If you own a home health, home care or hospice agency, the most active buyers today are national and regional home health and hospice operators and groups backed by private equity that buy local agencies one market at a time. Private equity firms also buy established agencies to build on, nonprofit hospice organizations and health systems buy or affiliate with agencies, and some owners sell to their own managers or employees.
What makes those buyers pay more is mostly predictable: a payer mix that fits the buyer, referral relationships that do not depend on you, caregivers and managers who stay after the sale, clean survey and compliance records, scale in a few markets, and clean financials.
The short version
- Who buys: national and regional home health and hospice operators, private equity backed home care groups, private equity firms, nonprofit hospice organizations and health systems, and your own managers or employees.
- What they pay more for: a payer mix that fits, referral sources that do not depend on you, caregiver retention, clean survey records, density, managers who stay, low owner dependence and clean financials.
- How to get the best result: put the agency in front of several of those buyers at once, confidentially, instead of taking the first offer that arrives.
Who has been buying home health and home care agencies
The deals below come from public announcements. None of them is a Hello Exit transaction, and naming a buyer here does not mean it works with Hello Exit or is looking for any particular business. They show who is active and how these deals tend to be structured.
Home health and hospice are healthcare businesses, like medical, dental and veterinary practices. Those pages show how buyers in neighboring fields weigh payers, referrals and the people who deliver care.
National and regional home health and hospice operators
Larger home health, hospice and home care companies keep buying local agencies, often to enter a new market or add a service.
- The Pennant Group completed its purchase of home health, hospice and personal care operations in Tennessee, Georgia and Alabama in October 2025. UnitedHealth Group and Amedisys sold those operations under their antitrust settlement with the U.S. Justice Department.
- Choice Health at Home, a home health, hospice and personal care provider based in Tyler, Texas, acquired Alliant Home Health, Palliative, and Hospice Care of Colorado and Cy-Fair Health Care of Tomball, Texas, in a deal announced in January 2026. Choice said Cy-Fair’s clinical and operational teams would keep serving its patients.
Private equity backed home care groups
Many active buyers are groups that already own several home care agencies and keep adding more, often keeping the local team.
- HouseWorks, a portfolio company of InTandem Capital Partners, acquired A Caring Experience Nursing Services of Cranston, Rhode Island, in March 2026, its first deal in the state. The companies said A Caring Experience would keep its local leadership.
- Care Advantage, backed by Searchlight Capital, acquired Attentive Angels Home Care, a non-medical in-home care provider in Columbia, South Carolina, in November 2025. The deal took Care Advantage into South Carolina.
Private equity firms
Private equity firms also buy established agencies outright, often as the base for a larger group.
- Gemspring Capital acquired Freedom Senior Services, a Louisville, Kentucky, provider of mostly non-medical home care and adult day services in five states, in June 2026. The company’s new chief executive said he wants it to be an active acquirer.
- Kinderhook Industries completed its purchase of Enhabit, a publicly traded home health and hospice company, in May 2026, taking it private. Enhabit kept its name.
Nonprofit hospice organizations and health systems
Nonprofit hospice organizations and health systems also buy, sometimes through an affiliation rather than a purchase. For example, Chapters Health System, a Florida nonprofit focused on hospice and advanced illness care, finalized an affiliation with Housecall Providers, a Portland, Oregon, nonprofit offering hospice, palliative and home-based primary care, in August 2026. The Oregon Health Authority reviewed the transaction under the state’s health care market oversight program.
Health systems sit on both sides of the market: some add agencies, and others sell their home health and hospice businesses to operators.
Your managers and employees
Some owners sell to the people who already run the agency, through a management buyout or an employee stock ownership plan (ESOP), in which a trust buys the company on behalf of the employees. Either keeps the agency with its people. Each is an option to compare against outside offers, not a replacement for testing them.
How selling a home health agency works differently
A few things come up in home health, home care and hospice deals that rarely come up elsewhere. These notes explain what buyers will ask about; they are not legal, regulatory, reimbursement or tax advice, so bring your own healthcare attorney and accountant in early.
Medicare certification and change of ownership
For a Medicare-certified agency or hospice, federal rules say a provider that is contemplating or negotiating a change of ownership must notify CMS, and that when a change of ownership occurs, the existing provider agreement is automatically assigned to the new owner, subject to the terms and conditions under which it was originally issued, including any existing plan of correction (42 CFR 489.18). So a buyer takes on the agency’s Medicare history, and will review it closely before it signs.
The 36-month rule
Home health agencies and hospices have an added rule. Under 42 CFR 424.550(b), if an agency undergoes a change in majority ownership by sale within 36 months after its initial Medicare enrollment or its most recent change in majority ownership, the provider agreement and Medicare billing privileges do not convey to the new owner, which must instead enroll as a new agency, unless an exception applies. The rule has applied to hospices as well as home health agencies since January 1, 2024 (Greenberg Traurig).
If the agency enrolled in Medicare or changed majority ownership in the last three years, expect a buyer to ask how these rules apply to its deal. How they apply to yours is a question for your healthcare attorney.
State licensing
Many states license home health and home care agencies separately from Medicare, and a state license may not move with the business. Missouri’s statute, for example, says a home health agency license is not transferable or assignable, and that when an agency is sold or its ownership or management is transferred, the license is voided and a new one must be obtained (Missouri Revisor of Statutes). Minnesota’s Department of Health says applications for a change of ownership of a home care provider must arrive at least 60 days before the buyer acquires ownership or a controlling interest (Minnesota Department of Health).
