アカディア・ヘルスケア（ACHC）2026年第3四半期決算説明会：ガイダンス上方修正、2027年EBITDAを6000万ドル押し上げ

主要な要点

• 2026年第3四半期の売上高は前年同期比5.1%増の8億9,500万ドルとなり、連結調整後EBITDAは1億7,640万ドルに達した。
• 既存施設ベースの売上高は前年同期比5.2%増加した。これは入院患者日数の1.1%増と、患者1日当たり売上高の4.0%増が寄与した。
• アカディアは2026年通期の業績予想を3四半期連続で引き上げた。現在、売上高は34億4,000万ドル〜34億6,000万ドル、調整後EBITDAは6億1,500万ドル〜6億2,500万ドルを見込んでいる。
• 同社は4,700万ドルのフリーキャッシュフローを創出し、6,300万ドルの負債を返済した。四半期末時点の純レバレッジ比率は調整後EBITDAの約3.9倍となった。
• 経営陣は、2023年から2026年にかけて開設された施設が、2027年に2026年比で約6,000万ドルの調整後EBITDA増分をもたらすと見込んでいる。
• 通期の設備投資見通しは、主に新規（デノボ）施設や合弁施設への支出減少を反映し、2億1,000万ドル〜2億3,000万ドルに引き下げられた。

主要財務データ

事業および業務実績

急性期治療が引き続き主要な成長ドライバーとなった。急性期の売上高は、既存病院および過去4年間に開設された合弁施設や新規（デノボ）施設に支えられ、前年同期比11%増の5億2,500万ドルに達した。当四半期の急性期患者数は7.5%増加した。

入所型治療センターの売上高は、患者数の着実な増加と1日当たり売上高の上昇を反映して7%増の9,300万ドルとなった。専門治療の売上高は1億3,600万ドルとなり、施設閉鎖およびペンシルベニア州の施設に対するニューヨーク州メディケイド改定の影響を除いたノーマライズドベースでプラス成長を示した。

包括的治療センターの売上高は1億4,100万ドルで、第2四半期並みで推移した。経営陣は9月と10月に入院患者数の傾向が改善したと報告し、業務効率化とコスト削減が売上への下押し圧力の相殺に寄与したと述べた。

アカディアは第3四半期中に認可病床を220床増床した。これにはフロリダ州ジャクソンビル近郊での144床の新規（デノボ）施設開設や既存施設での76床の増床が含まれる。同社は2026年中に542床を開設した。開発計画に含まれるすべての新施設は現在稼働している。

ニューヨーク州のメディケイド制度変更により、第3四半期の既存施設売上高成長率は約1%ポイント、既存施設患者数の伸びは約2.6%ポイント押し下げられた。経営陣は、ペンシルベニア州の施設において、同州および周辺州での新たな患者紹介関係の構築を通じて、影響を受けた患者の補填が進んでいると説明した。

業績予想（ガイダンス）

経営陣は、規制当局の審査下にあるフロリダ州およびオハイオ州の追加給付拡大プログラムにより、2,000万ドル以上のEBITDA増分がもたらされる可能性があると試算している。この潜在的な寄与分は業績予想レンジには含まれておらず、承認を条件として2026年第4四半期または2027年初頭に計上される可能性がある。

2027年について、経営陣は2023年から2026年の間に開設された施設から約6,000万ドルの調整後EBITDA増分を見込んでいる。そのうち約半分は新規立ち上げ施設から、残りの半分は2023年〜2025年に開設された施設からもたらされる見通しである。

同社は、立ち上げ段階の施設による年間損失が2026年の約4,500万ドルから2027年には約1,000万ドルへ縮小すると予測している。ただし経営陣は、最近開設された施設の立ち上げが続くため、残る損失は2027年前半に偏る見込みであると注意を促した。アカディアでは通常、病床稼働率が約40%に達した時点で施設が損益分岐点に近づく。

リスクと注視すべき点

• フロリダ州およびオハイオ州の追加給付プログラムによる2,000万ドル超の潜在的なEBITDA増分については、最終承認の可否およびその時期に不確実性が残っている。
• ニューヨーク州メディケイドの変更は、ペンシルベニア州の施設の患者数、売上高の伸び、在院日数に引き続き影響を与えているが、経営陣は代替の患者紹介が想定を上回るペースで進展していると述べている。
• 立ち上げ段階の施設は第3四半期に1,200万ドルの営業損失を計上し、2026年通期では約4,500万ドルの損失を生じる見通しである。
• 売上高に対する貸倒損失および保険者による支払拒否の比率は前四半期比で安定していたものの、前年同期比では依然として約400万ドルの逆風となった。
• 政府調査関連費用およびその他の法務費用は四半期によって変動する可能性がある。同社は引き続き政府に協力しているが、解決までのスケジュールは示していない。
• 第4四半期に実施される専門業務過誤賠償責任および総合賠償責任の見直しにより、2027年の費用水準に関する同社の見通しが影響を受ける可能性がある。

アナリスト質疑応答の要点

経営陣は、アカディアの短期的な成長優先事項として、最近開設した施設での稼働率向上、既存施設での患者数拡大、コスト規律の維持を挙げた。同社の2027年計画には現在、追加の新設は含まれていないが、新規（デノボ）施設、合弁事業、既存市場での拡張機会の評価は継続する方針である。

