How to sell a home health agency
The first question in any home health sale is whether the Medicare provider agreement can move to the buyer. That one date on your enrollment record decides the buyer pool, the price, and the structure.
Start with your enrollment date
Under the CMS 36-month rule, if majority ownership of a home health agency changes within 36 months of its initial Medicare enrollment or its last majority ownership change, the provider agreement does not transfer. The buyer enrolls as a new agency and goes through an initial survey.
During the nationwide moratorium on new home health enrollments that began May 13, 2026, a sale that counts as a new enrollment is blocked outright. So an agency inside its 36-month window is very hard to sell right now, and one outside it is in demand.
Confirm the date on your 855A record before you talk to buyers. It is the single most common reason a home health deal gets repriced late.
Documents to have ready
- Three years of financial statements and tax returns, plus year to date
- Episode or period volume by month, case mix, and LUPA rate
- Referral sources by volume, so a buyer can see concentration
- Survey history, accreditation status, and any ADR, TPE, or UPIC activity
- Staff roster, key contracts, and your office lease
What buyers pay
Certified home health agencies typically sell for 2.5x to 3.5x SDE under 200 annual episodes, 3.5x to 5.0x adjusted EBITDA from 200 to 600, and 5.0x to 6.5x above 600. An agency that cannot transfer its provider agreement sells for less, or needs a structure the buyer's counsel is comfortable with.
A high LUPA rate and heavy dependence on one hospital system are the two items buyers discount most often. Both can often be improved before you go to market.
Timeline
Most sales run four to eight months. The state change of ownership filing and the Medicare 855A filing run in parallel after the letter of intent, and together they usually set the closing date.
If you want to know where your agency stands, start with a free confidential valuation. We check the 36-month position as part of it.