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Full Editorial Writeup
This is a Northwest Ohio skilled home health agency generating roughly $2.04M in trailing twelve-month revenue and $549K of SDE, priced at about 3.3x. The business is Joint Commission accredited with deemed status, Medicare and Medicaid certified, Ohio licensed, and critically has passed its 36-month enrollment window, which means Medicare certification can transfer through a standard change of ownership rather than a fresh application. It carries an active census of 46 patients and runs a fully staffed, blended employee and contract clinical model with billing and payroll functions in place.
The payer mix is the single most important fact here: about 96% of revenue comes from Ohio Medicaid, split between state plan and MyCare managed care, with only ~4% tied to the active Medicare certification. That concentration is both the risk and the opportunity. Medicaid is sticky, essential, and recession-resistant, but low-margin and subject to state rate and policy changes, while the dormant-but-active Medicare certification is the obvious growth lever for a buyer who knows how to build Medicare census at higher reimbursement rates.
What makes this deal notable is the growth trajectory and the near-turnkey management structure. Revenue grew from $1.22M in 2024 to $1.88M in 2025 to $2.04M TTM, with SDE climbing from $375K to $450K to $549K and 2026 annualizing toward roughly $669K. The owner works only about 15 hours per week and has identified and trained an internal successor for the administrator role, so this is closer to a manager-run platform than a seller-dependent practice. The seller is explicit that only buyers with hands-on Ohio Medicaid home health operating experience and cash equal to the purchase price will be considered.
Why we like it
- Earnings quality is improving and verifiable, with SDE growing from $375K (2024) to $450K (2025) to $549K TTM and annualizing toward $669K in 2026. The P&L is cash-basis with an accountant-supported normalization schedule and a full earnings bridge in the data room, and management has broken out an adjusted EBITDA of $454K TTM after loading in a $95K administrator salary, which is the honest operator number.
- The moat is regulatory and operational, not brand-based. Joint Commission accreditation with deemed status, active Medicare and Medicaid certification, and completion of the 36-month enrollment window mean certifications transfer via a standard change of ownership instead of a years-long re-application, which is a genuine barrier to new entrants trying to compete.
- Home health is about as recession-proof as healthcare services get, with 96% of revenue flowing from Ohio Medicaid, a payer that does not disappear in a downturn. Demand is driven by an aging population and the structural shift toward in-home care over facility care, both long-duration tailwinds.
- The management structure is near-turnkey, with the owner working only ~15 hours a week and a trained internal successor already identified for the administrator role. Billing and payroll are staffed and the clinical model is fully built out across employee and contract labor, so a qualified operator inherits a running machine rather than a rebuild.
- The Medicare upside is clear and self-funding. Only ~4% of revenue currently runs through the active Medicare certification, so an operator who can build Medicare census is layering higher-reimbursement episodic revenue onto an already-certified, already-staffed platform without the usual startup friction.
How to improve it
- Attack the Medicare census immediately. The certification is active and in good standing but carries only ~4% of revenue, so build referral relationships with hospital discharge planners, physician groups, and SNFs to grow higher-reimbursement Medicare episodes on top of the existing Medicaid base.
- Diversify the payer mix to reduce the 96% Ohio Medicaid concentration. Map which MyCare managed care plans and private pay or VA opportunities are reachable, and set a 12-month target to bring single-payer exposure down to protect against state rate cuts or MyCare contract changes.
- Formalize the administrator transition in the first 90 days by locking the identified internal successor into a compensation and retention agreement. The $95K loaded administrator cost is already in the adjusted EBITDA, so securing that person protects both operations and the normalized earnings number.
- Tighten revenue cycle management on Medicaid and managed Medicaid billing, since days-in-AR and claim denial rates directly drive cash flow in a thin-margin, high-volume payer environment. Benchmark current collection velocity and build a denial-prevention workflow against MyCare plan requirements.
- Scale census above the current 46 by adding clinical capacity in the blended employee and contract model. Measure the marginal contribution per additional patient and staff ahead of demand so the fully-staffed infrastructure is leveraged rather than idle.
- Invest in caregiver recruiting and retention, the binding constraint in home health. Build a referral-bonus and scheduling-flexibility program to lower turnover, since every lost clinician caps the census you can serve and the revenue you can bill.
- Codify compliance and documentation to protect the Joint Commission deemed status and Medicare/Medicaid certifications. A single accreditation lapse or audit finding threatens the entire moat, so standardize clinical charting and OASIS accuracy from day one.
Diligence notes
- Scrutinize the 96% Ohio Medicaid concentration above all else. Pull the breakdown between state plan and MyCare managed care, review reimbursement rate history, and assess the state's budget and any pending rate or policy changes, because a Medicaid rate adjustment flows straight through to SDE.
- Confirm the Medicare change of ownership mechanics with specialized healthcare counsel. The listing claims the 36-month window has ended so enrollment transfers via standard CHOW, but verify there is no interruption in billing privileges during the transfer and that the certification survives the ownership change intact.
- Validate the normalization schedule and the gap between SDE and adjusted EBITDA. SDE is $549K TTM but adjusted EBITDA after the $95K loaded administrator is $454K, so confirm the add-backs are legitimate and that the true owner-independent cash flow is the EBITDA figure, not the headline SDE.
- Stress-test the revenue ramp from $1.22M (2024) to $2.04M TTM. Understand whether growth came from census additions, rate changes, or one-time factors, and confirm the 46 active patients and their payer sources are stable rather than concentrated in a few referral relationships that could leave.
- Audit staffing stability and the identified administrator successor. Verify clinical headcount, contractor-versus-employee mix, turnover rates, and whether the named successor is contractually committed, since the whole thesis rests on this being a manager-run platform at ~15 owner hours per week.
- Review the compliance and survey history for the Joint Commission accreditation and Medicare/Medicaid certifications. Request recent survey results, plans of correction, and any audit or recoupment history, because regulatory findings are the fastest way to impair this asset's value.
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