2027年に見込まれる6,000万ドルのEBITDA増加は、立ち上げ損失を約4,500万ドルから1,000万ドルへ削減することに一部基づいている。2023年〜2025年に開設された施設は概ね損益分岐点付近にあり、さらなる稼働率および利益率の改善を通じて貢献する見通しである。

経営陣は、新設施設の稼働拡大に支えられ、入院患者日数の全体的な成長余地は引き続き3%〜4%の範囲にとどまると予想している。第3四半期の患者数の伸びは既存施設が1.6%寄与し、ニューヨーク州メディケイドの影響を除いた調整後既存施設入院患者日数の伸びは3.7%となった。

平均在院日数の短縮は、専門治療や入所型治療プログラムよりも入院期間が短い急性期サービスの構成比が高まったことを主に反映している。施設閉鎖や、入院期間が比較的長いニューヨーク州メディケイド患者の減少も影響した。

第3四半期の民間保険の構成比は20.9%で、2026年を通じて20%台前半で推移している。経営陣は前年同期比での低下について主に専門治療施設の閉鎖によるものとし、構成比は今後も現在の水準近辺にとどまると予想している。

メディケイドの就労要件について、経営陣はアカディアのメディケイド患者の約50%が対象拡大州にいると述べた。同社はメディケイド患者の大部分が免除要件を満たすと予想しており、2027年に大きな影響が出るとは見込んでいない。

決算説明会トランスクリプト全文

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決算説明会の完全なトランスクリプト

経営陣による説明

Operator

Welcome to the Acadia Healthcare Third Quarter 2026 Earnings Call.

[Operator Instructions]

I will now hand the conference over to Jason Plagman, VP, Investor Relations. Jason, please go ahead.

Jason Plagman

Thank you, and good morning. Yesterday, after the market closed, we issued a press release announcing our third quarter 2026 financial results. This press release can be found in the Investor Relations section of the acadiahealthcare.com website. Today, Debbie Osteen, Acadia's Chief Executive Officer; and David Duckworth, Interim Chief Financial Officer, will discuss the results. To the extent any non-GAAP financial measures discussed in today's call, you will also find a reconciliation of that measure to the most directly comparable financial measure calculated according to GAAP in the press release that is posted on our website. This conference call may contain forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995, including statements, among others, regarding Acadia's expected quarterly and annual financial performance for 2026 and beyond.

These statements may be affected by the important factors, among others, set forth in Acadia's filings with the Securities and Exchange Commission and in the company's third quarter news release. and consequently, actual operations and results may differ materially from the results discussed in the forward-looking statements.

At this time, I would like to turn the conference call over to Debbie.

Debra Osteen

Good morning, and thank you for joining us. I'm pleased to be with you today to discuss Acadia's results for the third quarter of 2026. Acadia delivered strong results again this quarter that were ahead of our expectations as we continue to make progress on our key operational and financial priorities. As always, Acadia is guided by our mission to provide compassionate care that improves lives, inspired hope and elevates communities. Our capabilities and the commitment of our employees allow us to stand as a leader in the behavioral health care industry through the important work we do.

During the third quarter, we continue to execute on our key priorities, providing quality patient care, expanding access so we can provide care to a greater number of patients, delivering consistent operational excellence with strong financial discipline and continuing to strengthen our leadership team throughout the company. I'm pleased to say that our positive momentum continued in the third quarter.

A few notable highlights include the following: we delivered revenue, adjusted EBITDA and adjusted EPS that were above our expectations. We generated $47 million of free cash flow and reduced our debt by $63 million during the quarter. We opened our new 144 bed de novo acute facility near Jacksonville, Florida in August. Postal Pines Behavioral Health is our fourth new acute facility opening in 2026 and our 16th since the beginning of 2023. Our revenue in the third quarter increased 5.1% compared with the prior year period, driven by solid growth in patient volumes and strong revenue per patient day.

We saw contributions to our growth from new facilities that we've opened over the last 4 years as well as from legacy facilities. Same-facility revenue growth was 5.2%, which was at the high end of our expectations. As I discussed last quarter, our team is operating with a strong sense of urgency and focus. And this has allowed us to accelerate timelines across multiple key milestones for our new facilities, including licensing, accreditation and payer contracting.

This is important because it allows us to begin to serve patients sooner as well as accelerating contracting activities with commercial payers. All of the new facilities that were in our development plans are now open. Our team's focus and dedication enabled our new JV facilities, including Orlando Health and Methods Jenny Edmonson to move through the initial accreditation and licensure processes at a record pace for Acadia and much faster than in prior years.

As we've discussed in prior quarters, we are focused on delivering more value from the investments we've made in our expanded bed capacity and the new facilities that we've opened over the last 4 years. The positive momentum we are seeing in our new facilities that we've opened in 2026 as well as in 2023, 2024 and 2025 provides us with increasing confidence and visibility in our path to delivering on the $200 million of incremental adjusted EBITDA relative to 2025 that we've discussed previously. As a result, we expect to deliver approximately $60 million of incremental adjusted EBITDA from these cohorts in 2027 compared to 2026. This outlook is supported by our expectation for continued occupancy gains and strong fiscal discipline and efficiencies.

