Medicare & Medicaid-Certified Home Healthcare Agency, Franklin County Ohio

$14.0M

Revenue

$3.5M

SDE

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Full Editorial Writeup

This is a Medicare and Medicaid-certified home healthcare agency operating out of Franklin County, Ohio, generating $14 million in annual revenue against $3.5 million in adjusted EBITDA, a healthy 27% margin for a labor-heavy care business. The agency serves 245 active patients and bills roughly 17,000 hours per month across both skilled nursing (wound care, medication management, chronic disease management) and non-skilled personal care (activities of daily living, companion care, 24-hour high-acuity support). The payer mix spans Medicaid, managed care organizations, and commercial insurers, which gives the revenue base predictable, government-anchored reimbursement.

The workforce is substantial: over 240 employees including 30-plus registered nurses and roughly 210 caregivers, which is both the operating backbone and the single biggest risk in this category given chronic caregiver shortages. Roughly 95% of patient referrals come from established relationships with physicians, care coordinators, and hospital systems, meaning customer acquisition cost is low and intake quality is consistent. The business runs from a small leased office (2,300-2,400 sq ft at $2,600/month), so there is minimal real estate footprint and essentially no asset drag.

What makes this notable is the combination of demographic tailwind and detachable ownership. Ohio already has 2.2 million residents aged 65-plus, growing to 2.3 million by 2030, and the agency is described as owner-oversight rather than owner-operated, which suggests the management infrastructure can survive a transition. For a buyer, this is a scaled, compliant, cash-generative platform in a space where most competitors are sub-$5M in revenue.

Why we like it

Earnings quality is strong for the category: $3.5M EBITDA on $14M revenue is a 27% margin, well above typical home health comps that run in the low to mid teens. The payer mix of Medicaid, managed care, and commercial insurance means reimbursement is predictable and largely insulated from consumer discretionary spending.
The moat is the referral engine and certification. About 95% of patients come from physicians, care coordinators, and hospital systems, which keeps acquisition costs near zero and creates switching friction, while Medicare and Medicaid certification is a real regulatory barrier that takes years and clean survey history to replicate.
The demographic tailwind is about as durable as it gets. Ohio's 65-plus population is already 2.2 million and growing, the age-in-place preference is structural, and chronic conditions keep billing hours high, so demand is rising regardless of the economic cycle.
Operator advantage is unusually clean here. The business is described as owner-oversight rather than hands-on, runs from a cheap 2,400 sq ft lease, and has a built-out management, nursing, and compliance layer, so a buyer inherits a functioning org rather than a one-person dependency.

How to improve it

Audit and optimize the payer mix within 90 days. Shift intake toward higher-reimbursement skilled nursing and commercial/managed-care cases where margins beat straight Medicaid personal care, which can lift blended margin without adding a single new referral source.
Attack caregiver retention immediately. In a 210-caregiver operation, a few points of turnover reduction directly protects billable hours and overtime cost, so build referral bonuses, scheduling flexibility, and a clear career ladder to RN roles to stabilize the single largest cost line.
Launch the hospice service line the listing flags as an opportunity. Hospice carries higher per-patient reimbursement and leverages the same referral relationships and clinical staff, giving a natural adjacency that raises revenue per patient without new customer acquisition.
Expand geographically within Ohio using the existing certification and back office. Open or acquire satellite coverage in adjacent counties to grow the 245-patient base, since the administrative and compliance infrastructure can absorb more volume at low incremental cost.
Implement scheduling and billing automation. With 17,000 monthly billing hours across 240 employees, even modest reductions in billing leakage, denied claims, and manual scheduling errors flow straight to EBITDA and improve cash conversion.
Formalize and deepen hospital system referral contracts. Move from informal relationships toward preferred-provider or discharge-partner agreements to lock in intake volume and reduce the risk that a single referral source walks after the sale.

Diligence notes

Scrutinize payer concentration and reimbursement rates. Break down revenue by Medicaid vs managed care vs commercial, confirm current reimbursement schedules, and stress-test the model against potential Medicaid rate changes, since a large government-pay share is both the stability and the policy risk here.
Verify certification, survey history, and compliance standing. Pull the full Medicare and Medicaid survey and deficiency history, any corrective action plans, and billing audit exposure, because a certification lapse or clawback can erase the EBITDA thesis overnight.
Validate the referral concentration. Confirm how many physicians, hospital systems, and care coordinators drive the 95% referral figure, and quantify the top sources, since over-reliance on one hospital discharge planner is a hidden single point of failure.
Confirm the EBITDA adjustments and labor cost assumptions. Review the add-backs behind the $3.5M adjusted figure, and separately test caregiver pay, overtime, and turnover, because a tight caregiver labor market can quietly compress the stated 27% margin post-close.
Confirm the ownership transferability claim. Document who actually runs daily operations, administrator and director of nursing tenure, and whether key clinical and admin staff will stay, since the absentee thesis only holds if the management layer is genuinely independent of the seller.

Source

Originally listed on BizBuySell. View original listing →