important mature pediatric managed care state for Aveanna. Family First also adds or expands operations in Illinois, Iowa, North Carolina, Pennsylvania, South Dakota and Texas.

Following the acquisition, Aveanna raised its fiscal 2026 guidance. Shaner said the company now expects:

• Revenue of $2.63 billion to $2.65 billion, up $70 million at the midpoint from prior guidance.
• Adjusted EBITDA of $338 million to $342 million, up $10 million at the midpoint.

Shaner said the increase was “exclusively driven” by the timing of the Family First closing.

Preferred Payer Strategy Remains Central

Shaner emphasized that Aveanna’s growth strategy is based on demand for home care services outpacing the supply of caregivers and the lower cost of providing care in the home. He said a pediatric patient in an acute care setting can cost $5,000 to $6,000 per day, compared with $500 to $600 per day for private duty nursing services in the home.

According to Shaner, Aveanna’s preferred payer strategy aligns clinical capacity with managed care organizations willing to invest in reimbursement rates, while its government affairs strategy works with federal and state partners on reimbursement. He said both approaches rely on above-market reimbursement rates and above-market caregiver wages.

In Private Duty Services, Shaner said Aveanna had 34 preferred payers at the end of the first quarter of 2026, representing about 60% of total managed care organization volume. That compares with seven preferred payers and about 15% of MCO volume at the end of 2022. He said the company believes it can eventually reach 80% to 85% of MCO volume under preferred payer arrangements.

Shaner also said Aveanna ended 2025 with 12 value-based agreements and about $15 million in value-based performance bonus opportunities. He described those agreements as upside-only and tied to reducing total cost of care.

Segment Performance and Growth Outlook

CFO Matt Buckhalter said Private Duty Services is Aveanna’s largest segment, representing about 82% of total company revenue. He described the business as focused on medically fragile and complex children, including patients who are ventilator- or tracheostomy-dependent or have conditions such as cerebral palsy. Buckhalter said Aveanna expects long-term growth in the segment of 3% to 5%, though current growth is running higher due to pent-up demand and rate gains.

Home Health & Hospice accounts for roughly 10% of total company revenue, Buckhalter said. He described Aveanna as a regional player in that market, with hubs in the Midwest and Southeast. While the company expects long-term growth of 5% to 7% in the segment, Buckhalter said it grew 17.4% organically in the first quarter. He cited clinical performance, including a 4.5-star rating compared with an industry level of about three stars, and 49 preferred payer agreements.

Medical Solutions, which provides enteral nutrition to about 31,000 patients monthly, contributes about 8% of revenue. Buckhalter said the segment grew 7.4% organically in the first quarter and has undergone modernization efforts to improve efficiency.

Across the company, Buckhalter said Aveanna expects organic revenue growth of 6% to 8%, with additional upside from tuck-in acquisitions such as Family First. Shaner said the company’s long-term growth algorithm includes 6% to 8% organic and value-based growth, plus 1% to 2% from mergers and acquisitions, for total annual growth of 7% to 10%.

Balance Sheet and Capital Structure

Buckhalter said Aveanna had first-quarter liquidity of $525 million, including $189 million of cash, $110 million of availability on its securitization facility and $226 million on its revolver, which he said remains undrawn except for letters of credit.

He said the company has about $1.48 billion of variable-rate debt and has used hedges and swaps to reduce exposure to interest rate volatility. Buckhalter also said Aveanna generated $131 million of free cash flow in 2025 and expects increased results in 2026.

In 2025, Aveanna refinanced its term loan, combined its first- and second-lien debt into one Term Loan B, extended the maturity to 2032 and reduced interest expense by about $14 million annually, Buckhalter said. He added that a recent repricing and ratings agency upgrade reduced the term loan spread by 75 basis points, creating another $10 million in annual savings.

Executives Address Reimbursement and Labor

During the question-and-answer session, Shaner said preferred payer agreements help reduce reimbursement risk because they are negotiated directly with payers and typically reviewed annually. He said the agreements create a “floor” for Aveanna and allow the company to raise caregiver wages while aligning capacity with payer demand.

Asked about labor and rate dependency, Shaner said Aveanna has addressed reimbursement issues in nearly all of its states, with California Medi-Cal the remaining market he identified as not yet fixed. Buckhalter said the company now views future state rate efforts more like cost-of-living adjustments, adding that Aveanna has built a larger government affairs and payer relations team to avoid long gaps between rate changes.

Shaner attributed recent growth acceleration in Private Duty Services to pent-up demand from medically fragile children waiting in hospitals for home-based nursing services. He said rate gains and volume growth have compounded as the company signed more preferred payer agreements.

Shaner concluded that Aveanna is positioned to deliver long-term value through scale, clinical performance and payer and government partnerships, while continuing to grow both organically and through acquisitions.

About Aveanna Healthcare NASDAQ: AVAH

Aveanna Healthcare, Inc NASDAQ: AVAH is a national provider of in-home health care services, specializing in pediatric skilled nursing, therapy, and related support for medically complex and chronically ill children. The company delivers a range of clinical and therapeutic solutions designed to enable patients to receive care in the comfort of their own homes, reducing the need for hospital stays and long-term institutional care. Aveanna's offerings include registered nursing, physical, occupational and speech therapy, behavioral health counseling, and durable medical equipment coordination.

In addition to pediatric home health services, Aveanna operates adult home health and personal care support programs, assisting elderly and disabled adults with daily living activities, medication management, and rehabilitation therapies.

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