We anticipate contributions from new facilities opened in the last 12 months as they move towards breakeven, along with continued positive momentum from facilities that opened in earlier years. Overall, we continue to see strong demand for our services. We are well positioned to meet this demand with our expanded capacity and also through our initiatives aimed at providing patients with access to the full continuum of care, including our outpatient services that facilitate clinically appropriate step-downs to partial hospitalization and intensive outpatient programs.

In addition to our strong financial performance, we are also focused on building an even stronger set of leaders across our organization through investments in internal talent development and collaboration as well as targeted additions to the team.

As an example, in August, we hosted an Executive Leadership Summit that strengthens the connections and partnership between our facility CEOs, our corporate support teams and our executive leadership team. We also continue to make meaningful progress advancing clinical quality, patient safety and patient outcomes across Acadia.

During the third quarter, we expanded our measurement-based care initiatives across additional acute and specialty facilities, strengthening our ability to use patient-reported outcomes and other clinical data to guide treatment decisions and improve care. We remain focused on leveraging technology, analytics and evidence-based practices to increase transparency into key quality metrics support continuous improvement and drive better outcomes for patients. I'm also proud to share that Geisinger Behavioral Health Center Northeast was recognized with the Joint Commission's Inaugural Care Team Award.

Joint Commission sets the standard for health care quality in the United States. And its Care Team Award was established to recognize interdisciplinary teams that demonstrate exceptional collaboration, coordination and patient-centered care. Geisinger Northeast is the first recipient of this national honor. Since opening in 2023, our team at Geisinger Northeast has built a culture where patient safety, quality and experience are at the center of every decision. We believe this award reflects Acadian's commitment to safety, teamwork and patient-centered care at Geisinger Northeast and across our entire organization.

Overall, we have made significant progress on our key priorities so far this year, driven by our strong collaboration, execution and sense of urgency. I am confident that we have the team and the capabilities in place to continue to drive Acadia forward and build on our momentum in the fourth quarter and beyond. With that, I will turn it over to David to review the financial details.

David Duckworth

Thanks, Debbie, and good morning, everyone. Looking at our third quarter results. revenue of $895 million grew 5.1% compared to last year's third quarter. Same-facility revenue in the third quarter increased 5.2% on a year-over-year basis driven by 1.1% growth in patient days and 4.0% growth in revenue per patient day.

Similar to last quarter, the impact of changes in the New York Medicaid program on our Pennsylvania facilities reduced our third quarter same facility revenue growth rate by approximately 1% and our same-facility volume growth by approximately 2.6%. Revenue in our acute business was $525 million in the third quarter and grew 11% on a year-over-year basis. We delivered strong acute volume and admissions growth in the third quarter from both legacy facilities and the new JV and de novo facilities that we've opened over the last 4 years. Specialty revenue in the third quarter was $136 million which represents positive growth compared to last year's third quarter after normalizing for facility closures and the impact of changes in the New York Medicaid program on our Pennsylvania facilities. Looking at our RTC service line.

Revenue in the third quarter was $93 million and increased 7% year-over-year, driven by steady volume growth and growth in revenue per day. In our CTC business, third quarter revenue was $141 million, which was stable with the second quarter. Demand for CTC services remains solid, and we are seeing improving admissions trends in September and October related to some of the initiatives we've launched. Additionally, over the last few quarters, we have increased our operational efficiency and reduced our cost in the CTC service line.

Moving down the income statement. Consolidated adjusted EBITDA for the third quarter was $176.4 million. On a same-facility basis, adjusted EBITDA was $228.8 million in the third quarter and grew 6.1% compared to the prior year period. In terms of supplemental payments, during the third quarter, we recognize revenue and provider taxes related to Florida for the 2026 program year, consistent with our historical practice that we discussed last quarter. Third quarter adjusted EBITDA includes an accrual of $13.4 million for expected payments for the Florida supplemental payment program year ended September 30, 2026, which compares to $5.6 million included in our previous guidance.

There may be additional contribution from the 2026 program year pending final approval. From a revenue cycle perspective, our bad debt and denials in the third quarter were stable as a percentage of revenue compared to the prior quarter. As we moved through the quarter, we saw steady advances in our revenue cycle initiatives, and we anticipate continued progress in the fourth quarter. Outside of the same facility group, our losses from startup facilities were $12 million in the third quarter, which was slightly better than the midpoint of our expectations. For closed facilities, we had less than $1 million in operating losses during the quarter.

Moving to the balance sheet and statement of cash flows, we remain in a solid financial position. Operating cash flow in the third quarter was $98 million and capital expenditures were $51 million, resulting in free cash flow of $47 million. We repaid $63 million on our debt during the quarter, and our net leverage ratio as defined in our credit agreement, stood at approximately 3.9x adjusted EBITDA at the end of the quarter.

Looking at development. We added 220 licensed beds during the third quarter, which includes the opening of a 144-bed de novo facility near Jacksonville, Florida, as well as adding 76 beds to existing facilities. In total, we've opened 542 beds in 2026. Additionally, in the CTC service line we opened 1 new clinic and closed 1 existing clinic during the quarter.

With respect to capital expenditures, following a review of our ongoing and planned capital projects, we have reduced our full year forecast for CapEx to a range of $210 million to $230 million.

