By Cory Mertz, M&AMI, Managing Partner, Mertz Taggart The home-based care M&A market remains active in 2026 — but it's not uniform. For high-quality agencies with strong financials, clean compliance histories, strong management teams, established referral networks, stable census, and a favorable payer mix, buyer demand is real and premium valuations are still attainable — while multiples have come off their 2021 peak, they remain very strong by historical standards. For agencies that don't check enough of the right boxes, premium valuations are much harder to come by: buyers are interested but disciplined, and the path to a strong outcome may require more work. What has changed for everyone is the environment around the transaction itself. A combination of regulatory shifts, intensified fraud enforcement, and operational complexity is making deals harder to structure, take longer to close, and more dependent on experienced guidance to get across the finish line. Understanding these dynamics before going to market is increasingly what separates a smooth process from a difficult one. This article covers the major factors shaping home-based care transactions right now, what they mean for sellers, and how to navigate them. Before getting into the specifics, it's worth seeing how much of this is connected. The enrollment moratorium, the renewed bite of the 36-month rule, the enhanced oversight in high-risk states, and the recent enforcement takedowns are not separate events — they are facets of a single, coordinated federal crackdown on fraud in home health and, most acutely, hospice. Read together rather than as isolated hurdles, they explain both why the deal environment has tightened and why going to market well-prepared matters more than it used to. How Does the CMS Enrollment Moratorium Affect Your Sale? In May 2026, CMS announced a nationwide moratorium on new Medicare enrollments for home health and hospice providers. The moratorium, effective for an initial six-month period, was implemented as part of a broader effort to combat fraud, waste, and abuse in the Medicare program. For sellers, the immediate effect is arguably positive. Buyers who previously had the option to build de novo in a target market — rather than acquire — are now effectively forced into the acquisition lane. That increases buyer competition for existing Medicare-certified providers. What this means for sellers: Your existing Medicare certification has increased strategic value. But expect buyers and their counsel to spend more time on transaction structure and due diligence, so build extra time into your closing timeline. What Is the 36-Month Rule, and Does It Affect Your Sale? One of the most frequently misunderstood obstacles in home health and hospice M&A is the 36-month rule. Under CMS regulations, a Medicare-certified home health agency or hospice that was acquired, changed ownership, or was initially enrolled within the prior 36 months may be subject to restrictions on a subsequent change of ownership. In practical terms, this means that if your agency was acquired, enrolled, or involved in a prior transaction within the last three years, a buyer may not be able to complete a CHOW without triggering additional scrutiny, delays, or — in some cases — the need to re-enroll entirely. The 36-month rule affects de novo agencies, recently acquired agencies, and providers that have undergone structural changes such as mergers or entity reorganizations. It is not always apparent on the surface. A good advisor will surface this before you go to market. When sellers aren’t prepared, it can create real friction in an otherwise clean deal. There are exceptions — for example, when a parent company undergoes an internal restructuring, or when the agency has filed two consecutive years of full cost reports since its last ownership change — but they are narrow and fact-specific. What this means for sellers: Know your agency’s Medicare enrollment history and whether the 36-month window applies before you go to market. An experienced advisor will surface this early — before you're in exclusivity with a buyer and the clock is ticking. How Is the Fraud Crackdown Changing Buyer Diligence? Home-based care has been under increasing government scrutiny, and that trend has accelerated in 2026. CMS, OIG, and the Department of Justice have all signaled increased enforcement focus on home health and hospice billing practices — including documentation practices and length-of-stay patterns in hospice. The scrutiny is most acute in hospice. The same fraud concerns that prompted the enrollment moratorium have produced a coordinated crackdown: CMS has imposed heightened screening on hospices that are newly enrolling or changing ownership in the states it considers highest-risk — Arizona, California, Georgia, Nevada, Ohio, and Texas — and is rolling out a public hospice scoring system to flag providers with concerning utilization, quality, or compliance patterns. On the enforcement side, CMS, OIG, and the Department of Justice have suspended payments to hundreds of suspect providers — including roughly 800 hospices and home health agencies in the Los Angeles area — and continue to prosecute the operators behind sham hospice schemes. For hospice owners, that means buyers and their regulatory counsel will scrutinize eligibility documentation, length-of-stay, and live-discharge patterns especially closely, and a clean, well-documented patient record is now a genuine differentiator. For sellers, the direct impact is in the diligence process. Buyers — particularly those backed by private equity or working with healthcare regulatory counsel — are doing more work on billing compliance than they were two or three years ago. Claim-level review, documentation audits, and outside regulatory counsel are now routine on transactions of any meaningful size. This doesn't mean your agency has a problem. Most well-run providers have nothing to worry about. But it does mean that buyers are spending more time on compliance review, and that any practice that could be perceived as inconsistent with CMS guidance will require explanation and documentation. What this means for sellers: A billing audit before going to market is no longer optional — it's table stakes. Identifying and resolving compliance questions before a buyer finds them puts you in a far stronger negotiating position. Surprises in diligence are deal killers. This is even more critical in the enhanced-oversight states, where hospice providers face the closest scrutiny. How Do State Regulations Affect Your Sale? Beyond federal CMS requirements, state-level regulatory environments vary significantly and are becoming increasingly important in home-based care transactions. Several states have enacted or are enforcing heightened oversight of home health and hospice providers — California in particular has seen significant regulatory activity affecting transactions in that market. State licensure transfers and Certificate of Need (CON) requirements add layers of complexity that vary by geography. A growing number of states also require advance notice and regulatory review of a healthcare transaction before it can close — in some states by the attorney general — and these reviews can add months to the timeline, sometimes with the authority to impose conditions on or block a deal outright. For multi-state providers, the complexity multiplies. A transaction that is straightforward in one state may involve multiple parallel regulatory processes in another. Indiana is a useful example of how state and federal rules can compound. Under a recent state mandate, home health agencies enrolled in Indiana Medicaid must also be enrolled as Medicare providers to keep receiving Medicaid reimbursement — a requirement effective July 1, 2026, with a final completion deadline of June 30, 2027 for agencies that began the process on time. For agencies that were previously Medicaid-only, enrolling in Medicare starts a fresh 36-month clock — which can make them difficult to sell until that window closes, because a buyer’s change of ownership within 36 months of the new Medicare enrollment would keep the provider agreement from conveying. What this means for sellers: Know your state-specific regulatory requirements before going to market, and ensure your advisor knows how to navigate state-specific regulatory requirements. State-level issues that surface late in a transaction can cause delays and force renegotiations. Do 1099 Caregivers Create Risk When Selling? Home care agencies — particularly those using independent contractors for care delivery — have faced increased scrutiny around worker classification. Federal and state regulators have been active in examining whether caregivers classified as independent contractors should be treated as employees, with significant implications for payroll taxes, benefits obligations, and liability exposure. Buyers are well aware of this issue and typically conduct labor compliance reviews as part of diligence. Agencies with a high proportion of 1099 workers will face questions about the structure of those arrangements and whether they are defensible under applicable law. What this means for sellers: If your agency relies on independent contractors, have a clear and documented rationale for that classification. In some cases, transitioning workers to employee status before going to market may be appropriate. Your advisor can help you assess the risk and determine the right approach. What Does This Mean for Owners Considering a Sale? None of the above should be read as a reason not to sell. Demand across home health, hospice, and home care remains strong for well-positioned agencies, and even companies that don't check every box are transacting — it just requires more preparation, more patience, and more experienced guidance. What it does mean is that the path from LOI to close is more complex than it was a few years ago — and that complexity has a cost. Deals that surface compliance issues or regulatory gaps in diligence are more likely to fall apart, take longer to close, or close at a lower price than the owner expected. The owners who are achieving the best outcomes right now are the ones who understand where they stand before they go to market — clean financials, a billing audit behind them, a clear picture of their Medicare enrollment history and compliance status, no unresolved audits, surveys, or other regulatory issues that could hold up a deal, and an advisor who understands how these issues play out in a transaction. If you are considering a sale in the next one to three years, the best time to start that preparation is now. Cory Mertz, M&AMI, is Managing Partner at Mertz Taggart, a sell-side M&A advisory firm specializing in home health, hospice, home care, and behavioral health transactions. Mertz Taggart has closed more than 109 transactions across 35 states since 2014. To discuss a potential sale confidentially, contact Mertz Taggart at mertztaggart.com.

