Acadia Healthcare (NASDAQ:ACHC) outlined a renewed emphasis on “stability, execution, and clear communication” during its fourth-quarter 2025 earnings call, as CEO Debbie Osteen returned to lead the behavioral health provider. Management highlighted demand for services, continued bed expansion, and a shift from a multiyear growth buildout toward operational discipline and facility-level performance improvement.
Leadership priorities: execution, staffing, and operational discipline
Osteen said her immediate focus is on strengthening management quality “at all levels,” reviewing leadership depth and operational supervision layers, and returning to fundamentals such as tighter operating focus and quicker escalation when issues arise. She noted that some newer facilities “have not ramped as quickly as expected,” and said the company is evaluating each site individually while building a more standardized playbook for new hospital openings—particularly for 2026 openings.
On regulatory matters, Osteen said the company is “cooperating fully” and declined to comment on timing, adding that her focus is on recruiting and retaining qualified leadership and staff to deliver high-quality care and reduce risk through consistency.
Fourth-quarter and full-year 2025 results
CFO Todd Young reported fourth-quarter revenue of $821.5 million, up 6.1% year over year, and adjusted EBITDA of $99.8 million. Results included a $52.7 million adjustment to the company’s reserve for professional and general liability (PLGL), consistent with updated guidance provided on Dec. 2, 2025.
For full-year 2025, Acadia generated revenue of $3.31 billion, up 5% versus the prior year and slightly above the upper end of its prior guidance range, which management attributed to improved volume. Full-year adjusted EBITDA was $608.9 million, near the upper end of the company’s guidance range.
Same-facility performance improved in the quarter. Same-facility revenue grew 4.4% year over year, driven by a 1.3% increase in revenue per patient day and a 3.1% increase in patient days. Young also cited $12.8 million of startup losses related to newly opened facilities in the quarter (up from $11.2 million a year earlier) and $3.6 million in net operating costs associated with closed facilities. On a same-facility basis, adjusted EBITDA was $152 million in the fourth quarter.
Development activity, closures, and embedded earnings opportunity
Management described a business coming off “record expansion.” Osteen said Acadia added more than 2,500 beds over the past three years and is on track to add another 400–600 beds in 2026, while shifting focus toward operational excellence. She estimated that, relative to startup losses included in 2025 results, the incremental EBITDA opportunity represented by new facilities opened from 2023 through 2026 exceeds $200 million.
Young said the company added 181 beds in the fourth quarter, including 144 from opening a new joint venture facility in North Carolina. For full-year 2025, Acadia added 1,089 beds, exceeding the high end of its guidance range, including 778 beds from opening six new facilities.
Over 2025, the company decided to close five facilities (four specialty facilities and one acute care hospital), representing 382 beds. Osteen said the accelerated pace of closures seen in recent years is “behind us,” and that going forward closures would only be considered where there is “no clear path to viability.” She noted two leased specialty facilities in Pennsylvania were closed as a result of New York’s out-of-state Medicaid policy change and lease timing.
In joint ventures, Osteen highlighted 2025 openings with Henry Ford (Michigan), Geisinger (Pennsylvania), Ascension (Texas), ECU Health (North Carolina), and Fairview (Minnesota). Looking ahead to 2026, Young said expected bed additions include three joint venture facilities with Tufts Medicine, Methodist Health, and Orlando Health.
Young also said Acadia opened a new de novo in its CTC line of business during the quarter, bringing the total to 15 new CTCs added in 2025, which he described as a capital-efficient way to expand in underserved markets. Osteen later characterized CTC as low capital intensity, low labor intensity, and having strong, predictable demand.
2026 guidance: New York Medicaid headwind, lower CapEx, positive free cash flow targeted
For full-year 2026, Acadia guided to revenue of $3.37 billion to $3.45 billion, adjusted EBITDA of $575 million to $610 million, and adjusted EPS of $1.30 to $1.55. Same-facility volume growth is expected to be 0% to 1%, with the company citing incremental contribution from ramping beds (including roughly 630 beds moving into the same-store bucket in the first quarter) partly offset by an approximately 350 basis point headwind tied to changes in the New York Medicaid program.
Pricing expectations call for a 2% to 3% increase in same-facility revenue per patient day, including a decrease in Medicaid supplemental payment revenue for the year. Young noted that 2025 results included a non-recurring $34 million revenue benefit from Tennessee’s supplemental payment program recorded in the second quarter. For 2026, the company expects to recognize $11 million of out-of-period supplemental payments in the first quarter; guidance excludes unapproved programs, though management said certain programs awaiting regulatory approval could represent at least a $22 million EBITDA benefit if approved in 2026.
Startup losses are expected at $47 million to $53 million in 2026, down from $56 million in 2025, with about 60% occurring in the first half of the year. Young said the closure of facilities that contributed roughly $40 million of 2025 revenue is expected to provide an approximate $9 million tailwind to 2026 adjusted EBITDA.
On New York Medicaid, Young reiterated an expected $25 million to $30 million annual EBITDA impact from New York no longer allowing Medicaid patients to receive care in out-of-state facilities. Management said it is consolidating its footprint, has closed two leased specialty facilities, and is working to backfill occupancy and shift payer mix; the company also cited efforts to source patients from Pennsylvania and a newly opened state market, New Jersey.
PLGL expense is expected to be $100 million to $110 million in 2026, consistent with prior guidance. Management said it expects positive free cash flow in 2026 as CapEx declines to $255 million to $280 million, down from $572 million in 2025. As of Dec. 31, 2025, the company reported $133.2 million in cash and cash equivalents and approximately $595 million available under its $1 billion revolving credit facility, with net leverage of approximately 4x adjusted EBITDA.
First-quarter 2026 outlook and other call highlights
For the first quarter of 2026, Acadia forecast revenue of $820 million to $830 million and adjusted EBITDA of $130 million to $137 million. The outlook includes approximately $14 million of startup losses, recognition of the $11 million out-of-period supplemental payments, and an estimated $3.7 million impact from severe weather.
Additional items discussed on the call included:
- California staffing rules: Management said new nursing staffing ratio guidelines were pushed to June 1 from Jan. 31 and expects an approximately $4 million EBITDA impact embedded in guidance, driven more by higher-cost nurse mix than increased headcount.
- DSO and cash collections: Young said days sales outstanding rose year over year due to slower payments tied to finalization of certain state programs, and that cash collections are a focus with expectations for improvement in 2026.
- Value creation review: Osteen said the review is not on hold and described value creation as an ongoing effort, including a continued look at service lines, while emphasizing near-term execution in 2026.
Management framed 2026 as a year focused on stabilizing operations and improving performance across both the legacy and rapidly expanded facility base, with Osteen emphasizing accountability, faster action on operational variance, and demonstrating patient outcomes as part of the company’s relationships with payers and referral sources.
About Acadia Healthcare (NASDAQ:ACHC)
Acadia Healthcare Company, Inc (NASDAQ: ACHC) is a publicly traded provider of behavioral healthcare services headquartered in Franklin, Tennessee. Founded in 2005, the company has grown through organic expansion and strategic acquisitions to establish itself as a leading specialist in mental health and addiction treatment across the United States.
Acadia operates a diversified network of inpatient psychiatric hospitals, residential treatment centers, outpatient clinics and intensive outpatient programs.