Turning to our 2026 guidance. We are raising our guidance ranges based on progress made this year and our updated full year guidance now reflects revenue in a range of $3.44 billion to $3.46 billion, adjusted EBITDA in a range of $615 million to $625 million, adjusted EPS in a range of $1.70 to $1.80 and operating cash flow in a range of $375 million to $400 million. Our team continues to monitor supplemental payment programs that we believe could be approved in 2026 or early 2027. We estimate that programs in Florida and Ohio currently under regulatory review for the 2026 program years could add more than $20 million in incremental EBITDA, but we have not included those expanded programs in our guidance ranges.

I will now turn the call back over to Debbie.

Debra Osteen

Thanks, David. We've made significant progress on our key priorities so far in 2026. And our strong execution has allowed us to raise our financial guidance for the third consecutive quarter. We are confident that we have the capabilities in place to continue to drive Acadia forward and deliver additional value for our patients, our communities and our investors. And above all, our team of dedicated employees remains committed to our mission and to providing clinical excellence for our patients and the communities we serve. With that, we will now turn it over to the operator for questions.

Operator

[Operator Instructions]

Your first question comes from the line of A.J. Rice with UBS.

質疑応答

Albert Rice

Maybe thinking about where you're at in the recovery and turnaround process. I know you've made a lot of progress in this year. As you think about closing the year and going into '27, where do you think some of the best opportunities still remain for you to get the company completely back on track into a level of earnings and growth that you you think it's capable of make of developing?

Debra Osteen

Well, A.J., my goal when I returned as CEO was to position Acadia for long-term success. And part of that was strengthening the team, which I think we've done. We've refined our operational structures. We've made changes there to give more visibility and focus and I think that we've set a very clear set of priorities for the team. And as I think about our opportunities for the fourth quarter and also next year, I think we have opportunity to continue to drive volume and to ramp our facilities to realize the investments that we've made. And I believe that as the team works on those issues and also our legacy facilities that still have opportunity for occupancy and growth we're going to see not just a strong fourth quarter, but next year, I think we're very well positioned. We're maintaining discipline with our costs and our expense controls.

And along with that, I think we're working very well with payers. So I'm optimistic that we have opportunity. We've laid out the $60 million, but as we give our guidance in February, we'll talk more about other opportunities that we see.

Albert Rice

Okay. And maybe just then to -- for my follow-up, to ask about that $60 million of incremental EBITDA. It seems like the new bed capacity, the newer facilities are contributing, it sounds like more quickly than maybe you had even planned for. And I know you've laid out the contribution for next year that you expect from what you've already put in place. I wonder does it make you think about increasing the pace of new development or going back to maybe some incremental JVs? How do you think about that versus focusing on just the organic opportunity that you have?

David Duckworth

Well, A.J., we do believe the company right now with the 16 new facilities that we've added in the 4-year period and the capacity we have from that. We have just an incredible runway of growth over the next few years. As implied by the $60 million of incremental EBITDA that we outlined for next year, of course we will always be looking at new opportunities. The company has just tremendous flexibility for how we evaluate, whether it's a new facility, a new joint venture opportunity adding beds across our many markets that we're in, just our existing operations. We will continue to evaluate that, not factoring any new facilities into our plan for next year at the current time. But as we move forward, we'll continue to provide updates around that. And yes, the new facilities, the 16 that we've added over the last 4 years, they are beginning to contribute to our results.

Of course, we have had facilities in the start-up mode for several years in a row now. And so the contribution that we've seen this year from those new facilities we would just decide that for everybody, we would size at around $15 million that we've achieved thus far of the $200 million. So as we look ahead to next year, we see the pace increasing dramatically.

Part of that is just moving out of new facility losses. And it also reflects just the progress we've made, the new facilities that we've added this year are ahead of schedule in terms of how they have achieved key milestones with opening, getting license, getting through their accreditation process. We've been very pleased with that and are in a good position next year to just realize a greater portion of that $200 million opportunity.

Operator

Your next question comes from the line of Ben Hendrix with RBC Capital Markets.

Benjamin Hendrix

I just wanted to ask about the revised CapEx guidance. Are there any particular capital programs are looking less attractive that's kind of guiding your decision to kind of scale that back a little bit? Just kind of a little more detail on kind of what's driving that decision?

David Duckworth

Yes, Ben, at the moment, we do look at our CapEx plan regularly. And at the beginning of the year, of course, there was a decision already made to reduce the capital spend in terms of new facilities. That's the area where we've seen the largest adjustment, even as we've moved through the year, just looking at new facility investments, we'll continue to have maintenance and IT capital. That's just a normal part of our overall CapEx number and we will continue to have existing facility investments.

Those continue to be compelling opportunities for the company. But the reductions we've made, we would say are mostly related to de novo facilities as well as those joint venture facilities. Of course, we did still have some spending for those 2 components of our overall CapEx during 2026.

As we think ahead to next year, I think we expect further reductions in the overall capital just as we see the new facility spend that we've had this year, not recurring to next year. We'll continue to evaluate all of those capital opportunities going forward just under the disciplined framework that we have for looking at growth opportunities. But going forward, we would think existing facilities, maintenance capital and having a focus on mainly those buckets going into next year. That's the source of the reduction we've seen this year and the further reduction that we expect going into next year.

Benjamin Hendrix

Great. Appreciate that. And then kind of separately, I just wanted to follow up on the about the record licensure speed in some of the newer bed adds, newer facilities. Is that something that has to do with the way you're operationalizing the process internally? Or is that more kind of a reduction of a log jam on the regulator side.

