Acadia Healthcare Announces Fourth Quarter and 2025 Results
FRANKLIN, Tenn.--( BUSINESS WIRE)--Acadia Healthcare Company, Inc. (“Acadia” or the “Company”) (NASDAQ: ACHC) today announced financial results for the fourth quarter and year ended December 31, 2025.
Fourth Quarter 2025 Results
Full Year 2025 Results
Full Year 2026 Financial Guidance
Adjusted net income attributable to Acadia, Adjusted EBITDA, and Adjusted earnings per share are non-GAAP financial measures. A reconciliation of non-GAAP financial measures in this press release begins on page 11.
“Our results for the fourth quarter reflect improved volume growth with year-over-year revenue growth of 6%,” said Debbie Osteen, Chief Executive Officer of Acadia. “While we work to address the ongoing challenges affecting our business, my key priorities as CEO are to bring steady leadership, reinforce operational discipline, and help position the Company for long-term success. I have great confidence in our teams and in the long-term strategic direction of the Company, and I am fully committed to supporting Acadia through this next phase of execution and operational improvement.”
Fourth Quarter Financial Summary
(dollars in millions, except per share amounts)
2025
2024
Change (%)
Acute Inpatient Psychiatric Facilities
$451
$409
10%
Specialty Treatment Facilities
$136
$141
(4%)
Comprehensive Treatment Centers
$144
$137
5%
Residential Treatment Centers
$90
$87
3%
Total Revenue
$821
$774
6%
Reported Net (Loss)/Income
($1,178)
$33
NM
Adjusted EBITDA
$100
$153
(35%)
Diluted Earnings per Share
($13.02)
$0.35
NM
Adjusted Diluted Earnings per Share
$0.07
$0.64
(89%)
Discussion of Fourth Quarter Results
Acadia reported fourth quarter revenue of $821.5 million, an increase of 6.1% year-over-year. Same-facility revenue increased 4.4%, driven by a 3.1% increase in patient days and a 1.3% increase in revenue per patient day. Same-facility admissions increased 2.5% compared to the prior-year period. Revenue exceeded the high end of the Company’s implied fourth-quarter guidance, primarily a result of improved volume growth during the quarter. Facilities closed over the last twelve months represented a 2% drag to reported revenue growth in the fourth quarter.
Acute inpatient psychiatric facility revenue was $451 million, an increase of 10% over the prior year’s fourth quarter. Fourth quarter acute inpatient volumes increased 6%, driven primarily by expanded capacity from both new and existing facilities.
Specialty treatment facility revenue was $136 million, a decrease of 4% compared to the prior year’s fourth quarter. The year-over-year decline was primarily driven by the closure of specialty facilities, which represented a 7% headwind to specialty facility revenue growth in the fourth quarter.
Comprehensive treatment center (“CTC”) revenue was $144 million, an increase of 5% compared to the prior year’s fourth quarter. Residential treatment center (“RTC”) revenue of $90 million increased by 3% compared to the prior year’s fourth quarter.
Total operating expenses were $728 million for the fourth quarter of 2025, an increase of 15% over the prior year’s fourth quarter. Total operating expenses include a $52.7 million adjustment to the Company’s reserve for PLGL costs and a $5 million increase in provider taxes related to state Medicaid supplemental payment programs. Excluding these items, total operating expenses increased 6% over the prior year’s fourth quarter.
Salaries, wages and benefits increased by 8% primarily due to new facility openings, which generally run net loss positions as occupancy builds, as well as routine annual wage increases. On a per-patient-day basis, total salaries, wages and benefits increased by 4%. Same-facility salaries, wages and benefits increased by 5%. On a per-patient-day basis, same-facility salaries, wages and benefits increased by 2%.
Other operating expenses were $176 million in the fourth quarter, a $58 million increase over the prior year’s fourth quarter. As previewed on December 2, 2025, other operating expenses for the fourth quarter included a $52.7 million adjustment to the Company’s reserve for PLGL costs recognized during the fourth quarter of 2025 following the Company’s annual third-party actuarial review. With this adjustment, the Company has a net PLGL reserve on its balance sheet of $153.0 million as of December 31, 2025, compared with $78.2 million as of December 31, 2024. Full-year 2025 other operating expenses include $115 million in PLGL expenses compared to $54 million in the prior year, representing a year-over-year increase of $61 million.
Adjusted EBITDA for the quarter was $99.8 million, compared with $153.1 million in the prior-year period, primarily reflecting the impact of higher PLGL expenses.