By Cory Mertz, M&AMI, Managing Partner, Mertz Taggart At a Glance A letter of intent, or LOI, sets the framework for selling your business: the price, the deal structure, and an exclusive period to complete the deal. Most of it is not binding, but the exclusivity usually is. Signing it is the moment your negotiating leverage flips, so the terms are worth getting right before you sign, not after. When you sell a healthcare business, one moment shapes much of what follows more than owners tend to expect: the day you sign a letter of intent. By then, you have a serious buyer, a number on the table, and real momentum, and signing can feel like the deal is essentially done. It usually is not, and a few of its terms carry more weight than they first appear. Here is what to understand before you sign one. What a letter of intent actually commits you to A letter of intent, often called an LOI, is the document a buyer and seller sign to lay out the main terms of a deal and a plan to reach closing. It typically covers the price, the broad structure of the deal, the timeline, and the major conditions that have to be met. Most of those terms are not legally binding, just a statement of intent, a framework both sides agree to work from while diligence is conducted and the details are finalized. A few parts of the LOI usually are binding, and one matters more than the rest: exclusivity. When you sign, you generally agree to stop talking to other buyers for a set period, often 60 to 90 days, while this buyer completes their work. Confidentiality is typically binding as well. So the document that can feel non-committal, because the price is not locked, actually does commit you to one thing that is hard to undo, which is taking your business off the market for everyone else. Your leverage is highest the moment before you sign The reason exclusivity matters so much is what it does to your negotiating position. Up to the point you sign, a well-run sale keeps more than one qualified buyer interested, and that competition is what gives you leverage. Buyers who know others are at the table tend to put forward their strongest terms and move with urgency. The moment you grant exclusivity, that dynamic changes. You have committed to one buyer, the others have stepped back, and the pressure that produced a strong offer is gone. This is why the terms in the LOI deserve real attention before you sign rather than after. Anything you would want to negotiate, whether on price, structure, or conditions, is easier to address while you still have alternatives. It also helps to keep the exclusive period as short as is reasonable, with clear milestones and a firm end date, so a buyer cannot let diligence drift while your business sits off the market. → Related: Seller Beware: Going Direct with a Buyer Could Cost You Millions The price in the LOI is not the price you close on The number written into the LOI is a starting point, and the period that follows it is where that number gets tested. After both sides sign, the buyer begins detailed due diligence, a close review of your financials, contracts, compliance, and operations. That review can confirm the offer, or give the buyer reasons to lower it, a practice known in the industry as re-trading, and it is most likely when diligence turns up something the buyer did not expect. The best protection against a re-trade is built before you ever sign. Clean, well-organized financials, documented compliance, and earnings a buyer can verify give a buyer far less room to revise the number downward. It also helps to understand the buyer’s reputation. Some buyers are known for honoring their LOI, and others are known for using diligence to chip away at the number. That history is worth knowing before you take your business off the market for them. Read the deal structure before you sign, not after An LOI does more than name a price. It also sets the structure of the transaction and that structure is hard to renegotiate once you are committed. The LOI sets how the purchase price is paid: how much is guaranteed cash at closing, and how much is tied to what happens later, through pieces like rollover equity, a seller note, holdback, or an earnout. Weighing those pieces against each other is a subject of its own. The point at the LOI stage is simpler, because these terms are far easier to influence before you sign than to define or, worse case, renegotiate afterward. Look closely at how much of the price is guaranteed versus conditional, and treat the conditional portions as possibilities rather than certainties. Earnouts in particular deserve scrutiny, and we generally push back on them and try to keep them out of a deal, or we simply treat them as “icing on the cake”. → Related: Have an Offer to Buy Your Home Care Agency? What to Do Next The buyer behind the LOI decides whether it closes A signed LOI is only as good as the buyer’s ability and intent to finish the deal. The risk here is specific to the LOI. Once you grant exclusivity, a buyer who cannot finish the deal has tied up your no-shop period and your momentum. If the deal then falls apart, you are back at the start, after months spent on a buyer who could not close. So, before you sign, it helps to understand whether the buyer can actually fund and complete the transaction. A buyer with capital in hand tends to move quickly and predictably, while one who still has to raise the money, or who has a habit of renegotiating, brings more risk. A high number is not worth much from a buyer who cannot get to closing. The stretch between the LOI and the closing table is where deals are most often won or lost. It is detailed and demanding, and it is where unexpected problems tend to surface. Many advisors step back once the LOI is signed. Staying closely involved through diligence and closing, keeping the process moving and heading off problems before they become leverage for the buyer, is where advisors earn their keep. Key Takeaways A letter of intent sets the framework for the deal: price, structure, timeline, and an exclusive period. Most of it is not binding, but the exclusivity usually is. Your leverage is highest right before you sign. Once you grant exclusivity, the other buyers step back and the pressure that produced a strong offer is gone. Get the terms right before you sign, not after. Keep the exclusive period as short as is reasonable, with clear milestones and an end date. The price in the LOI can still move. Clean, verifiable financials are the best protection against a buyer lowering the offer during diligence. Read the structure carefully. Separate what is guaranteed cash at closing from what is conditional, such as rollover equity, seller notes, and earnouts. A signed LOI is only as good as the buyer’s ability to close. A buyer who cannot fund the deal can cost you hours of your time, the ability to move forward with another buyer and your momentum. Deciding whether to sign an LOI, and on what terms, is one of the most consequential moments in selling a business, and it is far easier with someone who has been through it many times. Mertz Taggart is a healthcare M&A advisory firm that represents owners through the sale of their businesses, from the first conversation through diligence and closing. We help owners understand what an LOI really commits them to, hold the line on terms, and keep deals moving to a close. If you have an LOI in front of you, or expect one before long, it is worth a confidential conversation before you sign. Let’s talk.

By Kevin Taggart, CM&AP, Managing Partner, Mertz Taggart At a Glance When buyers make offers on a behavioral health business, most owners look first at the multiple. That’s understandable, but it can be misleading. A strong offer depends on more than the headline number. Owners should look closely at how much cash they’ll receive at closing, how much of the price is tied to future conditions, and whether the buyer is truly able to close at the value presented. If you own a strong behavioral health business, buyers are reaching out. Private equity firms, larger operators, and investor groups building platforms in the space are all actively looking, and it is not unusual for more than one to reach out in the same week. At some point, those conversations may turn into real offers. When they do, it’s natural to focus on the multiple. A multiple is simply how many times your normalized cash flow (or Adjusted EBITDA) a buyer is willing to pay. If your business earns $2 million a year and a buyer offers eight times earnings, that suggests a $16 million deal. That shorthand is useful, but it can also be misleading. A multiple doesn’t tell you how much money you’ll receive at close, how much risk is built into the offer, or whether the buyer can execute. Why the multiple is only part of the picture A multiple only matters in relation to the earnings figure behind it. Most buyers start with adjusted EBITDA, which is a measure of normalized earnings before interest, taxes, depreciation, and amortization. But not every buyer calculates adjusted EBITDA the same way. One buyer may use last year’s results. Another may use the most recent few months and annualize them. A third may factor in synergies. That means the same multiple can produce very different results. Two offers that look far apart on paper may be much closer in actual dollars. Two offers that look similar may not be similar at all. For example, one buyer may offer seven times AEBITDA and another may offer five times AEBITDA. At first glance, seven sounds better. But if the seven-times offer is based on last year’s lower earnings, and paid out over time, while the five-times offer is based on the business’s current performance, and paid in cash at closing, the lower multiple may actually produce more value. Before comparing offers, there are many questions worth asking each buyer. Two of the most important: How are you determining adjusted EBITDA? How is the purchase price paid out? Then compare the dollars, not just the multiple. What reaches your account matters more than the headline number The number a buyer quotes is usually the total value of the deal. It is not necessarily the amount you take home at closing, or ever. Several items can reduce the cash you receive at closing. Business debt is typically paid off first. There will likely be a working capital target and subsequent adjustment to account for the cash and short-term assets needed to keep the business operating. A portion of the purchase price is always held in escrow for a period after closing to cover any liabilities that arise from the seller's period of ownership. Other forms of consideration that affect your net proceeds include a seller note or an earnout. Once those items are factored in, two offers with the same headline value can produce very different outcomes. A slightly lower offer with more cash at closing, a cleaner working capital adjustment, and no earnout may be stronger than a higher offer with more conditions attached. The number worth comparing is not only the purchase price. It is what you are likely to receive, when you are likely to receive it, and how much uncertainty sits between the offer and the final outcome. Not every dollar in an offer is guaranteed Every offer includes some combination of guaranteed money and conditional money. Owners should separate the two before deciding which offer is truly stronger. Cash paid at closing is the most certain part of the deal. Other forms of consideration usually depend on what happens later. One common example is rollover equity. Instead of taking the entire purchase price in cash, you reinvest part of your proceeds into the buyer’s larger company and become a part owner. This can be a meaningful opportunity, but its value depends heavily on the buyer. If the buyer is well-run and continues to grow, the rollover may become worth significantly more than the cash you reinvested. If the buyer struggles, that equity may be worth far less.