Debra Osteen

I think it's really -- I give credit to the team. We've had a whole playbook now around licensure and all the pieces that go with that as you get all the approvals in our Medicare and Medicaid numbers. And they've done a good job of looking at who the key decision makers are. It differs by state and really mapping that out and looking at where we need to be if there are delays pushing because our patients need cater. And I think that by really focusing on each one of the facilities we've opened this year and also who those decision makers are and being willing to collaborate with our partners has made a big, big difference.

And we've been able to dramatically cut the time that it took last year as well as years before. And in some cases, it's just been remarkable how fast we've been able to get these approvals.

Operator

Your next question comes from the line of Brian Tanquilut with Jefferies.

Brian Tanquilut

Congrats on the quarter. Maybe, Dan, just to double click on that $60 million. So you said you already have recognized $15 million this year, there's an incremental $60 million next year. So when I look at your guidance and maybe adjust for PLGL and some of the DPP, I think baseline at about [ 610 ]. So we just basically add that $60 million and then assume whatever growth on the legacy portfolio to get to a right EBITDA number? Is that the way you're thinking about it?

David Duckworth

Yes. We will provide more commentary in February around our 2027 outlook, I wanted to provide the $60 million target for now because we have all the facilities open, all of them at a key point in the process where we now have more visibility. So the $60 million is a key part of the company's opportunities for next year. But we'll provide more detail in February as it relates to how that fits into our overall 2027 outlook. Of course, we've already talked about continued momentum and progress that we see even in the legacy facilities. Many of those have added beds over the last few years. So there's other sources of opportunity for the company going into next year. And we'll provide more commentary as well around the supplemental programs we did have during our first quarter and our second quarter a couple of out-of-period of items, $11 million in Q1, $26 million in Q2 for Ohio and Florida, respectively. So that's something to just keep in mind as we go into next year, but we also have, as we mentioned earlier, some upside around what we've recognized thus far for 2026 and what we ultimately think we might get, which is more than $20 million of upside. Don't have certainty right now as to whether that will be a fourth quarter item or early next year, but a positive there as we think about the final potential approval in those programs. More to come in February though, Brian.

Brian Tanquilut

Got it. Okay. And then as I look at the revenue that we reported for CTC and specialty, it looks like it's been flat sequentially. So do you guys think that we're now bottoming out or we're stabilizing and that this is the right baseline to inflect from and grow these businesses from?

Debra Osteen

I'll just -- we are seeing improving admission trends in September and October, and it's related to some of the initiatives that we put in place, we still feel like there is a strong demand for the services. And I think it's 16% of our total revenue and we're in 33 states. So we're going to see variances there from time to time. But the team is very focused on looking at making sure we're providing access for those who need the CTC services, but then also the patient experience. And I think that it's making a difference. So we are, as you said, stable sequentially. And going forward, we're looking at each region really that we're in across those 33 states. And we have plans that are more detailed around those regions, which is, I think, the right way to look at it.

Operator

Your next question comes from the line of Pito Chickering with Deutsche Bank.

Pito Chickering

Can you remind us of the timing is on when you do PLGL checks. They are going to cause increases or decreases to those assumptions. As you look at number of lawsuits, the size and scale today versus a few years ago, is it possible that these expenses start to reverse? And when could that occur? And any color on the legal settlement on the gain that occurred [indiscernible]

David Duckworth

Yes. Pito, the timing of our PLGL review, we talked about moving -- as we moved into 2026, a more frequent review. We did complete the midyear review during our second quarter, and we will have another review in the fourth quarter. And so that's the frequency and the updated timing around the reviews that we've had in place this year. We'll have more commentary once we go through that fourth quarter review as to our expectations for the 2027 expense. And in terms of the legal settlement that I think you're asking about on our line item, we did have a positive gain that was from, as we disclosed in our 10-Q, that was from our derivative lawsuit settlement. So I think you're probably asking about that $7 million gain on our P&L, added back is not included in our adjusted EBITDA results, but related to a derivative settlement that we had disclosed.

Pito Chickering

Okay. Great. And then a follow-up question to Brian's CTC questions. Just can you size a number of new patients to coming to clinics versus a year ago. Any view on medications like buprenorphine versus methadone. And just can you about -- can it, sort of, be a growth category again going forward? Or is it just sort of more untreated there less of you [indiscernible] as doctors are trying to actively [indiscernible].

Debra Osteen

Yes, Peter, we currently give both of those medications, but methadone is by far -- it's considered the gold standard and 90% of our patients received that. But we want to meet the patient needs and so we're able and prepared if a patient and a physician decides that they need not methadone, but another medication. We're able to dispense that. We're -- part of what I mentioned a minute ago on patient experience is just making sure they're coming to us for help with their addiction, and we want to make sure that, that medication fits their needs. So I think that both have been around for years, but we're able to do both. We just think that methadone is considered the gold standard as we think about those that need that kind of care.

David Duckworth

And in terms of, Pito, the number of patients, as we've expanded and added de novo clinics, I think we've seen and the industry has seen just a lesser number of patients being served by clinic which has just been a positive in terms of access to care, more people getting treatment. But where we stand today, there's still, unfortunately, a small percentage of patients that are getting treated today that need treatment.

