Acadia Healthcare Reaffirms 2025 Guidance at Conference, Highlights 2026 Headwinds and Bed Ramp Upside

Executives from Acadia Healthcare (NASDAQ:ACHC) used a company event to reiterate 2025 guidance, review operational progress and challenges from the past year, and outline the major headwinds and potential earnings drivers heading into 2026.

2025 guidance reiterated and company footprint

Chief Executive Officer Chris Hunter said the company reiterated its 2025 outlook that morning, continuing to expect revenue of $3.28 billion to $3.3 billion, adjusted EBITDA of $601 million to $611 million, and adjusted EPS of $1.94 to $2.04. Hunter said the company expects to provide fourth-quarter results in late February.

Hunter described Acadia as the largest standalone behavioral health company in the U.S., with 277 facilities spanning 40 states and Puerto Rico. The company operates across four service lines:

• 59 acute facilities treating high-acuity inpatient psychiatric conditions
• 31 specialty facilities focused largely on residential substance use disorder treatment
• 178 opioid use disorder outpatient clinics, which Acadia calls comprehensive treatment centers (CTCs)
• Nine child and adolescent residential treatment centers (RTCs)

Management said Acadia serves more than 82,000 patients daily and views its multi-service-line breadth as a differentiator because many patients have comorbidities spanning acuity levels.

Joint ventures, diversification, and strategic priorities

Hunter highlighted Acadia’s joint-venture strategy for acute psychiatric care, noting partnerships with 21 health system JV partners. He said some partners have returned to establish additional JV facilities in different geographies, citing Geisinger and Ascension as examples.

He also emphasized diversification across service lines, payers, and geography. Acute care represents 55% of the company’s service line mix, and management said over half of revenue comes from Medicaid. Acadia’s strategic vision, Hunter said, is to be the “indispensable behavioral health provider” for high-acuity and complex populations, anchored by priorities to deliver high-quality care, enhance core capabilities (including technology and workforce support), and selectively expand capacity.

Operational progress in 2025: quality, labor, and capacity

Hunter said 2025 progress included multi-pronged quality initiatives spanning people, process, and technology. He pointed to electronic medical record (EMR) implementations in acute hospitals and RTCs, remote patient monitoring devices to support adherence and documentation, and expanded analytics and dashboards for facility operators.

On labor, Hunter said Acadia recorded six straight quarters of increased retention, attributing improvement to a better wage inflation environment and efforts such as centralized recruitment, employee engagement, and training. He also described a transformation of the acute leadership team over the past year, adding more experienced facility-level operators amid heightened industry survey activity and scrutiny.

Acadia also reported significant bed growth. Hunter said the company opened over 1,000 new beds in 2025, including 778 beds at newly constructed facilities, and added more than 2,500 newly constructed beds over the past year. Another slide cited nearly 1,100 new beds opened in 2025, including new joint venture facilities with Henry Ford (Michigan), Geisinger (Pennsylvania), and Ascension (Texas). The company also closed five facilities in 2025 as part of a portfolio review process.

Management presented outcomes and experience metrics it said reflect improving performance, including a 29% improvement in mental health quality of life and a 54% improvement in depression, alongside an over 10% improvement in overall care ratings and likelihood to recommend. Hunter added that the number of patient surveys collected rose 43% versus the prior year period.

In the CTC outpatient business, management emphasized operational changes aimed at access. Hunter said the company now has no waitlists at its clinics and average wait times are around five minutes or below, which he said improves patient experience and throughput while supporting operating leverage in what he described as a low-capital-intensity business.

2025 financial shortfall: liability, volume, rates, and occupancy ramp

Despite operational initiatives, Hunter characterized 2025 as “a difficult year from a financial performance perspective.” He walked through drivers behind the gap between initial guidance at the start of 2025 and the midpoint of current guidance, led by higher-than-expected professional liability costs. He said more than half of the variance was driven by higher liability expense tied to claims from prior policy years and elevated claim frequency, noting the “long tail” of claims means it will take time for quality investments to show up in results.

