Medicare-Certified Home Health & School Nursing Provider, 21-Year Miami-Dade Operator

$11.9M

Revenue

$2.8M

SDE

5.0x

Multiple

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Full Editorial Writeup

This is a 21-year-old Medicare-certified home health care provider operating in Miami-Dade County, Florida, delivering skilled nursing, pediatric home health, school nursing, rehabilitation, and personal care services. Founded in 2005, the business has carved out differentiated expertise in high-acuity pediatric care and school nursing, two niches that are harder to staff and less commoditized than standard adult home health. The company runs on a workforce of 187 people, with 24 full-time and 163 part-time staff supporting a multidisciplinary clinical model.

The financial profile is strong for the category. The business generates roughly $11.9M in annualized 2026 revenue against $2.8M of SDE, and ownership reports expanding SDE margins from 17% in 2024 to 24% in 2026. Revenue is split between Fee-for-Service (73%) and School Nursing Contracts (27%), giving the business a blend of per-visit billing and contracted, calendar-driven nursing work that returns year after year.

At a $14M ask on $2.8M of cash flow, the deal is priced at roughly 5x SDE, which is full for home health but defensible given the size, the margin trajectory, and the contracted school-nursing book. The seller is exiting to pursue opportunities outside the industry rather than retiring, and the sale includes a company-owned warehouse used in operations, though the office space itself is leased through early 2029.

Why we like it

Earnings quality is anchored by a diversified payer mix, with 73% Fee-for-Service and 27% school nursing contracts producing $2.8M of SDE on $11.9M of revenue. The margin expansion from 17% to 24% over two years signals real operating leverage rather than one-time cost cuts, and a 24% SDE margin is healthy for a labor-heavy home health operation.
The moat sits in the high-acuity pediatric and school nursing niches, which require specialized clinical staffing and established referral relationships that new entrants cannot assemble quickly. Twenty-one years of Medicare certification and a built reputation in Miami-Dade create switching friction with payers, families, and school districts.
Home health demand is genuinely recession-resistant and demographically tailwinded, as aging populations and the shift from facility-based to in-home care continue regardless of the economic cycle. Pediatric and school nursing are especially sticky because they are tied to ongoing medical need and the school calendar rather than discretionary spend.
The school nursing contracts behave like recurring revenue, renewing on a calendar basis and providing a predictable base that smooths the more variable Fee-for-Service visits. An operator can underwrite that 27% with more confidence than a pure per-visit book.

How to improve it

Audit the payer and referral mix within the first 90 days to identify concentration risk, then prioritize deepening the highest-margin school nursing and pediatric relationships. Locking in multi-year district contracts would strengthen the recurring base and improve the resale multiple.
Install or upgrade an EVV and scheduling system to tighten visit utilization across the 163 part-time clinicians, since labor is the single largest cost lever in home health. Even a few points of improved caregiver utilization flow straight to SDE given the 24% margin.
Expand service geography into adjacent Broward and Palm Beach counties using the existing Medicare certification and clinical playbook. The pediatric and school nursing expertise is portable and underserved in neighboring markets.
Formalize a recruiting and retention engine for skilled nurses, including referral bonuses and clinical ladders, because census growth in this business is capped by staffing, not demand. Reducing turnover directly protects margin and allows the company to accept more high-acuity cases.
Review billing and revenue cycle operations to shorten days in AR and reduce denial rates on Medicare and Fee-for-Service claims. Tighter collections improve working capital and reveal whether the reported SDE is cash-backed.
Build a referral marketing function targeting hospitals, discharge planners, and pediatric specialists to diversify intake beyond existing channels. A documented, repeatable referral pipeline makes the business less dependent on legacy relationships tied to the departing owner.

Diligence notes

Scrutinize the Medicare certification status, survey history, and any compliance or audit findings, since a certification lapse or clawback is an existential risk in home health. Confirm the certification transfers cleanly in the contemplated deal structure (asset vs. stock).
Validate the margin jump from 17% in 2024 to 24% in 2026 by tracing what changed: pricing, mix shift toward school nursing, staffing model, or cost cuts that may not be sustainable. The use of annualized 2026 figures rather than trailing audited financials warrants a full quality-of-earnings review.
Examine payer concentration and reimbursement risk, including exposure to Medicare rate changes and the renewal terms, pricing, and cancellation provisions on the school nursing contracts that make up 27% of revenue. Understand how many districts the contract revenue depends on.
Assess staffing dependency and 1099 vs. W-2 classification across the 163 part-time workers, as misclassification and nurse turnover are common liabilities in this category. Confirm whether key clinical supervisors and the director of nursing are staying through and beyond the 4-week transition.
Clarify exactly what the company-owned warehouse is, its standalone value, and whether it is included in or excluded from the $14M ask, given that the office itself is leased through January 2029. Pin down the real estate and lease economics so the operating multiple is clean.
Confirm the reason for sale and the owner's role in clinical and referral operations, since the stated exit is to pursue other opportunities rather than retirement. Quantify owner dependency to ensure the business does not lose census when the seller leaves after four weeks.

Source

Originally listed on BizBuySell. View original listing →