(maybe add, “even worthless”?) The percentage matters, but the company you are rolling into matters just as much. A seller note is another example. This means the buyer pays part of the purchase price over time, with interest, effectively making you a lender until the note is paid off. An earnout goes a step further, tying part of the purchase price to future performance targets. We generally push back on earnouts and try to keep them out of the deal. When they cannot be avoided, owners should treat that portion of the offer as conditional, not guaranteed. A simple way to compare offers is to start with the guaranteed money. Then look at the conditional pieces separately and ask what has to happen for that money to be paid, and what are the chances of it happening? This will usually be in the form of a range. Who is behind the offer affects whether it closes A strong offer only matters if the buyer can complete the transaction. Not every buyer has capital ready. Some buyers, including many larger private equity firms, have committed capital and can fund a transaction directly. Others raise capital deal by deal after agreeing to buy a business. These buyers, often independent sponsors or search funds, may be credible, but the funding process adds time and risk. That difference matters. A buyer who still needs to raise the money may take longer to close. In some cases, the capital may not come together at all. A slightly higher offer from a buyer still raising funds is not the same as a slightly lower offer from a buyer with committed capital, an industry thesis, and a clear path to closing. In a competitive process, certainty has value. The best offer is not always the highest number. It is the offer that gives the owner the strongest combination of value, terms, buyer fit, and likelihood of closing. Every transaction will have challenges before closing. Understanding who the buyer is, how they plan to fund the deal, and how they behave in the process is essential to separating a real offer from a number on paper. → Related: Seller Beware: Going Direct with a Buyer Could Cost You Millions Why the offer you accept can still change before closing The offer you accept is not always the number you close on. After both sides sign a letter of intent, the buyer reviews the business in detail. That process can confirm their valuation assumptions, but it can also cause the buyer to revise the offer. One of the most important parts of that review is the quality of earnings process. A quality of earnings review examines whether the company’s reported earnings are accurate, sustainable, and supported by the financial records. There is judgment involved, especially around add-backs. Add-backs are expenses a seller adds back to profit because they are not expected to continue after the sale. Different reviewers may reach different conclusions about which add-backs are valid and how earnings should be measured. That is why a strong offer is not only about the number presented upfront. It’s also about how well that number can hold up once the buyer performs their quality of earnings. Clean financials, strong compliance, clear documentation, and a strong management team all help protect value. Those strengths are usually built long before an offer arrives. They give buyers confidence and reduce the chances of a late-stage price reduction. When comparing offers, owners should consider how each offer is likely to hold up during diligence. A slightly lower offer that survives the review may be better than a higher offer that gets retraded before closing. → Related: How to Prepare Your Behavioral Health Business for Sale in 2026 Key Takeaways A multiple is only a starting point. It does not tell you what you’ll actually receive. Compare offers based on actual dollars, cash at closing, timing, and certainty. Separate guaranteed money from conditional money, including rollover equity, seller notes, and earnouts. If rollover equity is part of the offer, evaluate the buyer carefully. The company you join matters as much as the percentage you receive. A buyer with committed capital is generally more likely to close than one still raising money. The offer you accept can change during diligence, so clean financials and strong documentation help protect value. The strongest offer is usually the one that balances price, structure, buyer fit, and certainty to close. Comparing offers is difficult to do on your own, especially when each buyer presents value in a different way. It is also one of the most important parts of a well-run sale process. Mertz Taggart is a healthcare M&A advisory firm that represents behavioral health owners through the sale of their businesses. We help owners look beyond the headline number, understand the real value and risk in each offer, and negotiate from a stronger position through a disciplined, competitive process. If you are weighing an offer now, or expect to receive one soon, it’s worth having a confidential conversation before you respond.

By Cory Mertz, M&AMI | Managing Partner, Mertz Taggart At a Glance Healthcare business owners considering a sale or recapitalization will encounter business brokers, M&A advisory firms, and investment banks. Each serves a purpose, but they operate very differently. Brokers typically handle smaller transactions and market companies broadly. M&A advisory firms run structured, competitive processes targeting strategic and financial buyers. Understanding which path fits your situation can make a meaningful difference in your outcome. Not every transaction requires the same type of advisor. That’s the point I think healthcare business owners need to understand before they start comparing firms, fees, or processes. A business broker, an M&A advisory firm, and an investment bank may all help owners sell or recapitalize a company, but they’re not built for the same situations. This isn’t about one being good and the other being bad. Brokers serve an important role in the lower end of the market. For the right type of business, a broker-led process can make sense. But when you’re talking about a sizable healthcare services business, especially one that could attract strategic acquirers or private equity-backed buyers, the process needs to be different. The advisor you choose should match the business you built, the buyer universe you need to reach, and the outcome you’re trying to achieve. You only get to do this once. Brokers, M&A advisors, and investment banks are not the same thing The lines can get blurry because people often use these terms interchangeably. But there are important differences. A business broker typically works on smaller transactions, often owner-operated businesses generally up to $2–3 million in enterprise value, though the range varies. The process is usually listing-driven. The broker prepares basic materials, markets the opportunity broadly, sometimes through listing websites like BizBuySell, and waits for interested buyers to come forward. That model can work well when the buyer universe includes individuals, searchers, or someone looking to buy themselves a career. They call them listings. For us, they’re engagements. It’s a different mindset. An M&A advisory firm typically works with larger, more complex companies, usually $5 million and above in enterprise value, sometimes lower depending on the situation. Instead of listing the business publicly, the advisor identifies a curated group of strategic and financial buyers, prepares a comprehensive data book and offering memorandum, manages confidentiality, runs buyers through a coordinated process, and negotiates from competitive leverage. An investment bank is a more specific designation. Investment banks are registered with the SEC as broker-dealers. They may be involved in debt raises, capital raises, growth equity, Series A, B, or C financing, and other work that requires that registration. M&A advisory firms are not licensed for that kind of work. What they can do — and what Mertz Taggart does — is represent owners in majority-stake M&A transactions, including private equity recapitalizations. In everyday conversation, people sometimes use “investment bank” to describe any firm running a larger M&A process. But technically, not every M&A advisory firm is an investment bank, and that’s an important distinction. For most healthcare business owners, the more practical question isn’t the label. It’s this: what type of process does my business require? A listing is not the same as a competitive process One of the biggest differences between a broker and an M&A advisor is how the business goes to market. For brokers, the company is often treated like a listing, with an asking price. The business may be posted on a website or marketed to a broad audience. Offers come in as they come in. There is no established timeline. The seller reviews them one at a time. If one looks reasonable, the parties may move to a letter of intent or even a purchase agreement quickly. That can be appropriate for some businesses. But a larger healthcare services company is different. You’re not trying to find just any buyer. You’re trying to identify the right buyer, at the right time, under the right conditions, with the right terms. A competitive M&A process brings qualified buyers to the table on the same timeline, with the same information, and with a clear understanding that they’re competing. That structure changes buyer behavior. It creates urgency. It gives you a better view of the market. And it gives your advisor a stronger position when negotiating price and terms. → Related: 6 Considerations When Choosing a Home-Based Care M&A Advisor Not every transaction is an exit Here’s something else worth understanding. When people hear “selling a business,” they usually picture the owner walking away with a check. That happens, but it’s not the only type of transaction. We draw a distinction between an exit and a transaction. An exit means the owner sells everything and walks away. A transaction can also mean selling a majority stake to a financial partner while usually staying on to run the business — same owner, different capital structure. That second scenario is a big one. A lot of owners have grown their companies to a point where they want to take some chips off the table, bring on a partner with resources, and take the business to the next level. That’s not an exit, that’s a recapitalization, that requires a process built for that kind of buyer. This is typically a financial sponsor (private equity firm, family office, independent sponsor), not an individual looking to buy a business. Why does healthcare M&A require specialized experience? Healthcare transactions are not generic business sales. A home health agency, hospice, home care company, behavioral health provider, or infusion business comes with a specific set of factors buyers will evaluate closely: reimbursement risk, referral diversity, clinical documentation, compliance history, quality metrics, payer mix, transition risk, and management depth. Most owners understand their business operationally but may not know how buyers evaluate those same factors in a transaction context. That's where healthcare-specific experience matters. A good advisor isn't just finding a buyer. The advisor should be helping you understand what buyers will focus on before the business is exposed to the market, which issues are likely to surface during diligence, which buyers are credible, which are known for retrading after an LOI is signed, and which are most likely to value the specific strengths of your company. That kind of judgment is different from general M&A experience, and different again from having built and sold a healthcare business yourself, which is the perspective Mertz Taggart's principals bring to every engagement. The stakes around process and buyer selection are real. The wrong buyer can consume months without closing. The wrong process creates unnecessary market exposure, and in healthcare, where agencies operate in tight-knit communities, confidentiality is not a courtesy. It's a strategic requirement. A company surfacing on a listing website creates a fundamentally different dynamic than one introduced confidentially to a pre-qualified buyer list. The right advisor helps reduce surprises Owners often focus on price, and they should. For many founders, the business represents most of their net worth. Getting the best possible outcome matters, but price is only one part of the transaction. A strong M&A process is also designed to reduce late-stage surprises. That means setting expectations early, preparing buyers properly, managing information flow, and keeping pressure on the process from first outreach through close. Some of the most difficult issues in a transaction don’t show up in the first offer. They show up later, during diligence, legal negotiations, financing, regulatory review, or final closing mechanics. That’s when advisor involvement matters most. In a broker-led process, much of the heavy lifting happens before the LOI is signed. In a larger M&A process, the LOI is not the finish line. It’s the beginning of a more demanding phase. Your advisor should still be there, still pushing, still protecting your interests, still managing the buyer toward close. → Related: How to Sell Your Home Care Agency: 3 PE Exit Strategies Questions to