On volume, Hunter said growth was softer than expected, particularly in Medicaid-heavy acute markets, which management attributed to payer pressure and more aggressive utilization management. He also cited a slower occupancy ramp at newly built facilities, along with pressure on revenue yield per patient day from bad debt and denials. Hunter said this was partially offset by improved Medicaid supplemental payments as more states expanded access to those programs.

Management also detailed why occupancy ramp lagged expectations across cohorts opened in 2023, 2024, and 2025. Hunter cited two main factors: softer Medicaid volumes in certain markets and the complexity of ramping new facilities under heightened regulatory scrutiny. He outlined timing hurdles including licensure surveys and accreditation (around 75 days), Medicare tie-ins (two to six weeks), Medicaid eligibility (often six to eight months), and payer credentialing.

2026 outlook: execution focus, CapEx reduction, and key headwinds/tailwinds

Looking ahead, Hunter said Acadia’s focus for 2026 is “execution,” including optimizing occupancy, leveraging payer engagement, and driving operational excellence. He reiterated the company’s view that recent bed cohorts represent an embedded earnings opportunity: across 2023 through 2026, management said new facility builds represent over 2,000 beds and at least $150 million of future EBITDA at maturity, and that when startup losses are considered, the incremental opportunity exceeds $200 million, excluding expansion beds.

Hunter also said the company expects capital spending to decline meaningfully. Acadia anticipates 2026 CapEx will be down at least $300 million versus its $610 million to $630 million 2025 guidance, while still adding 500 to 700 beds, with further declines expected in 2027. Management said the reduction should enable meaningful free cash flow generation, and later noted it expects positive free cash flow in 2026.

Among 2026 headwinds, Hunter flagged continued softness in acute Medicaid volumes and ongoing payer-related pressures. He also cited a New York policy change that would prevent Medicaid patients from receiving care in out-of-state facilities, which management said could impact multiple specialty facilities in Pennsylvania near the New York border. Hunter estimated a $25 million to $30 million annual EBITDA impact if those beds cannot be backfilled. He also referenced the absence of a previously disclosed non-recurring $28.5 million benefit from Tennessee’s 2024 supplemental payment program that was recorded in the second quarter of 2025, and said the company is monitoring potential staffing ratio changes in California that could require census reductions.

Tailwinds cited for 2026 included bed ramp contributions, potential expanded supplemental payments that management said could provide a $22 million one-time EBITDA benefit plus an incremental run-rate benefit, anniversary benefits from facility closures, and a modest decline in startup losses.

During Q&A, Chief Financial Officer Todd Young said the company expects to unlock growth as occupancy increases, noting most capital is “behind” the 2023-2025 cohorts and largely behind 2026 beds as well. Young added the company decided to slow investment after a period of rapid expansion and quality-related implementation, citing “growing pains” in 2025 and an expectation that greater continuity of facility leadership can help going forward. He also said that in a fragmented industry, it may sometimes be more efficient to acquire beds rather than build, depending on capital markets.

Young said the company is using outcomes data—supported by EMRs and other investments—to engage with payers on topics like length of stay, readmissions, and network cost impacts, particularly given Medicaid represents over half of revenue. He also linked quality and process investments to expectations of reducing future liability costs, noting many claims contributing to recent increases relate to earlier periods before those investments were made.

About Acadia Healthcare (NASDAQ:ACHC)

Acadia Healthcare Company, Inc (NASDAQ: ACHC) is a publicly traded provider of behavioral healthcare services headquartered in Franklin, Tennessee. Founded in 2005, the company has grown through organic expansion and strategic acquisitions to establish itself as a leading specialist in mental health and addiction treatment across the United States.

Acadia operates a diversified network of inpatient psychiatric hospitals, residential treatment centers, outpatient clinics and intensive outpatient programs.