Acadia Healthcare Q3 Earnings Call Highlights

Key Points

• Acadia raised its 2026 guidance for the third consecutive quarter after Q3 revenue grew 5.1% to $895 million and adjusted EBITDA reached $176.4 million. It now expects revenue of $3.44–$3.46 billion and adjusted EBITDA of $615–$625 million for the year.
• Acute-care facilities led growth: acute revenue rose 11% to $525 million, while same-facility adjusted EBITDA increased 6.1%. New York Medicaid changes weighed on Pennsylvania results, but Acadia said it is building new referral relationships to offset the impact.
• Management sees $60 million in incremental adjusted EBITDA in 2027 from facilities opened since 2023, partly as startup losses decline. Acadia also cut its 2026 capital expenditure forecast to $210–$230 million; possible additional payments from expanded state programs are not included in guidance.

Acadia Healthcare NASDAQ: ACHC raised its full-year 2026 financial guidance for the third consecutive quarter after reporting third-quarter revenue growth and stronger-than-expected adjusted earnings, executives said on the company’s earnings call.

Revenue rose 5.1% from a year earlier to $895 million. Chief Executive Officer Debbie Osteen said revenue, adjusted earnings before interest, taxes, depreciation and amortization (EBITDA), and adjusted earnings per share exceeded the company’s expectations. Acadia reported $176.4 million in consolidated adjusted EBITDA but did not provide a quarterly adjusted EPS figure on the call.

The behavioral healthcare provider also outlined expectations for $60 million in incremental adjusted EBITDA in 2027 from facilities opened since the beginning of 2023, compared with their contribution in 2026. Management said it would provide a fuller 2027 outlook in February.

Growth led by acute facilities

Same-facility revenue increased 5.2% in the third quarter, reflecting a 1.1% rise in patient days and a 4.0% increase in revenue per patient day, Interim Chief Financial Officer David Duckworth said. Same-facility adjusted EBITDA rose 6.1% to $228.8 million.

Changes to New York’s Medicaid program affecting Acadia’s Pennsylvania facilities reduced same-facility revenue growth by approximately 1 percentage point and volume growth by about 2.6 percentage points, Duckworth said. Osteen said the company has replaced patients through new referral relationships in Pennsylvania and surrounding states, though the effort remains a work in progress.

Acute-care revenue rose 11% to $525 million, with patient volumes in the service line up 7.5%. Residential treatment center revenue increased 7% to $93 million. Specialty revenue was $136 million, while comprehensive treatment center, or CTC, revenue was $141 million, stable with the second quarter.

Osteen said CTC admissions trends improved in September and October as the company pursued initiatives focused on access and patient experience. Duckworth said the CTC team had also reduced costs and improved efficiency, though he did not quantify the savings.

Guidance rises as capital spending forecast falls

Acadia’s updated 2026 guidance calls for:

• Revenue of $3.44 billion to $3.46 billion.
• Adjusted EBITDA of $615 million to $625 million.
• Adjusted earnings per share of $1.70 to $1.80.
• Operating cash flow of $375 million to $400 million.

The company lowered its full-year capital expenditure forecast to $210 million to $230 million. Duckworth said the reductions were mostly related to spending on new standalone and joint venture facilities. He expects overall capital spending to decline further next year as new-facility spending incurred in 2026 does not recur.

Third-quarter operating cash flow was $98 million, and capital expenditures were $51 million, resulting in $47 million of free cash flow. Acadia repaid $63 million of debt during the quarter. Its net leverage ratio, as defined by its credit agreement, was approximately 3.9 times adjusted EBITDA at quarter-end.

Adjusted EBITDA included a $13.4 million accrual for expected payments under Florida’s supplemental payment program for the year ended Sept. 30, compared with $5.6 million included in prior guidance. Duckworth said expanded Florida and Ohio programs under regulatory review could add more than $20 million in incremental EBITDA, but that amount is not included in guidance. The timing of potential approval remains uncertain.

New facilities underpin 2027 opportunity

Acadia added 220 licensed beds during the third quarter, including 144 at Coastal Pines Behavioral Health, a new acute facility near Jacksonville, Florida, that opened in August. The company has opened 542 beds in 2026 and 16 acute facilities since the beginning of 2023.

Osteen said faster licensing, accreditation and payer contracting have helped new facilities begin serving patients sooner. Duckworth said the company is not currently factoring any new facilities into its plan for next year, although it will continue evaluating development opportunities.

The $60 million projected increase in 2027 is part of a previously discussed $200 million incremental adjusted EBITDA opportunity from the new-facility cohorts relative to 2025. Duckworth estimated that Acadia has achieved approximately $15 million of that opportunity so far in 2026.

A key assumption is that startup operating losses decline from about $45 million this year to roughly $10 million in 2027. Duckworth said approximately half of the projected $60 million improvement would come from newer facilities and the remainder from facilities opened between 2023 and 2025. Individual facility targets vary, he said, and break-even occupancy is generally around 40%.

Medicaid and investigation questions

Asked about federal Medicaid work requirements, Osteen said Acadia expects little impact next year and believes the vast majority of its Medicaid patients will be exempt. She estimated that about half of the company’s Medicaid patients are in expansion states and said Acadia is prepared to help patients navigate the process.

Osteen also said government investigation-related and other legal expenses will vary by quarter. In response to a question about the pace of activity with the Justice Department and Securities and Exchange Commission, she said the company continues to cooperate fully with the government but did not comment on potential resolution timing.

About Acadia Healthcare (NASDAQ:ACHC)

Acadia Healthcare Company, Inc is a provider of behavioral healthcare services headquartered in Franklin, Tennessee. The company operates psychiatric hospitals, specialty treatment facilities and outpatient programs focused on mental health and substance use disorders.

Acadia's services include inpatient and outpatient psychiatric care, addiction treatment, residential treatment, eating-disorder programs, and services for children and adolescents. Its facilities serve patients with a range of behavioral health conditions, including depression, anxiety, trauma-related disorders and substance use disorders.

Founded in 2005, Acadia operates primarily in the United States and also has a significant presence in the United Kingdom through its ownership of Priory, a behavioral healthcare provider.

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