ask before choosing an advisor Before hiring anyone, ask direct questions about the process. The answers will tell you a lot about how they work and whether they’re the right fit for your situation. Who is the likely buyer for my business? Will you market the company broadly, or will you build a targeted buyer list? Will my business be publicly listed anywhere? What materials will you prepare before going to market? How do you protect confidentiality? How many buyers will be contacted, and how will they be screened? Do you have relationships with strategic and financial buyers in my sector? What happens after an LOI is signed? Who will be involved during diligence and negotiation? How do you create competition instead of simply fielding interest? Key Takeaways Business brokers handle smaller transactions and market companies broadly through listing sites. M&A advisory firms run targeted, competitive processes with strategic and financial buyers. Not every transaction is an exit. Some owners are bringing on a financial partner while staying involved. That kind of deal requires a process built for institutional buyers, not individuals. Healthcare M&A requires industry-specific expertise around reimbursement, compliance, quality metrics, and buyer behavior. Generalist approaches can leave value on the table. A competitive process changes buyer behavior. It creates urgency, gives you a clearer picture of the market, and strengthens your advisor’s negotiating position. The LOI is not the finish line. The advisor’s role through diligence, legal negotiation, and closing mechanics is where outcomes are protected or lost. Ask direct questions about the process before choosing an advisor. How they go to market tells you more than what they promise. Ready to learn more? If you’re thinking about what’s next for your healthcare business, whether that’s a full exit or bringing on a financial partner, we’re happy to have a confidential conversation. No pressure. No obligation. Just a straightforward discussion about where you are, what your business might be worth, and what your options look like. Most owners wait longer than they should to start these conversations, not because they aren’t thinking about an exit, but because they aren’t sure if the timing is right or whether the business is ready. Those are questions worth working through with an advisor who knows the market, before you’re in the middle of a process. Mertz Taggart has been advising healthcare services owners for nearly two decades. We know this space because we’ve lived in it. Reach out to start a conversation. Legacy Preserved. Value Enhanced.

By Cory Mertz, M&AMI | Managing Partner | Mertz Taggart | May 2026 At a Glance Home care agency owners have more access to deal data than ever, from published multiples to transaction announcements to AI-generated market summaries. But access to information isn’t the same as having leverage in a negotiation. Buyers know what they are willing to pay for your agency. They also know what you do not know. A competitive, advisor-led process is the mechanism that closes the information gap between sellers and buyers, and it is consistently the difference between an adequate outcome and a top-of-market one. I talk to home care agency owners every week who tell me they already know what their company is worth. They have read the industry benchmarks. They have seen the deal announcements. Some have run their own numbers through AI tools. The information is more accessible than it has ever been. But knowing what range the home care sector trades in and knowing what a motivated buyer will actually pay for your agency are two very different things. That second number only reveals itself when buyers are competing against each other. And the gap between what a buyer offers when they are the only one at the table and what they will pay when three or four others are in the room is not small. In a recent deal, we received twenty-three indications of interest on a single company. The lowest came in at roughly 40% of the highest. Every one of those buyers had the same information about the business. The difference wasn’t what they knew. It was what they stood to lose. What Do Buyers Know That You Don’t? When a buyer contacts you about your home care agency, they have already done more preparation than most owners realize. They know which geographies they need to fill. They know what their portfolio is missing. They know what their investors expect in terms of returns and timeline. And they know, within a tight range, what they have paid for agencies like yours in the past. You typically know none of that. You don’t know what the buyer paid for their last acquisition. You don’t know how urgently their fund needs to deploy capital. You don’t know whether your geography, your payer mix, or your caregiver retention metrics fill a gap that is worth a premium to them. And you do not know whether another buyer would value those same attributes even more. This isn’t a reflection on the seller. It is the nature of the situation. Buyers are professional dealmakers who do this every day. Most agency owners are selling for the first and only time. Even when both sides are acting in good faith, that is not an even playing field. Why “Knowing the Multiples” Can Work Against You An increasingly common pattern: an owner reads that home care companies are trading at a certain range of SDE or EBITDA multiples. A buyer calls and offers something within that range. The owner thinks that is within the benchmarks, so it is probably fair. But “within the range” and “what the market would actually bear for this specific agency” are not the same thing. A published range reflects the full spread of outcomes across deals of varying quality, size, and competitive dynamics. It does not tell you where your agency falls in that spread. And it does not tell you whether the right buyer, under competitive pressure, would go above the range entirely. The bigger risk is subtler. When an owner anchors to a number from a report, they stop asking whether more is possible. They evaluate the offer against the published range instead of against what the market would produce under competitive conditions. And once that frame of reference is set, it is very hard to undo. Worse, when an owner shares their expectations with a buyer, even casually, they create a ceiling. The buyer now has a target to negotiate around rather than a market to compete in. → Related: If a Buyer Approaches You Directly, a Competitive Process Will Almost Always Get You More Money Why This Matters More Now Than Five Years Ago The buyer landscape in home care has shifted considerably. Non-medical home care led M&A transaction volume for eight consecutive quarters through mid-2025, and the sector continues to attract significant private equity interest. New platform investments have created a wave of PE-backed buyers actively pursuing add-on acquisitions to build scale in key markets. Several forces are driving that demand. Aging demographics continue to increase the need for in-home services. Medicaid rate improvements in a number of states have strengthened margins for agencies with meaningful Medicaid exposure. And agencies with strong caregiver recruitment and retention programs are commanding particular attention from buyers who understand that workforce stability is one of the hardest assets to build from scratch. At the same time, agency owners are being contacted more frequently and from more directions than ever before. Private equity groups, strategic buyers, independent sponsors, search funds, even brokers prospecting for a listing. The volume of inbound interest can make an owner feel like they already have options. But receiving interest isn’t the same as creating competition. A competitive process takes that scattered interest and turns it into something actionable: multiple qualified buyers, on the same timeline, evaluating the same materials, with clear deadlines to submit their best terms. That structure is what changes behavior. → Related: Someone Wants to Buy Your Home Care Agency — Now What? What a Competitive Process Tells You About Your Own Agency Running a process doesn’t just produce a better price. It tells you things about your agency that you cannot learn any other way. A financial buyer building a home care platform will value your agency differently than a strategic buyer expanding into your geography. A buyer looking for Medicaid-heavy volume will see a very different opportunity than one focused on private-pay clients. An operator who values your caregiver training program and low turnover may see something that a generalist fund overlooks entirely. You cannot discover any of that by talking to one buyer. You discover it by putting the agency in front of a curated group of qualified acquirers and letting them show you what they see. The result isn’t just a higher number. It is a better understanding of where the real value in your agency lives, and that changes how you negotiate everything that follows. → Related: How to Sell Your Home Care Agency: 3 PE Exit Strategies What You Will Never Find Out Going Direct When a seller closes a direct deal, they walk away believing they got a good outcome. And they may have. But they will never know for sure, because they never tested it. They won’t know that the buyer who approached them was already prepared to bid significantly higher if there had been competition. They won’t know that a different buyer, one they had never heard of, would have valued their service area or their referral relationships at a meaningful premium. They won’t know that the deal structure they accepted was something the buyer would have improved considerably to win a competitive process. That is the real cost of going direct. It isn’t just what you leave on the table. It is that you never see the full table. You make the most consequential financial decision of your career with a fraction of the information you could have had. For most home care agency owners, 80 to 95 percent of their net worth is tied up in the business. That is not a decision that should come down to how one buyer happened to frame their opening offer. The Cost of Getting It Almost Right The hardest situation isn’t the owner who gets a bad offer and knows it. It is the owner who gets a reasonable one. An offer within the published range can feel like validation. It may even feel generous compared to what the owner expected. But if the market would have produced a significantly higher outcome under competitive conditions, that gap is not a rounding error. On a home care agency generating $2 to $3 million in adjusted earnings, even a modest difference in multiples translates to real, irreversible dollars. That is a different retirement. A different outcome for the family. And once the deal closes, there is no going back to test whether more was available. The information to make a better decision exists. It just does not show up in a Google search or a buyer’s opening phone call. It shows up when you put your agency in front of the right buyers, under the right conditions, with someone in your corner who has been through this before. → Related: 7 Common Challenges Home-Based Care Owners Face When Selling Their Agency Key Takeaways Published multiples tell you what category your agency falls into. They don’t tell you what a specific buyer will pay under competitive pressure. Buyers who approach you directly aren’t doing anything wrong. But they are negotiating with an information advantage you cannot close on your own. Receiving inbound interest isn’t the same as creating competition. Structure is what changes buyer behavior. A competitive process doesn’t just produce a better price. It reveals what different buyers see in your agency and how they value it differently. For most home care agency owners, the business represents 80 to 95 percent of their net worth. That is reason enough to let the market show you what it is willing to pay. For over twenty years, Mertz Taggart has advised home health, home care, and hospice owners on sell-side transactions. If you are weighing your options, whether a buyer has already reached out or you are just starting to think about what comes next, we are happy to have a confidential conversation. Request a confidential valuation → About the Author Cory Mertz, M&AMI, is a managing partner at Mertz Taggart, where he advises home health, home care, and hospice owners on selling their businesses. With over two decades in healthcare M&A and firsthand experience owning and operating a healthcare business, Cory brings a practitioner’s perspective to every engagement.