Interest expense was $38 million in the fourth quarter of 2025, compared to $30 million in the fourth quarter of 2024. The increase was primarily driven by increased borrowings.
Legal settlements expense of $147 million primarily consists of the cost to settle the 2019 securities litigation, net of expected insurance recoveries, as previously disclosed on the Company’s Current Report on Form 8-K filed on November 10, 2025.
Loss on impairment was $1,006 million for the fourth quarter of 2025, compared to $6 million in the fourth quarter of 2024. The non-cash impairment charge included a $996.2 million goodwill impairment charge.
Transaction, legal and other costs were $25 million for the fourth quarter of 2025, compared to $30 million in the fourth quarter of 2024. Transaction, legal and other costs includes the cost of government investigations, which was $12 million for the fourth quarter of 2025 compared to $39 million in the third quarter of 2025 and $25 million in the fourth quarter of 2024.
Development Activity
The Company added 37 beds to existing facilities in the fourth quarter, bringing the total to 311 beds added to existing facilities for the full year 2025.
The Company added 144 beds from newly constructed facilities in the fourth quarter, with a total of 778 beds added in full year 2025.
In December the Company commenced operations at 144-bed ECU Health Behavioral Health Hospital, the Company’s joint venture facility with ECU Health in Greenville, North Carolina, and one of North Carolina’s premier healthcare delivery systems. The hospital offers comprehensive inpatient and intensive outpatient programs for people in need of behavioral health services.
In addition, Acadia added one new CTC, bringing the total to 15 CTCs added for the full year 2025, extending the Company’s market reach to 178 CTCs across 33 states, treating approximately 76,000 patients daily in this critical area of care.
Cash and Liquidity
As of December 31, 2025, the Company had $133.2 million in cash and cash equivalents and $595 million available under its $1.0 billion revolving credit facility. As of December 31, 2025, Acadia’s net leverage ratio was 4.0x adjusted EBITDA.
2026 Financial Guidance
Acadia is providing financial guidance for full year and first quarter 2026 as follows, subject to the assumptions described below:
2026 Guidance Range
Revenue
$3.37 to $3.45 billion
Adjusted EBITDA
$575 to $610 million
Adjusted earnings per diluted share
$1.30 to $1.55
Capital expenditures
$255 to $280 million
The Company’s full-year guidance includes the following assumptions:
Same-facility volume growth is anticipated to be in the range of 0% to 1%. This growth is expected to be driven primarily by improved occupancy at ramping facilities, offset in part by an approximate 350 basis point headwind from certain Pennsylvania specialty facilities following changes in New York Medicaid policy regarding the provision of care at out-of-state facilities.
Same-facility revenue per patient day growth is expected to be in the range of 2% to 3%.
Startup losses are expected to be in the range of $47 to $53 million, compared to $56 million in 2025. Startup losses represent the anticipated net operating loss for new facilities opened over the previous twelve months and, to a lesser extent, preopening costs associated with facilities expected to open in future periods.
The change in New York Medicaid policy regarding the provision of care at out-of-state facilities is anticipated to have a $25 to $30 million negative impact on adjusted EBITDA versus the prior-year period.
A decrease of $15 to $20 million in existing Medicaid supplemental payments, net of provider taxes. As previously discussed, full year 2025 net supplemental payments included approximately $28.5 million in out-of-period benefit to adjusted EBITDA from the state of Tennessee. Guidance does not assume any benefit from potential new or expanded supplemental programs that have yet to be approved by the Centers for Medicare & Medicaid Services (CMS). The Company is currently monitoring certain potential new and expanded programs which is estimated to represent at least a $22 million annual run rate benefit to adjusted EBITDA, if approved.
Additional Assumptions:
First Quarter 2026 Guidance Range
Revenue
$820 to $830 million
Adjusted EBITDA
$130 to $137 million
Adjusted earnings per diluted share
$0.25 to $0.30
The Company’s first quarter guidance includes the following assumptions:
The Company’s adjusted EBITDA and adjusted earnings per diluted share guidance does not include the impact of any future acquisitions, divestitures, transaction, legal and other costs or non-recurring legal settlements expense.
Conference Call
Acadia will hold a conference call to discuss its fourth quarter financial results at 8:00 a.m. Central Time/9:00 a.m. Eastern Time on Wednesday, February 25, 2026. A live webcast of the conference call will be available at www.acadiahealthcare.com in the “Investors” section of the website. The webcast of the conference call will be available for 30 days.