So we do think there are growth tailwinds for this business as we think about the strength of the service line, the diversification our geographic profile today, but also where there still is in need across the country. So it's stable. We've actually seen improved admission trends, as we mentioned earlier, just in the last couple of months. And the team has been able to, just with some revenue, challenges in certain of our markets. The team has been able to manage very well with operational efficiencies and a reduced cost structure. So operationally, the team is doing a great job, and we do think there are growth opportunities in that service line.

Operator

Your next question comes from the line of Matthew Gillmor with KeyBanc Capital Markets.

Matthew Gillmor

On the bad debt and payer denial topic, the year-over-year pressure moderated in the third quarter, but I think some of that may have just been due to an easier comp. I was curious if there's any additional comments to make just in terms of the underlying activity and sort of what level of pressure do you expect year-over-year going forward?

David Duckworth

Well, we have -- we've seen just steady progress and are pleased with the team and the tools that we've deployed over the course of the last year related to our revenue cycle initiatives. Have been encouraged to see stability sequentially. As we just look at our bad debt and denials on a percentage of revenue basis, especially comparing to the first part of the year. And you're right. I think the year-over-year headwind moderation that we've seen going down is as much about the comp and the trend that we saw in 2025, but also reflects stability that we've seen throughout 2026.

And I think it's even more impressive, the result that we've seen just as you think about it on a percentage of revenue basis, our $4 million that we highlighted on our slides, which is our year-over-year headwind. A significant portion of that, more than half of that is just revenue and volume growth in our business. The other part is a slight uptick in the percentage of revenue. So it is -- it is down to being in our minds, just a very nominal level of a year-over-year headwind and an opportunity for the company as we move forward. We'll continue to advance our revenue cycle initiatives, what we're doing as a team to deploy new tools and to front-end documentation positioning for continued improvement as well as how we just intervene quickly and manage every aspect of our revenue cycle, which is a greater sense of urgency and closer monitoring in terms of what's happening across our markets. So pleased with the stability that we've seen and hopefully, we'll see further opportunities as we move forward.

Debra Osteen

And I'll just add, we are -- we're rolling out technology and analytic tools in this area just to help our team identify the trends earlier and to intervene, as David said more quickly. The team is very focused on kind of the back to basics, which is making sure that our documentation reflects the acuity of the patient that's in our care. And so we've tried to approach it by what is our part here, but then also, particularly with denials, making sure that we vigorously appeal those because with medical necessity, our patients are acute and across all service lines, they need our care. So it's up to us to make sure we're able to reflect that acuity to document that. But then also to work with our payers in a collaborative way, but also to be aggressive to make sure that we're getting paid for what we do.

Matthew Gillmor

That's great. And then on the New York Medicaid issue, I wanted to see if there was any additional details to share with respect to backfilling those facilities and conversations with other referrals versus across the state?

Debra Osteen

I think the team has done just a great job of replacing patients. As you know, we still had some new or patients in our Pennsylvania facilities in the first quarter and second quarter, we had no New York patients. We've been able to be successful in developing new referral relationships in states that are surrounding Pennsylvania. But we've also seen an increase in referrals from Pennsylvania. So it's still a work in progress because it was a pretty large number of patients, but they are exceeding our expectations as far as what they've been able to replace. But we're very focused on that and still in dialogue with New York. And we know that there are referral sources in New York that would like to use our facilities. So we're making sure that New York understands that.

Operator

Your next question comes from the line of Jason Cassorla with Guggenheim.

Unknown Analyst

This is [indiscernible] on for Jason. First of all, congrats on a solid quarter. So I have a question -- I have a question on length of stay. So length of stay declined 5.1% this quarter and last quarter. So just wondering what's driving the shorter lengths of stay? And actually how you should think about length of stay into like 2027?

David Duckworth

Understood. Okay. It's a function -- and we've talked about this over the last several quarters as our service mix has changed to reflect a greater number of acute facilities and acute volume. Our length of stay naturally declining due to service mix, a greater mix of those acute beds relative to a longer length of stay for our specialty as well as our RTC business. And I think we'll continue to see that trend as the $200 million opportunity that we talk about is achieved. Those are acute facilities. The JV and de novo facilities that represent those 16 facilities are all acute facilities. So we will continue to see service mix reflected in certain metrics, especially the length of stay metric.

Debra Osteen

And I'll just add back to New York. Those patients paid a much longer length of stay. And also some of the closures that we've done in our specialty area, they had a longer length of stay. So that does impact the number as well as the acute mix that David talked about.

Unknown Analyst

Okay. That's very helpful. A second question, like you just mentioned that your legacy facilities still have opportunity for growth and efficiency. I'm just wondering like how much incremental volume growth and efficiencies you can possibly drive from legacy facilities later.

David Duckworth

Well, for the company, our legacy facilities have always focused on growing their programs and the services that they provide within the markets. And we're now in a greater number of markets and have an even stronger footprint than we've had in years past. So we feel like those opportunities to grow in our existing markets will continue to be there for the company. The beds that they've added over the last few years, we think give them the opportunity to increase the occupancy from where we see it today. So just as we've seen strong performance from those legacy facilities, 1.6% volume growth during the third quarter, we think there's continuing opportunities especially as we just continue to evaluate services that we provide and whether we can expand within our existing markets.