Why Exit Does Not (and Should Not) Mean Retirement Many people assume that when the subject of “exit” comes up with a business owner, we are discussing the owner’s retirement. This is not always true, and assuming it is true creates problems for owners, their companies, and their families. Exit does not have to mean retirement. Separating exit and retirement (and approaching them differently) makes for better exit planning, a smoother transition for the company, and happier life for the owner and his or her family. Here’s why. Business owners typically interact with their companies in three ways: Ownership – you own some or all of your company Involvement – you are engaged in your company’s activities, usually on a day-to-day basis Leadership – you are a leader within your company, typically the chief executive or similar level Put these three letters together and you get the word OIL. It’s helpful to remember this acronym because it can help owners better understand their personal exit goals and build flexibility into the exit planning process. The OIL Doesn’t Need to Flow Together In most situations, business owners think about and act as though their ownership of the company, their involvement within the company, and their leadership over the company are completely intertwined and inseparable. In other words, the OIL must always flow together. Owners often think this way because that’s how it’s been during their careers. Business ownership dominates their financial reality, they are fully involved in the company from a time and emotional standpoint, and they are clearly a leader over the company. However, the OIL does not need to flow together. You could sell some or all of your ownership of your company but remain fully Involved in the company and continue as the key leader. Or, you could keep your ownership of your company but hire a new CEO (or equivalent) to replace you as the company’s leader. Both examples demonstrate that you can pursue and implement different timelines for reducing or ending your ownership of the company, involvement in the company, and leadership over the company. Sure, sometimes at exit all three things end at once, but it does not have to be that way. You absolutely can “exit” your company but not retire. Overcome 3 Common Exit Planning Challenges All of this is significant because sometimes business owners get stuck in their “exit planning” if they think and act as though the OIL must always flow together. Here are three common exit planning challenges, and how thinking about OIL differently can lead to exit success: You want to sell some or all of your business to “take some chips off the table,” but you are worried about not knowing what you would do with yourself because you don’t want to retire. Well, we now know that you don’t have to retire. Consider targeting buyers who will acquire some or all of your company but want to keep you around and can offer exciting opportunities in the new organization. You want to sell your company to one or more employees, but you are worried about control — you must make sure the company performs well while buying you out. Well, we now know that you can continue to be involved in the company and remain the leader over the company while selling your ownership of the company. It’s possible for your ownership to decrease to nothing while you remain the chief leader of the company! (Ask us how to do this.) You want to pass your business down to one or more family members, but you don’t want to retire for now (and maybe never), nor do you want to give up control just yet (and maybe never). It’s possible to transfer some to all of your ownership to those family members without ever retiring (meaning without ending your involvement) and without giving up leadership unless and until you are ready. (Ask us how to do this.) Assuming that exit equals retirement creates roadblocks to exit success for the owner, his or her family, and his or her company. A better approach is to think about O, I, and L separately, and examine how unbundling these issues can create a better exit plan. -Mertz Taggart

The Simple Little Org Chart Can Produce Big Value at Your Exit Few business tools are as overlooked and underappreciated as the organizational (“org”) chart. Likely, you have diagramed one for your company. We tend to pull them out at specific moments such as when we need to meet with a third party like a vendor, customer, lender, or new hire. If out of date, which they often are, we quickly update them. Then, after the meeting, the chart gets put away, forgotten until the need arises to pull it out again. Most business owners stop there, having no further use for this unexciting little instrument. But hidden within the org chart is the potential to drive significant value in your company between now and exit. Here’s how. The Future Org Chart Exercise Convene your leadership team for an exercise called “The Future Org Chart.” Pick a future period of time such as three to five years out, and lead the team through the process of diagramming what the company org chart must look like on that date in order to support the expected growth between now and then. Choose a date that matches up with the growth plans and timetable defined in your company’s long-term strategic growth plan. Start with a completely blank sheet, and then discuss and fill in the organizational structure needed to realize and support this growth. Assign job titles (those are the boxes) and define reporting roles and relationships (those are the connecting lines), but do not assign current employees to the future org chart — not yet. You and your team will be tempted to start filling peoples’ names in the boxes, but it is important that you do not do this until you have a completed org chart that the entire team agrees with and supports. At this point, you now have a clear and written vision for the team that is required to grow and lead your company over the next three to five years. Meeting With Your Leaders There’s more to be gained. With the Future Org Chart template built, it is time to put names in the boxes. We recommend you meet individually and confidentially with your leaders to get their input because some of these conversations involve people’s careers: Some of your employees may have ambitions about climbing the organizational ladder and progressing into one of the higher positions forecasted in the Future Org Chart. Some employees may aspire to occupy a position currently occupied by another person. The Future Org Chart may call for adding new management layers into the company, and some employees may worry about being eclipsed or losing status if the level they currently occupy is subsidiary to a new level above it. Issues or opportunities uncovered by these one-on-one conversations have the potential to be good for both the team and the company. Leaders aspiring to do more and earn promotions can be trained and coached on what is necessary to achieve their goals, and any fears about growth can be addressed. By necessitating these conversations, the Future Org Chart helps you develop and grow your current team. Assigning Names After receiving input from your team members, now it’s time to finally put current employees’ names in the appropriate boxes within the Future Org Chart. Once done, you may see the following: Some newly created positions have empty boxes. This indicates that to create the team of the future, your company will need to identify and hire a person qualified to fill that need. Some existing positions that are currently occupied become empty between now and the Future Org Chart’s effective date. This reveals some succession planning that must take place, typically because the employee currently occupying that position is retiring sometime within the next few years. Some names are listed in multiple boxes. This indicates that you have some people doing too many things. You may need to find ways to add new talent into the picture to reduce the organizational dependency on any one person who is over-allocated. The most important person to be wary of here is yourself — as the business’s owner, you cannot remain directly involved in too many functions. If the company is overly dependent on you it will be difficult if not impossible to achieve a successful exit. Some names do not belong in any box. This might happen for a couple of reasons. Perhaps the employee is not in alignment with the rest of the organization, and this exercise is shining a light on that challenging reality. Alternatively, perhaps the direction and pace of the company’s growth will eventually eliminate the need for a person’s role and skills. In either situation, it is best to recognize these inconsistencies and develop a response rather than miss or overlook the issue. With this exercise complete, you now have a written picture of what the company’s team needs to look like in the future, as well as specific insights on what work needs to be done to make that future happen. The Future Org Chart exercise provides you with a road map for the company’s coaching, training, hiring, succession, and team development needs in order to realize the desired growth over the next several years. From there, you and your team can develop the plans and incremental steps required to migrate from the current organization to this organization of the future. Maximizing Company Value Having a solid plan for growth and the right team to achieve that plan would be reason enough to complete a Future Org chart, yet there is one final benefit for you to reap from this exercise. Building a competent team for the future that can deliver on this growth drives value in your company, which in turn supports achieving your exit goals: getting maximum value for the company, building a sustainable organization, and leaving on your own terms. All of this is from the simple, little, often-overlooked org chart.