About Acadia
Acadia is a leading provider of behavioral healthcare services across the United States. As of December 31, 2025, Acadia operated a network of 277 behavioral healthcare facilities with over 12,500 beds in 40 states and Puerto Rico. With approximately 25,000 employees serving more than 84,000 patients daily, Acadia is the largest stand-alone behavioral healthcare company in the U.S. Acadia provides behavioral healthcare services to its patients in a variety of settings, including inpatient psychiatric hospitals, specialty treatment facilities, residential treatment centers and outpatient clinics.
Forward-Looking Information
This press release contains “forward-looking statements” within the meaning of Section 27A of the Securities Act of 1933, as amended, and Section 21E of the Securities Exchange Act of 1934, as amended (the “Exchange Act”), including statements related to our strategy, growth, and anticipated operating results for future periods. Generally, words such as “may,” “will,” “should,” “could,” “anticipate,” “expect,” “intend,” “estimate,” “plan,” “continue,” and “believe” or the negative of or other variation on these and other similar expressions identify forward-looking statements. These forward-looking statements are made only as of the date of this press release. We do not undertake to update or revise the forward-looking statements, whether as a result of new information, future events or otherwise. Forward-looking statements are based on current expectations and involve risks and uncertainties and our future results could differ significantly from those expressed or implied by our forward-looking statements. Factors that may cause actual results to differ materially include, without limitation, (i) potential difficulties in successfully integrating the operations of acquired facilities or realizing the expected benefits and synergies of our facility expansions, acquisitions, joint ventures and de novo transactions; (ii) Acadia’s ability to add beds, expand services, enhance marketing programs and improve efficiencies at its facilities; (iii) potential reductions in payments received by Acadia from government and commercial payors, including because of the significant changes to Medicaid financing mechanisms introduced by the One Big Beautiful Bill Act (“OBBBA”) enacted on July 4, 2025; (iv) the occurrence of patient incidents, governmental investigations, litigation and adverse regulatory actions, which could adversely affect the price of our common stock and result in substantial payments and incremental regulatory burdens; (v) the risk that Acadia may not generate sufficient cash from operations to service its debt and meet its working capital and capital expenditure requirements; (vi) changes in expectations resulting from actuarial and other reviews of the Company’s liability reserves and other aspects of its business; (vii) potential disruptions to our information technology systems or a cybersecurity incident; and (viii) potential operating difficulties, including, without limitation, disruption to the U.S. economy and financial markets; reduced admissions and patient volumes, including, without limitation, due to OBBBA’s introduction of work or community engagement requirements in the Medicaid expansion population; increased costs relating to labor, supply chain and other expenditures; changes in competition and client preferences; and general economic or industry conditions that may prevent Acadia from realizing the expected benefits of its business strategies. These factors and others are more fully described in Acadia’s periodic reports and other filings with the Securities and Exchange Commission.
Acadia Healthcare Company, Inc.
Three Months Ended December 31,
Year Ended December 31,
2025
2024