Debra Osteen

And I'll say that the team has done a a good job of really looking at our legacy facilities and those that might be underperforming, they are looking at detailed plans around what are the issues. What is -- what can we do to problem solve those issues and making sure patients have access to our facility and it's -- they are able to access it in a timely way looking at the expense structure that's within the facility. So they've really -- each facility has more visibility, I think, than they've ever had and just how do we improve those that might be underperforming. But then as David mentioned, how do we grow those that still have capacity.

Operator

Your next question comes from the line of Andrew Mok with Barclays.

Andrew Mok

Admissions growth accelerated to roughly 6.5% this year, but the patient day growth remains in the low single digits across your legacy and ramping facilities. One, could you give us -- can you talk about the sources of strength on admissions? And two, given all the mix effects on length of stay that you just talked about, can you give us a sense of what patient day growth looks like within the acute inpatient business?

David Duckworth

Yes, Andrew, in that admissions metric is a similar dynamic to what we just talked about around length of stay where our acute facilities do have a greater number of admissions, just with a shorter length of stay, greater number of admissions relative to other service lines. And so we see that reflected in the relationship between the admissions and the patient days that we report for the overall company.

Within patient days, the acute business has performed very well this year, seeing very strong demand and inquiry growth within that business and our volumes within the acute service line increased 7.5% during the quarter. So they are having a great year just tremendous momentum in the legacy facilities as well as those new facilities going into next year.

Andrew Mok

Great. If I could just follow up on commercial mix. It finished at 20.9% this quarter, which is down nearly 400 basis points and more than 10 percentage points below the high of 2022. Can you give us -- can you help us understand how you're thinking about the progression of commercial mix over the next 12 to 18 months? And where does specialty fit now in like the broader strategy?

David Duckworth

Well, the change that we see year-over-year, we've been stable at that lower level in the low 20s for commercial throughout the year. And the change year-over-year reflects the closures that we had within the specialty service line. That is where we see, especially in certain of our specialty facilities and the ones that we closed. That's where we saw a greater commercial mix and I think it would settle out around where we have it today, just as it's been stable throughout this year.

The specialty service line has had a great year and has grown their revenue if you adjust for the headwinds that we've called out between New York Medicaid as well as some of the closures that we've had. That business line is performing very well as we move through the year and is -- it is an important service line for the company moving forward.

Operator

Your next question comes from the line of Anne Heinz with Mizuho.

Ann Hynes

Great. Just on the One Big Beautiful Bill. Can you remind us how you view your exposure as the work requirements going to effect next year? And can you remind us how many of your Medicaid patient days are in expansion states.

Debra Osteen

About 50% of our Medicaid patients are in expansion states. And I'll let David -- I don't think that -- next year, we don't see much impact from the Big Beautiful Bill. We -- when we look at the work requirements and other parts of that bill, we don't feel that our patients are going to be significantly impacted. We believe that the vast majority of our Medicaid patients will be exempt from those work requirements.

And as we've watched some of the states and how they've set out the -- how it's going to work within each state, there is a process where the patient would be able to attest that they have the medical frailty and we hope that all the states will look at how to make it as streamlined as possible, but we're also prepared to work with our patients to help them and I do think that overall, we're not going to see the impact that perhaps other areas of health care might see with that requirement.

Ann Hynes

Okay. Great. And then just the $60 million for next year, can you give us some key assumptions that you think those hospitals will achieve medium like capacity? What capacity on hours are they running at now, and what capacity do they have to reach next year to get to that $60 million of EBITDA positive?

David Duckworth

Yes, sure, Ann. And it really depends. All of those 16 facilities in this over a 4-year period. So they are in a different point in time within their start-up processes. And they all have a different target for next year. And even that target that they have depends on factors other than how long they've been open. For example, a larger facility may have a little more time to reach the occupancy target that we think it will ultimately reach where a smaller facility can often ramp up more quickly.

But in general, a key part of the $60 million is the start-up losses that we've incurred this year and the progress that we can make on just getting those facilities not only ramped up to a breakeven occupancy level, which for us is usually around 40% is where we start to see that breakeven opportunity, but also just manage the cost structure that we have for those facilities as they ramp up to that occupancy level.

So a key part of the $60 million in our minds is the $45 million of current year operating losses for those start-up facilities going away, especially as we move from the beginning of the year to the later part of the year, but the facilities that have been opened longer than that have a contribution to make as well.

About half of the $60 million is from the start-up facilities or the new facilities with the other half being the older facilities within the cohort, call it, the 23 to 25 openings that we've done, which also are at a really good point where they're breaking even today for the most part and now have the opportunity to continue to make gains around occupancy and margins.

Operator

Your next question comes from the line of Whit Mayo with Leerink Partners.

Benjamin Mayo

Yes, I just wanted to follow up for some of that last question, a clarification of this. Are you assuming that the $45 million of start-up losses completely goes away next year?

David Duckworth

Yes, our preliminary math is that we think that we can get it down from about $45 million to around $10 million. But as you think about that and plan for your quarterly modeling of that, obviously, where we are beginning of the year, the beginning of 2027 is very different from where we think we can end the year just with where the newer facilities are today, 2 facilities opened in June, 1 in our last facility opened in August. So as we end the year, start next year, we'll see a greater weighting and quarterly spread of that $10 million into the first part of the year and expect for those facilities to make significant progress over the course of the year, but a reduction from $45 million to $10 million is our projection that's incorporated into that $60 million projection.