If you’re an owner of a behavioral health company, chances are you are getting approached regularly, even daily, by private equity groups, strategic buyers, independent sponsors, and search funds, all eager to talk. Some may have suggested attractive “multiples” that they will pay for companies like yours. It sounds flattering, even tempting. You think, “I’ve got a willing buyer, let’s keep it simple and cut out the middleman.” Think again. We know how this might sound. Yes, we’re advisors — and yes, we benefit when sellers hire us. But stay with us. This isn’t a sales pitch. Whether you work with us or another experienced advisor or banker, this is about making sure you don’t leave millions on the table. Here’s why: 1. It’s Not Just About Finding Buyers – It’s About Finding Your Ideal Buyer In today’s market, especially in the behavioral health sector, there is no shortage of buyers. If you own a solid business, you’re most likely getting approached regularly. You may even be thinking, “I don’t need a banker; the buyers are coming to me.” But here’s the reality: finding a buyer is the easy part. Finding the right buyer, getting top-of-market terms, and protecting yourself through diligence, closing, and post-closing reconciliation — that’s the hard part. That’s where a competitive, advisor-led process delivers real, measurable value. 2. Good People – Even Better Negotiators Buyers may seem friendly. Most are genuinely high-integrity people. But don’t forget who they work for: investors. And their job is to get the best deal possible — for them, not for you. Private equity firms, in particular, are professional dealmakers. They do this every day. They know what levers to pull. They know how to frame their offer just right to make you feel like you’re winning, even when the deal is structured entirely in their favor. Meanwhile, most business owners are selling for the first (and only) time. That’s not an even playing field. 3. Even PE Firms Hire Bankers When They Sell — Why Don’t You? Here’s a telling fact: when private equity groups go to sell a portfolio company, they almost always go through a banker-led competitive process. Why? Because they know it’s the only way to: Maximize valuation and terms Maximize closing certainty Generate competitive tension among buyers Create backup options if the chosen buyer drags their feet or tries to renegotiate post-LOI If the pros won’t go to market without an advisor, why would you? 4. Where Many Sellers Slip: Naming Your Price First It often starts with a simple question from a buyer: “How much do you want for your company?” You give them a number. They come back with something just below that, maybe with some “stretch” language to make it feel generous. But look closer at the deal: There’s a seller note (you’re effectively financing the buyer) Payments are deferred (vs cash at close) There’s an earnout (you’re taking on all the post-close performance risk) You’re rolling equity, but you’re last to get paid from a liquidity event, and often at a diluted value It’s not just about the headline number — it’s about structure, terms, timing, and control. And most self-negotiated deals get structured in ways even the well-informed seller doesn’t fully understand until it’s too late. 5. “Fair” ≠ “Market” Buyers love to position their deals as “fair.” It sounds reasonable. It sounds cooperative. But in practice, it’s a subjective term – one that can make a deal seem better than it is. “Fair” is subjective. “Market” is real. And unless you’ve run a proper process and seen multiple offers, you don’t know what “market” is. That’s how buyers keep you in the dark — and get you to accept less than you could have achieved. 6. Premium Companies Get Premium Outcomes Strong, high-performing companies don’t just deserve “a good deal” — they often receive something better: a premium. We always give valuation guidance to our clients before going to market — informed by comps, investor sentiment, experience, and current deal trends. But we’re often pleasantly surprised by where the market actually takes the deal, especially with premium businesses. Why? Because when the right buyer meets the right opportunity at the right time, strategic motivation can drive valuations far above guidance. It’s not uncommon to see bidding wars erupt over highly differentiated companies — and those wars don’t happen without process, positioning, and pressure. If you’re running a great company, don’t settle for “reasonable.” There’s a good chance your business is worth more than you think — but only if you let the market tell you. 7. We’ve Seen This Movie Before — And Changed the Ending We’ve had multiple clients approach us after they’d already negotiated a letter of intent directly with a reputable, strategic buyer. They were ready to sign. Each time, we reviewed the deal. We saw opportunities to push back. To create leverage. To run a fast but focused market process, all while keeping the buyer interested and at bay. Each time, we got them a significantly better deal. In some cases, it was with the same buyer. In others, it was a new buyer altogether. Either way, just introducing competition changed everything — often adding millions to the final purchase price and dramatically improving the terms. Even the threat of competition made buyers step up. That’s how leverage works. 8. Think You’re Saving Money? Think Again. Some sellers avoid hiring an advisor because they think they’re saving money by going direct. Hiring a banker is not a cost. It’s an investment. And like any smart investment, it comes with a return — one that pays off at closing, in the form of a better price, better terms, and higher certainty of close. It’s a performance-based investment with virtually guaranteed, immediate ROI. 9. Better Odds of Closing. Better Terms at Close. Deals fall apart for all kinds of reasons — diligence issues, financing delays, buyer fatigue, retrades. But when sellers work with an experienced advisor who runs a real process, the odds of closing go up dramatically. And just as important, the odds of closing on the originally agreed terms go up too. Buyers are far less likely to drag their feet or re-cut a deal if they know there are other interested parties waiting in the wings. And they will not want to have a reputation in the behavioral health M&A world as less-than-honest dealmakers. You’ve Heard Our Perspective We’re not asking you to take it on faith — we’re asking you to look at the facts, the market, and what happens when real competition is introduced. Whether you work with us or not, make sure you’re not negotiating alone. The Bottom Line When a buyer approaches you directly, they’re doing what buyers do — trying to get the best possible deal for themselves. There’s nothing wrong with that. But it means the process will be tilted in their favor unless you change the dynamics. That’s what an advisor does. We reset the playing field. We bring the right buyers to the table, create competition, and ensure you’re in a position of strength throughout the process — not just at the LOI stage, but all the way through diligence and closing, and often even beyond. You’ve spent years building your business. When it’s time to sell, you deserve more than just a “reasonable” offer. You deserve a market-tested outcome that reflects the true strategic value of what you’ve built.