2025
2024
$
821,459
$
774,238
$
3,312,769
$
3,153,963
460,846
425,597
1,820,703
1,691,024
48,329
47,470
195,475
189,706
30,761
28,560
118,047
112,713
12,020
11,720
48,022
47,861
176,105
117,888
553,308
440,788
45,754
39,541
189,249
149,595
37,925
30,071
138,864
116,368
—
—
1,269
147,462
—
150,966
—
1,006,440
5,817
1,007,892
17,276
—
—
(8,715
)
—
25,214
29,566
163,630
46,753
1,990,856
736,230
4,378,710
2,812,084
(1,169,397
)
38,008
(1,065,941
)
341,879
7,843
4,479
25,982
77,395
(1,177,240
)
33,529
(1,091,923
)
264,484
(279
)
(914
)
(10,849
)
(8,872
)
$
(1,177,519
)
$
32,615
$
(1,102,772
)
$
255,612
$
(13.02
)
$
0.36
$
(12.16
)
$
2.79
$
(13.02
)
$
0.35
$
(12.16
)
$
2.78
90,442
91,769
90,705
91,621
90,442
91,986
90,705
92,059
December 31,
2025
2024
$
133,242
$
76,305
440,604
365,339
240,293
135,848
814,139
577,492
3,111,212
2,853,193
1,296,342
2,264,851
96,672
70,003
2,528
20,964
134,005
118,369
72,550
52,043
$
5,527,448
$
5,956,915
$
28,438
$
76,816
150,403
232,704
188,638
155,426
21,160
25,462
136,555
87,511
525,194
577,919
2,471,529
1,880,093
66,605
83,946
121,961
101,828
201,607
122,298
3,386,896
2,766,084
191,592
117,116
905
918
2,713,896
2,685,464
(765,841
)
387,333
1,948,960
3,073,715
$
5,527,448
$
5,956,915
Year Ended December 31,
2025
2024
$
(1,091,923
)
$
264,484
189,249
149,595
4,864
4,088
31,708
37,113
1,094
67,708
1,269
—
3,504
—
1,007,892
17,276
(8,715
)
—
1,623
(4,686
)
(75,024
)
(2,329
)
(47,209
)
(7,462
)
(11,291
)
521
14,882
(420,893
)
26,678
12,115
83,297
12,163
131,898
129,693
(8,165
)
(53,550
)
(571,807
)
(690,385
)
23,848
10,435
(90
)
(2,979
)
(556,214
)
(736,479
)
1,200,000
350,000
1,069,000
305,000
(1,035,000
)
(15,000
)
(12,188
)
(56,331
)
(670,856
)
—
(18,615
)
(1,518
)
(4,226
)
(1,341
)
(50,034
)
—
8,639
5,180
(3,877
)
(2,972
)
(1,500
)
—
(90
)
—
481,253
583,018
56,937
(23,768
)
76,305
100,073
$
133,242
$
76,305
$
53,647
$
59,235
(893
)
(4,185
)
—
(1,500
)
(44,589
)
—
$
8,165
$
53,550
Three Months Ended December 31,
Year Ended December 31,
2025
2024
% Change
2025
2024
% Change
$
792,677
$
759,409
4.4
%
$
3,231,421
$
3,079,862
4.9
%
787,174
763,680
3.1
%
3,152,358
3,087,691
2.1
%
49,003
47,818
2.5
%
199,379
194,833
2.3
%
16.1
16.0
0.6
%
15.8
15.8
-0.2
%
$
1,007
$
994
1.3
%
$
1,025
$
997
2.8
%
$
152,010
$
189,655
-19.8
%
$
824,336
$
855,183
-3.6
%
$
821,459
$
774,238
6.1
%
$
3,312,769
$
3,153,963
5.0
%
811,766
776,456
4.5
%
3,221,704
3,151,933
2.2
%
52,170
48,679
7.2
%
208,225
199,761
4.2
%
15.6
16.0
-2.5
%
15.5
15.8
-1.9
%
$
1,012
$
997
1.5
%
$
1,028
$
1,001
2.8
%
$
136,181
$
184,359
-26.1
%
$
759,717
$
849,411
-10.6
%
Three Months Ended December 31,
Year Ended December 31,
2025
2024
2025
2024
$
(1,177,519
)
$
32,615
$
(1,102,772
)
$
255,612
279
914
10,849
8,872
7,843
4,479
25,982
77,395
37,925
30,071
138,864
116,368
45,754
39,541
189,249
149,595
(1,085,718
)
107,620
(737,828
)
607,842
6,451
10,099
31,708
37,113
25,214
29,566
163,630
46,753
—
—
1,269
—
147,462
—
150,966
—
1,006,440
5,817
1,007,892
17,276
—
—
(8,715
)
—
$
99,849
$
153,102
$
608,922
$
708,984
(36,332
)
(31,257
)
(150,795
)
(140,427
)
136,181
184,359
759,717
849,411
(15,829
)
(5,296
)
(64,619
)
(5,772
)
$
152,010
$
189,655
$
824,336
$
855,183
Three Months Ended December 31,
Year Ended December 31,
2025
2024
2025
2024
$
(1,177,519
)
$
32,615
$
(1,102,772
)
$
255,612
25,214
29,566
163,630
46,753
—
—
1,269
—
147,462
—
150,966
—
1,006,440
5,817
1,007,892
17,276
—
—
(8,715
)
—
7,843
4,479
25,982
77,395
9,440
72,477
238,252
397,036
3,322
13,326
55,537
92,940
6,118
59,151
182,715
304,096
90,578
91,986
91,309
92,059
$
0.07
$
0.64
$
2.00
$
3.30
Three Months Ended December 31,
Year Ended December 31,
2025
2024
2025
2024
$
11,985
$
24,986
$
135,259
$
30,620
4,425
2,631
19,871
1,362
8,804
1,436
8,500
11,172
—
513
—
3,599
$
25,214
$
29,566
$
163,630
$
46,753