Benjamin Mayo

Okay. And I thought I heard in the prepared comments, David, you mentioned something about some expense or cost action that you took in the CTC segment. Any way to frame or size what the annualized savings is?

David Duckworth

Well, in our minds, it's just operational focus and execution, especially in the markets that have underperformed slightly relative to our expectations this year. But even across other markets, being able to drive efficiencies and make some cost reductions to make sure that the impact to the company of the revenue performance that we've seen is mitigated. And that from a earnings perspective that -- and it's 16% of our revenue, and then they've been able to manage through the revenue performance very well from a cost perspective. And so the earnings impact just with those 2 dynamics has really helped to mitigate the revenue performance that we've seen. So it's not something we would really quantify as incremental cost savings as much as it is an ability of that team to be able to manage their cost structure based on what they see operationally.

Debra Osteen

And I'll just add with -- part of it also is just looking at how we're set up by region and how we have the organization structure, who's -- if we have a regional person, are there ways to combine that structure and we've had a lot of growth, as I think everyone knows and some acquisitions. So really just making sure that we have the right leadership structure in place and it's been part of what the team has looked at. And I just have to give them a lot of credit. They've been very proactive with this area, and I think it's made a big difference.

Operator

Your next question comes from the line of Ryan Langston with TD Cowen.

Ryan Langston

Debbie, I'd be interested if you had any initial thoughts on this week's election cycle and maybe how that might not only impact Acadia, but maybe just the behavioral health industry overall.

Debra Osteen

Sure. I mean, I think both parties recognize the need to protect and expand access to benavioral health and substance use care. Over my career in behavioral health, and I had a leadership role at one point on the NABH Board. I always believe and I know that many -- NABH believes this, it's always important to work with both parties and to bring visibility. And I do think that we're going to remain a priority at both the state and the federal level. We have so much demand for our services, and there is, I think, a recognition with both parties that access to care is a challenge in part of the country. So we're going to -- we will be engaging constructively with Democrat and Republican leadership and as well at the state level where we think it's important for them to know what we do and we often invite them to come to our facilities to see what we're doing and how we're serving patients.

We think that's important. And our Chief Strategy Officer was appointed earlier this year to the HHS and CMS Healthcare Advisory Committee. And so they are looking at how to shape and improve and strengthen health care. So we have a voice there. Again, I think both parties understand the importance of what we do.

Ryan Langston

Great. And then just maybe an update on staffing and hiring. Anything in particular you'd call out in terms of trends and maybe how recruiting is progressing at the newer facilities you've recently opened?

Debra Osteen

Well, we utilize a centralized approach in many of the positions, particularly CEOs, but also RNs. And if we find that there's -- whether it's be a therapist or social worker that is being -- is difficult to recruit for, we use our centralized team. And they have done a very good job of making sure that when they have visibility around openings that they're filling those positions. And it varies by market, but that's not really been -- there may be a few exceptions, a gating item to really building volume. So in many -- in almost all of our markets, we've been able to get the staff in a timely way and also with the idea of retaining them, there's a whole effort going on right now within the company on retention and how we onboard staff and making sure they understand their roles. So I would say the labor trends are stable, and we've been able to find the individuals we need to staff the new facilities.

Operator

Your next question comes from the line of Joanna Gajuk with Bank of America.

Joanna Gajuk

So I guess, maybe first on just follow up on the discussion around the core business growth, which I know you're not prepared now to give us guidance for next year. But in terms of just 1 element, same-store volumes, right? So they're tracking call it by 1% this year, but there's obviously that [indiscernible] headwind here. So the question is essentially, what do you think the sustainable same-store facility volume growth could be once you overcome the New York issue? And really, can you grow 2%, call it, plus next year from this legacy facilities? And also what level of volume growth you need to get operating leverage?

David Duckworth

Well, yes, Joanna, if you look at our reporting throughout this year, obviously, the same facility patient day metric is affected by the New York items that we've highlighted. If you adjust for that, the Q3 patient day growth was 3.7% and and a key driver of that is, of course, the new facilities and the progress we've made there, but also legacy facilities contributed 1.6% to that 3.7%. We're not going to size today our expectation for those legacy facilities going into next year, but I think that they do have growth opportunities and think that the -- just the impact from that $60 million that I know we've been talking about throughout the call, but the impact from those facilities should continue to drive that overall patient day growth opportunity to continue to be in that 3% to 4% range. But we'll provide more detail around that in February.

Joanna Gajuk

Great. And if I may, a different topic, the government investigation related cost down a lot year-over-year, but it's still like $18 million in this quarter. Is there anything about the current pace of activity with DOJ or SEC that maybe changes how we should think about legal spending next year or maybe potential resolution timing?

Debra Osteen

I mean, it's going to vary, Joanna, by quarter. I wouldn't read anything into that. We're still working in collaboration, cooperating fully with the government. And so we wouldn't have any other comment there. But it's going to vary, and there's other legal expenses in there as well. So I wouldn't read too much into it.

Operator

Thank you. There are no further questions at this time. I will now turn the call back to Debbie Osteen, CEO, for closing remarks.

Debra Osteen

Thank you for your time this morning and for your interest in Acadia Healthcare. Please feel free to contact us if you have any additional questions, and have a good day.

Operator

This concludes today's call. Thank you for attending. You may now disconnect.