By Cory Mertz, M&AMI, Managing Partner — Mertz Taggart | Updated March 2026 If you’ve decided to explore selling your home health, home care, or hospice agency, one of the first, and most important, decisions you’ll make is who to work with. There are a lot of firms reaching out to agency owners right now. Some are well-established advisory firms with deep healthcare experience. Others are generalist brokers. Some are newer entrants still building their track records. And increasingly, buyers themselves are reaching out directly, hoping to start a conversation before you’ve engaged any representation at all. Here's something we believe strongly: finding a buyer for your agency is the relatively easy part. There's no shortage of active buyers in home-based care right now, and most of them are personable, credible operators. But here's the question that matters more: how do you know which buyer is the ideal buyer for you and your agency? That's where the process makes the difference. What separates a good outcome from a great one is having an advisor who can run a confidential, competitive process that surfaces the right buyers, maximizes your value, navigates diligence, and gets you to a closing with few surprises. That takes a particular kind of firm. Executive Summary: When choosing an M&A advisor to sell your home care agency, evaluate six things: their credibility with active buyers, their ability to run a confidential competitive process, their track record in healthcare transactions, their willingness to be candid about valuation, their communication and negotiation skills, and their depth of knowledge in the home-based care industry. 1. Does the Firm Have Credibility with the Buyer Community? This is one of the most overlooked factors, and one of the most important. The firm representing you needs to have earned the respect of the buyers and investors who are active in home-based care M&A. That credibility directly affects how buyers respond to the marketing materials, how they view the financial adjustments your advisor presents, and how negotiations unfold. Buyers respond well to firms they know, firms that have a reputation for thorough preparation and honest advocacy. When a respected advisory firm brings a deal to market, buyers take it seriously from the start. They know the process will be well-run, the information will be credible, and the advisor will hold them accountable throughout. You can get a feel for this by asking about the firm’s experience with active buyers in the space, the kinds of transactions they’ve recently brought to market, and how they position clients with sophisticated buyers. A strong advisor should be able to answer those questions clearly and confidently. 2. How Will the Firm Protect Confidentiality? Confidentiality is one of the biggest concerns owners have when considering a sale, and for good reason. If word gets out prematurely, it can unsettle your employees, your referral sources, and your patients. Ask your prospective advisor how they handle confidentiality at each stage: How do you curate your target buyer or investor list? Will your agency be listed publicly, or is the outreach targeted and discreet? Some firms rely on online listings or broad-market blasts that can give competitors and local agencies clues about your intentions. A thoughtful advisor tailors the process to your situation, reaching the right buyers without exposing your business to unnecessary risk. Every transaction is different, and a good advisor will customize their approach based on your specific goals, your local market, and your timeline. 3. What Is the Firm’s Track Record in Healthcare M&A? Experience matters, but the kind of experience matters even more. You want a firm that has completed meaningful transactions in the home-based care space specifically, not just healthcare broadly, and not just a handful of deals. Ask about the number and types of transactions they’ve closed. Look for evidence that they’ve worked with agencies similar to yours. Client testimonials and case studies can give you a sense of how the firm handled the complexities that come with healthcare deals. A firm with a strong track record in your sector will also know the active buyer landscape well, including who’s acquiring, what they’re looking for, and what terms are realistic in the current market. → See examples of completed transactions on our Transactions page. 4. Will the Firm Be Candid with You About Valuation? This one is worth paying close attention to. When you’re evaluating advisors, you’ll likely get a sense of what they think your agency is worth. Be cautious of any firm that leads with an unusually high valuation, especially before they’ve done any real analysis. An inflated number can feel good in the moment, but it’s often a tactic to win the engagement rather than an honest assessment of what the market will bear. Most advisory engagements include a one-year term, plus a tail period of 18–24 months covering any buyers the firm introduced during the engagement. That’s a meaningful commitment. You want to make sure you’re entering it with a firm that’s being straight with you, not one that overpromised to get your signature. The right advisor will let the market determine value through a well-run competitive process, and they’ll help you understand the range of likely outcomes based on real data and current M&A marketplace. 5. How Will the Firm Communicate and Negotiate on Your Behalf? Selling a home care agency is a complex process with a lot of moving parts: attorneys, accountants, due diligence teams, and multiple buyer conversations happening simultaneously. Your advisor is the person managing all of it on your behalf. Their ability to communicate clearly, keep you informed without overwhelming you, and advocate for your interests in negotiations is what separates a good experience from a stressful one. During your initial conversations with an advisor, pay attention to how they communicate with you: Are they responsive? Do they explain things in plain language? Do they listen to what matters to you, or do they default to a one-size-fits-all pitch? The way a firm treats you before they have the engagement is usually a good indicator of how they’ll treat you after. On the negotiation side, look for a firm that’s comfortable holding firm when it matters, on price, on deal terms, on timeline, while maintaining constructive relationships with the other side. The best outcomes happen when your advisor earns both your confidence and the buyer’s respect. 6. Does the Firm Truly Understand the Home-Based Care Industry? Healthcare M&A is not the same as selling any other business. Home health, home care, and hospice agencies operate in a world of state licensing, Medicare certification, Medicaid reimbursement, and clinical compliance requirements that directly affect valuation and deal structure. An advisor who doesn’t understand these dynamics can miss things that cost you real value. Industry expertise also means knowing how buyers in this space think and operate. Strategic acquirers (larger home care companies building regional scale) evaluate deals differently than PE firms assembling healthcare platforms. A knowledgeable advisor can position your agency in a way that resonates with both buyer types and highlights the specific value drivers that matter in your sector. Ask your prospective advisor about the subsectors they’ve worked in and how they stay current on market trends. An advisor who publishes original research, speaks at industry conferences, and engages with the home-based care community is more likely to bring the depth of insight you need. Choosing Well Is Worth the Time Deciding to sell your agency is often the biggest decision of an owner’s career. For most home care owners, the business represents not only their livelihood but also their life’s work, their team, and their reputation in the community. The firm you choose to represent you will shape every part of the experience, from the initial valuation guidance through closing and beyond. Take the time to ask the right questions. Talk to more than one firm. Pay attention to how they make you feel, not just what they promise. And remember: the goal isn’t just to find someone who can sell your agency. It’s to find someone who will protect your interests, maximize your value, and help you feel confident through every step of the process. Want to learn more about how we work? We’re happy to walk you through our process, answer your questions, and help you understand your options — with no pressure and no obligation. Start a confidential conversation → About the Author Cory Mertz, M&AMI, is a managing partner at Mertz Taggart, where he advises home health, home care, and hospice owners on selling their businesses. With nearly two decades in healthcare M&A and more than 160 completed transactions across the firm, Cory brings firsthand experience to every conversation.

By Cory Mertz, M&AMI, Managing Partner — Mertz Taggart | Updated March 2026 Executive Summary: Owners of home health, hospice, and home care agencies are often approached by buyers before they are actively planning a sale. While those inquiries can be useful, they should be handled carefully. A buyer-led conversation rarely produces the best possible outcome for the seller. Agency owners should prepare before responding, understand how professional buyers approach acquisitions, and consider working with an experienced healthcare M&A advisory firm if they are seriously considering a sale now or in the future. If you own a home health, home care, or hospice agency, you already know the feeling. The emails. The LinkedIn messages. The phone calls from people you’ve never met, saying they want to buy your company. It’s flattering. It’s a little overwhelming. And if you’re at a point in your career where you’ve thought about what’s next, it can be tempting to engage. But here’s what most agency owners don’t realize: an unsolicited offer isn’t really an offer. It’s an opening move. The buyer doesn’t know your financials, your payer mix, your retention numbers, or what makes your agency special. If they’re quoting a “multiple of X” or telling you they paid “Y for a company just like yours,” they’re working with assumptions, not information. When a buyer contacts you about purchasing your home care agency, don’t ignore the inquiry, but don’t rush into it either. Take time to research the buyer, understand your agency’s true value, and consider engaging a healthcare M&A advisor who can help you evaluate whether it’s the right time and the right opportunity. That doesn’t mean you should ignore these inquiries. They can actually be useful. But how you respond matters a great deal. Here’s how to approach it thoughtfully. How Should You Respond to an Unsolicited Offer for Your Agency? The most important thing is not to rush. You don’t need to respond the same day, and you certainly don’t need to share any confidential information in an initial conversation. Before you reply, take a few steps to understand who you’re dealing with. Look at their LinkedIn profile and company website. If it’s a buyer (not a broker), check whether they’ve completed previous acquisitions in home care, hospice, or home health. If the identity of the buyer is vague or hard to verify, that’s a reason to proceed carefully. If someone claims to be a broker representing a buyer, a credible one will share the buyer’s name early in the conversation and be clear about who’s paying their fee. Be cautious of brokers who initially claim to have a buyer, then pivot to pitching themselves as your sell-side representative. When you do respond, keep it simple. Ask how they plan to finance the acquisition and what drew them to your agency specifically. A serious buyer will have clear answers. Then let them know you’ll want to consult with an advisor before moving forward. Any credible buyer or investor will respect that, and in fact, most of them appreciate having a professional intermediary in the process because it sets clear expectations on both sides. Should You Sell Your Home Care Agency to the First Buyer Who Reaches Out? We understand the appeal. When someone puts a number on the table, especially if it sounds reasonable, it’s natural to want to explore it. But in our experience, negotiating with a single buyer almost always results in a lower price and less favorable terms than a structured process with multiple qualified parties. Think about it from the buyer’s perspective. If they know they’re the only one at the table, there’s no urgency to