A buyer will plan its closing around that timeline. Rules vary by state, so check with your state agency and your attorney.
Payer mix
Medicare.gov says Medicare covers part-time or intermittent skilled care at home for people who are homebound, and does not cover personal care, such as help with bathing or dressing, when that is the only care a person needs (Medicare.gov). So agencies can have very different payers: Medicare, Medicare Advantage and other insurers, state Medicaid programs, the Department of Veterans Affairs, and clients who pay privately.
For Medicaid personal care and home health visits, the 21st Century Cures Act requires states to use electronic visit verification (Medicaid.gov). Expect a buyer to ask for revenue and margin by payer, how visits are verified and how many claims are denied.
Caregivers and clinicians
The business is the people who make the visits. Buyers will ask how many caregivers, aides, nurses and therapists you have, how long they stay, whether they are employees or contractors, and how they are paid. How your workers are classified and paid is a question for your employment attorney and accountant.
Survey, compliance and quality records
Medicare-certified agencies and hospices are surveyed by state agencies or accrediting organizations, and CMS publishes star ratings for home health agencies on Medicare’s Care Compare site, based on quality of patient care and on patient surveys (CMS). Expect a buyer to ask for your recent survey reports, plans of correction, complaints and Medicare audits, and to compare your ratings with nearby agencies.
What home health buyers pay more for
Every buyer looks at earnings first. After that, these are the things that most often move what a home health, home care or hospice buyer will pay and how much of the price comes at closing.
A payer mix that fits the buyer
Some buyers want Medicare home health and hospice, some want Medicaid personal care, and some want clients who pay privately. Know your mix by revenue and by margin. If one payer is a large share of revenue, a buyer will ask what happens if its rates or rules change.
Referral relationships that do not depend on you
Buyers want to see where admissions come from, such as hospitals, physicians and senior living communities, and whether those relationships belong to your team or to you personally. Referrals spread across many sources, and handled by staff who are staying, are worth more.
Caregivers and clinicians who stay
An agency that cannot staff its visits cannot grow. Buyers look at how long your caregivers, nurses and therapists stay and how many hours you turn down for lack of staff. Retention you can show by month and by role is more convincing than a number from memory.
Clean survey and compliance records
Recent surveys without serious findings, plans of correction closed on time, documentation that supports what was billed, and current licenses make the agency easier to underwrite. Problems found late can cut the price or stop a deal.
Scale or density in a few markets
Patients close together mean more of each clinician’s day is spent on visits, not driving, and an agency with a branch near you may see your territory fitting into its own.
Managers who stay
Your administrator, director of nursing and clinical managers are much of what a buyer is paying for. Buyers look at how long they have stayed, whether they will stay after the sale, and whether referral sources know anyone other than you. Some of the announcements above noted that the local team stayed.
How much the business depends on you
If you hold the key referral relationships and handle every survey, a buyer is paying for an agency that may not run without you. Owners who have a leadership team running daily operations usually get better terms, with more of the price paid at closing and less tied to future results.
Clean financials
Buyers will ask for several years of financial statements and detail by payer, service line and location: visits or hours, labor cost, margins, denied claims, and personal expenses separated from business costs. Clean books make the agency easier to underwrite and harder to discount.
Why it pays to have several buyers at the table
The same agency can look very different to different buyers. A national home health and hospice operator may value your market as a way in. A private equity backed home care group nearby may value your caregivers and your referral sources. An investment firm may value a team to build on, and your own managers may value keeping the agency independent. When you talk to only one of them, you only learn what that one will pay.
Putting the agency in front of several qualified buyers at once, confidentially, tests price and terms against each other. Buyers learn who you are only after signing an NDA, so employees, patients, referral sources and competitors do not find out early.
Hello Exit is a sell-side M&A advisor for founders selling businesses from $1 million to $400 million, and it is the team behind 1,000+ acquisitions and exits. Every engagement starts from accurate information. Hello Exit’s Exit Report is an advisory estimate that shows the strategic case, where strategic buyers exist, and the financial case side by side, along with an honest read on readiness. If the business is not ready to sell, Hello Exit says so and helps you get there first.
See how the process works, from the first confidential call to closing, and what Hello Exit does.
Size matters too. Below roughly $1 million in value, a marketplace or local business broker is usually the practical route to a sale. Above $400 million, an investment bank is usually the better fit.
Before you talk to buyers
- How to value a small business for sale: the methods buyers use and what moves the number.
- The free Valuation Report: an advisory estimate range for your business in minutes.
- Preparing your business for sale: a checklist of what to get in order first.
- Sell my business: the full path from first decision to closing.
Common questions
Who buys home health and home care agencies?
Mostly national and regional home health and hospice operators, private equity backed home care groups, private equity firms, nonprofit hospice organizations and health systems, and managers or employees through a buyout or an ESOP. Which of them fits depends on your size, your services, your payer mix and your region.
What happens to my Medicare certification when I sell?
Under Medicare’s rules, the existing provider agreement is automatically assigned to the new owner when ownership changes. For home health agencies and hospices, a change in majority ownership within 36 months of initial enrollment or the last such change means the new owner must enroll as a new agency unless an exception applies. Review your history and the deal structure with your healthcare attorney before you go to market.
Does it matter whether my agency is home health, home care or hospice?
Yes. The three have different payers, licenses and rules, and they draw different buyers. If you offer more than one, know your revenue and margin by service line before you talk to anyone.
Is my home health agency big enough for an M&A advisor?
Hello Exit works with businesses from $1 million to $400 million in value. Below roughly $1 million, a marketplace or local business broker is usually the better route.
