Acadia Healthcare Announces Fourth Quarter and 2025 Results

Fourth Quarter 2025 Results

• Revenue totaled $821.5 million, a 6.1% increase compared with the fourth quarter of 2024, supporting full-year revenue results above the Company’s previously issued guidance range
• Same facility revenue increased 4.4% compared with the fourth quarter of 2024, including an increase in patient days of 3.1% and an increase in revenue per patient day of 1.3%
• Net loss attributable to Acadia totaled $(13.02) per diluted share, compared with net income of $0.35 per diluted share in the prior-year period driven by a non-cash goodwill impairment charge of $996.2 million
• Adjusted net income attributable to Acadia totaled $6.1 million, or $0.07 per diluted share, compared with $59.2 million, or $0.64 per diluted share in the prior-year period
• Adjusted EBITDA was $99.8 million, compared with $153.1 million in the prior-year period and at the upper end of the Company’s implied fourth-quarter guidance range. Fourth quarter 2025 Adjusted EBITDA includes a $52.7 million adjustment to professional and general liability (“PLGL”) reserves, as previously disclosed on December 2, 2025
• Added 181 newly licensed beds during the fourth quarter, including 37 beds to existing facilities and 144 beds from new facilities opened in the fourth quarter

Full Year 2025 Results

• Revenue totaled $3,312.8 million, a 5.0% increase compared with the prior year
• Net loss attributable to Acadia totaled $(12.16) per diluted share, compared with net income of $2.78 per diluted share during the prior year
• Adjusted net income attributable to Acadia totaled $182.7 million, or $2.00 per diluted share, compared with $304.1 million, or $3.30 per diluted share during the prior-year
• Adjusted EBITDA was $608.9 million, compared with $709.0 million in the prior year
• Added 1,089 licensed beds during the year, including 311 to existing facilities and 778 beds from new facilities opened during the year

Full Year 2026 Financial Guidance

• Revenue of $3.37 to $3.45 billion
• Adjusted EBITDA of $575 to $610 million
• Adjusted earnings per diluted share of $1.30 to $1.55

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.”

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:

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:

• Interest expense of $157 to $162 million.
• Tax rate of approximately 26%
• Depreciation and amortization of $198 to $203 million
• Stock compensation expense of $40 to $45 million
• Operating cash flow of $280 to $320 million
• Expansion capital expenditures of $140 to $155 million
• Maintenance and IT capital expenditures of $115 to $125 million
• Total bed additions of 400 to 600 beds

The Company’s first quarter guidance includes the following assumptions:

• Startup losses of approximately $14 million
• The recognition of $11 million in supplemental payments related to fiscal year 2025

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.