Acadia Healthcare Beats Big And Raises Guidance Again, But A Florida Windfall And Weak Commercial Mix Temper The Quality Of The Quarter

Acadia Healthcare delivered a convincing headline beat in the third quarter. Adjusted earnings of $0.60 per share topped the $0.46 consensus by 30.4%, and revenue of $895.3 million beat expectations by 3.0% while growing 5.1% year over year. Management also raised full-year guidance for the third consecutive quarter and put a number on its 2027 opportunity for the first time. The central tension is that the beat was larger than the underlying improvement. Adjusted EPS still fell 16.7% from $0.72 a year ago, GAAP EPS slipped to $0.38 from $0.40, and a meaningful part of the upside came from a state supplemental payment accrual rather than core operations.

The quality of the beat deserves scrutiny. Third-quarter adjusted EBITDA of $176.4 million included a $13.4 million accrual from Florida's supplemental payment program, compared with the $5.6 million the company had assumed in guidance. Without that roughly $7.8 million surplus, adjusted EBITDA would have been about flat with the prior year's $173.0 million. The year-over-year EPS decline also reflects a higher tax burden: the tax rate applied to adjustments rose to 24.8% from 19.8%, and the GAAP tax provision jumped to $17.8 million from $1.7 million. On a nine-month basis, adjusted EBITDA is still down to $469.9 million from $509.1 million. Acadia is recovering, but it has not yet returned to its 2025 earnings power.

Beneath the headline, the operating trends did improve. Same-facility revenue grew 5.2%, a clear acceleration from flat reported growth, or 3.2% normalized, in the second quarter. Revenue per patient day rose 4.0%, and same-facility admissions climbed 6.6%. Same-facility adjusted EBITDA increased 6.1% to $228.8 million, outpacing same-facility labor cost growth of 4.3%. The acute segment is doing the heavy lifting: revenue rose 11.3% to $524.8 million and volumes grew 7.5% as new capacity filled. Total adjusted EBITDA grew only 2%, and the gap between those two figures is the de novo drag. Losses at new, acquired, and closed facilities widened to $12.6 million from $4.8 million a year earlier.

That drag is also the core of the forward story. Management now expects about $60 million of incremental EBITDA in 2027 from the 16 acute facilities opened since 2023, with startup losses falling from roughly $45 million to about $10 million. All planned facilities are now open, including the 144-bed Jacksonville-area de novo. Management also said licensure timelines have been shortened, which should speed the ramp. Full-year adjusted EBITDA guidance moved to $615-$625 million from $590-$615 million, and adjusted EPS guidance rose to $1.70-$1.80 from $1.45-$1.60. Capital expenditure guidance was cut again, to $210-$230 million, and net leverage eased to 3.9x from 4.1x. Management said more than $20 million of Florida and Ohio supplemental upside remains excluded from guidance.

Bears still have legitimate ammunition:

• **Commercial payer mix:** fell to 20.9%, about 400 basis points lower year over year and more than 10 points below 2022 levels.
• **Weak segments:** CTC revenue was stuck at $141 million for a second straight quarter, and specialty revenue fell 8.2% on Pennsylvania pressure and closures. The call also cited a New York Medicaid drag.
• **Cash flow:** free cash flow dropped to $47 million from $124 million in the second quarter.
• **Legal overhangs:** government-investigation costs ran about $18 million and the DOJ/SEC matter remains unresolved. A professional and general liability actuarial review is pending in the fourth quarter.
• **Leadership and policy:** the CFO role remains interim, and Medicaid work requirements begin in 2027.
• **Tough 2027 comparisons:** out-of-period supplemental payments of $11 million and $26 million earlier this year will be hard to lap.

Investor sentiment shifted meaningfully, moving from -0.24 at the prior report to +0.12, a swing from mildly negative to modestly positive. Price action has been more restrained. At $32.25, shares are down 2.0% since the open following the July report, though they sit about 24% above the $26.00 200-day moving average. Momentum and AVWAP trend readings are positive while the price trend is neutral. That pattern is consistent with a stock that rerated earlier and has since been consolidating rather than chasing each guidance raise.

The bottom line is that Acadia's quarter strengthened the credibility of its new-facility ramp and same-store recovery, and repeated guidance raises show momentum in execution. However, the size of the beat overstates the improvement: supplemental payments, a weakening commercial mix, and lingering legal and leadership questions mean 2027 still has to prove that the earnings recovery is durable.

Read our earnings preview for Acadia Healthcare Company, Inc.: https://www.earningswhispers.com/article/ACHC/21766

This earnings review was originally published on Earnings Whispers.

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