Acadia Healthcare Raises 2026 Outlook as Q3 Revenue Grows 5%

Acadia Healthcare Company Inc. raised its full-year 2026 outlook after third-quarter revenue increased 5% and operating cash flow rose 34%, supported by growth in acute inpatient psychiatric facilities and existing operations. Adjusted earnings per share declined, however, as startup losses, higher professional and general liability costs, and other operating pressures offset part of the underlying growth.

Revenue for the quarter ended September 30 rose to $895 million from $852 million a year earlier. Adjusted EBITDA increased 2% to $176 million, while adjusted diluted EPS fell 17% to $0.60 from $0.72. GAAP net income attributable to Acadia declined to $34.5 million from $36.2 million.

Operating cash flow increased to $98 million from $73 million. Capital expenditures fell to $51 million from $136 million, reflecting a sharp reduction in growth spending, and free cash flow—defined by the company as operating cash flow less total capital expenditures—improved by $110 million to $47 million.

Acute facilities drive revenue growth

Acute inpatient psychiatric facilities generated revenue of $525 million, up 11% year over year, making them the largest source of growth. Residential treatment center revenue increased 7% to $93 million. By contrast, specialty treatment facility revenue declined 8% to $136 million, while comprehensive treatment center revenue fell 2% to $141 million.

Same-facility patient days increased 2.1%. Facilities opened from 2023 through 2025 contributed 1.1 percentage points of growth, while legacy facilities added 1.6 points. New York Medicaid restrictions reduced the overall result by 2.6 points. Acadia said the restrictions and related administrative practices limit certain beneficiaries from receiving treatment outside New York, affecting specialty facilities in Pennsylvania near the state border.

Same-facility revenue per patient day rose 4.0%, including 3.3% underlying rate growth and a 1.1% benefit from mix. Bad debts and claim denials reduced the measure by 0.4 percentage points.

Acadia’s revenue bridge showed approximately $56 million of core same-facility growth and $11 million from facilities operating for less than one year and other portfolio changes. Those gains were partly offset by about $8 million related to New York Medicaid, $4 million from bad debts and denials, and $11 million from facility closures.

Adjusted EBITDA benefited from about $34 million of core growth. Offsetting factors included roughly $12 million of startup losses, $11 million of higher professional and general liability expense, $6 million related to New York Medicaid, $4 million from bad debts and denials, $2 million of corporate general and administrative costs, and the effect of closures.

Expansion continues as spending remains disciplined

The company added 220 licensed beds during the quarter, including a 144-bed de novo facility near Jacksonville, Florida, and 76 beds at existing locations. Acadia expects approximately 550 gross bed additions in 2026, with estimated net additions of 289 after accounting for 251 recent closures associated with New York Medicaid and other factors.

Management expects facilities opened from 2023 through 2026 to generate approximately $60 million of incremental EBITDA in 2027 compared with 2026. At full maturity, the company estimates those de novo and joint-venture cohorts represent a $200 million incremental EBITDA opportunity relative to 2025.

Gross debt stood at $2.4 billion at September 30, while net debt was $2.25 billion under the company’s credit-agreement calculation. Cash and cash equivalents totaled $163 million. Net leverage was approximately 3.9 times trailing 12-month adjusted EBITDA, and Acadia expects the ratio to end 2026 between 3.6 and 3.8 times.

Full-year outlook raised

Acadia now expects 2026 revenue of $3.44 billion to $3.46 billion, compared with its July range of $3.40 billion to $3.45 billion. The company increased its adjusted EBITDA outlook to $615 million to $625 million from $590 million to $615 million and raised adjusted EPS guidance to $1.70 to $1.80 from $1.45 to $1.60.

The operating cash flow forecast increased to $375 million to $400 million from $350 million to $400 million. Acadia reduced its capital expenditure guidance to $210 million to $230 million from $235 million to $255 million.

The outlook assumes same-facility patient-day growth of 1% to 2%, same-facility revenue per patient day growth of 2.5% to 3.5%, and startup losses of $45 million to $47 million. It also incorporates depreciation and amortization of $203 million to $208 million, interest expense of $148 million to $153 million, stock compensation expense of $35 million to $40 million, and an approximately 26% tax rate.

Acadia cautioned that its outlook remains subject to payment reductions or delays from government and commercial payors, claim denials, patient incidents, investigations, litigation and regulatory action. Other disclosed risks include changes to Medicaid financing and eligibility requirements, integration and execution challenges related to new facilities, cybersecurity disruptions, labor and supply-chain cost pressures, weaker patient volumes, and the company’s ability to generate enough cash to service debt and fund operations and capital expenditures.