put forward their strongest offer. They can take their time, ask for more concessions, and renegotiate after due diligence. When there are multiple interested parties, the dynamic changes. Buyers who know others are interested tend to move more decisively and submit more competitive terms. This is exactly how private equity firms handle every one of their exits. They hire an investment bank or M&A advisory firm to run a competitive process with a curated group of qualified buyers and investors. They believe, and we’ve seen it confirmed over and over, that this is the most reliable path to the best possible outcome for the seller. → Related: How to Sell Your Home Care Agency: 3 Exit Strategies from Private Equity What Makes a Buyer “Qualified” to Acquire a Home Care Agency? Not every buyer who reaches out is the ideal buyer for your agency. Whether you’re working with an advisor or evaluating interest on your own, it helps to understand what separates serious acquirers from casual shoppers. A qualified buyer generally meets three criteria: They have the financial resources to complete the transaction, including access to sufficient cash or a committed fund. A professional buyer won’t hesitate to share this information with you or your advisor. They understand the home-based care industry. Strategic buyers will naturally have this knowledge, but if you’re speaking with a financial buyer or PE firm, you want to make sure they’re well-educated on the sector before you invest time in the process. They have meaningful transaction experience. Most serious strategic acquirers have dedicated M&A teams. Smaller or newer buyers may struggle to execute efficiently, which can extend timelines and introduce risk. Building an “A-list” of buyers who meet all three of these criteria is one of the most valuable things an M&A advisor does. It’s also one of the hardest to do on your own, because it requires knowing who’s actively acquiring, what they’re looking for, and how to approach them confidentially. Why Does Confidentiality Matter When Selling a Home Care Agency? This is something that weighs heavily on owners, and rightly so. If word gets out that you’re exploring a sale, it can unsettle your employees, your referral sources, and even your patients. In some cases, it can disrupt the sale itself. An experienced healthcare M&A firm protects confidentiality by controlling what is shared, with whom, and when. The right information is shared with the right buyer at the right time, so you can create interest without exposing details too early or disrupting the business. This is one of the key reasons we encourage owners not to engage deeply with unsolicited buyers on their own. One conversation with the wrong person, at the wrong time, can create problems that are difficult to walk back. What Does a Healthcare M&A Advisor Actually Do? One of the main benefits of working with a healthcare M&A advisory firm is that it lets you stay focused on what you do best, running your agency, while your representatives handle the details of the transaction. A good advisor takes the time-intensive work off your plate: preparing and updating the financial data book and Confidential Information Memorandum, curating the buyer list, running the competitive bid process, coordinating with attorneys and accountants, and addressing potential roadblocks before they become deal-breakers. They also bring perspective on what’s considered “market” for both value and terms, so you can negotiate from a position of knowledge rather than guesswork. For home health, home care, and hospice owners, working with an advisor who specializes in healthcare M&A is especially important. A healthcare-focused advisor understands how buyers in this space evaluate agencies, what they are willing to pay for, and how to position the business credibly in the market. They can also spot issues early, help resolve them before going to market, and bring added credibility with buyers because they understand the industry and can speak their language. → See how Mertz Taggart has guided agency owners through successful transactions on our Transactions page. It’s Never Too Early to Understand Your Options Receiving an inquiry about your agency can be the start of an important conversation, even if you’re not ready to sell today. The best way to respond from a position of strength is to understand what your agency is worth, what the current market looks like, and what a well-run process can deliver. For most home care owners, 80–95% of their net worth is tied up in their business. That’s reason enough to treat the sale like the significant financial event it is, with the right preparation, the right team, and the right process behind you. Curious about what your agency is worth? Mertz Taggart provides confidential, complimentary valuations for home health, home care, and hospice agency owners. Whether you’re considering a sale now or just want to understand your options, we’re happy to have the conversation. Request a confidential valuation → About the Author Cory Mertz, M&AMI, is a managing partner at Mertz Taggart, where he advises home health, home care, and hospice owners on selling their businesses. With nearly two decades in healthcare M&A and more than 160 completed transactions across the firm, Cory brings firsthand experience to every conversation.

By Cory Mertz, M&AMI, Managing Partner — Mertz Taggart | Updated April 2026 Executive Summary: Insights from a recent webinar with Maxwell Healthcare Associates and Mertz Taggart. A buyer is not just valuing what a home health or hospice agency has earned. A buyer is valuing how durable those earnings look, how transferable the business feels, and how much risk comes with the transition. At a glance: Revenue matters, but buyers also evaluate the quality of earnings and the reliability of the reporting behind them Accrual-basis financials help buyers assess performance more accurately Operations matter, especially intake, scheduling, productivity, revenue cycle, and payer workflows Technology matters when it improves reporting, efficiency, and transition readiness Cultural fit matters because disruption after closing can affect retention, service delivery, and performance In a recent webinar hosted with Maxwell Healthcare Associates, Mertz Taggart managing partner, Cory Mertz, and Maxwell’s COO, Jay Duty, walked through the key factors that drive how home health and hospice agencies are valued in an M&A transaction. What Financial Metrics Do Buyers Look at When Valuing a Home Health or Hospice Agency? When we assess a company on behalf of a seller, we focus on three high-level financial metrics: revenue, gross margin, and adjusted EBITDA margin. Revenue is where it starts. Generally, larger agencies with higher revenue tend to command stronger multiples, all else being equal. Gross margin tells you how much is left after your cost of providing care, things like: clinician compensation, burden costs, travel, and supplies. Healthy ranges often look like this: Home health: 45% to 55% Hospice: 50% to 55% Home health can be more variable depending on revenue mix, including episodic revenue, Medicare Advantage, Medicaid, VA reimbursement, and geography. Adjusted EBITDA margin is what’s left after subtracting overhead from your gross profit, with certain adjustments factored in. Ranges often viewed as attractive include: Home health: 15% to 25% Hospice: 18% to 25% But adjusted EBITDA is rarely simple. Different buyers may evaluate the same agency differently depending on: owner involvement replacement cost retention cost growth trajectory time period under review what the buyer believes is sustainable after closing That is why a multiple means very little without a credible view of adjusted EBITDA. One important detail: buyers evaluate these numbers on an accrual basis, not cash basis. That means revenue is recognized when it’s earned, and payroll is matched to the month the work was performed. The goal is to line everything up so that margins are consistent from month to month. If your books are on a cash basis, having them converted to accrual before going to market gives buyers, and you, a much clearer picture. Why Is Adjusted EBITDA So Important, and So Variable? Adjusted EBITDA is the number that multiples are applied to, which is why it matters so much. But it’s also one of the most variable parts of a valuation. Two buyers can look at the same company and arrive at different adjusted EBITDA figures, and both can be reasonable. The adjustments depend on factors like: the time period being evaluated (pro-rata, trailing twelve months, or another period), whether the company is growing, and how the buyer models replacement or retention costs for the owner after closing. This is worth keeping in mind if someone approaches you with a high multiple. A multiple doesn’t mean much without understanding what it’s being applied to. An advisor or broker who leads with a lofty multiple before doing a thorough analysis of your financials may not be giving you the full picture. The more valuable conversation is one that starts with what your adjusted EBITDA actually looks like, on an accrual basis, with honest adjustments, so you can make a sound decision about whether and when to go to market. How Do Operational Efficiencies Affect an Agency’s Value? Beyond the financials, buyers look closely at how well an agency runs day to day. The areas that come up most often include: clinical quality, intake and scheduling, revenue cycle management, and workforce productivity. How efficiently you convert referrals into admissions, process eligibility and authorizations, and collect on claims all contribute to the picture a buyer forms of your agency. If those back-office processes are running smoothly, it signals lower risk. If they’re not, buyers may see it as margin they can improve, which can work in their favor during negotiations, not yours. Workforce management is especially important because labor is the largest cost in this business. Buyers want to understand how you staff your branches, how productive your clinicians are, and what systems you use to manage scheduling and capacity. The more visibility you have into your own workforce data, the stronger your position. Clinical quality matters too. Strong documentation, solid patient outcomes, and a clean regulatory track record reduce risk for a buyer. And in a market that’s moving more toward managed care and Medicare Advantage, the ability to manage authorizations and payer-specific requirements efficiently has become a significant factor. How Does Technology, Especially EMR Compatibility, Factor Into Valuation? Technology has moved from a “nice to have” to a real factor in how agencies are evaluated. The EMR system is the starting point. From a buyer’s perspective, if the seller is on the same EMR, that’s a bonus as it reduces transition risk, and some buyers may be willing to pay a bit more for that smoother integration path. Even when the EMR platforms match, the way each organization uses the system can vary significantly. How you define terms, how you structure reporting, and whether you close out months consistently all affect how useful the data is to a buyer during due diligence. Beyond the EMR, buyers are paying attention to the broader technology stack. Speech recognition tools that cut documentation time for nurses, referral management platforms, predictive analytics, workforce scheduling tools, patient satisfaction surveying — these are all areas where technology investments can show a buyer that your agency is operating efficiently and making data-driven decisions. The key question a buyer asks about technology isn’t just “what do they have?” It’s “how are they using it?” An agency that has strong tools and is leveraging them to improve productivity, manage care quality, and make strategic decisions is a more attractive acquisition than one with the same tools collecting dust. What Kinds of Risk Are Buyers Most Focused On? For strategic buyers (companies already in the space looking to grow), the primary concern is transition risk. What happens to the business if the owner steps away? Buyers want to understand: what systems are in place, what the leadership bench looks like, and whether key referral relationships are tied to the owner personally or distributed across the team. If a buyer feels that the cash flow could deteriorate once the owner disengages, that’s a risk they’ll price into their offer. Building a management or executive team that can operate independently, and referral relationships that aren’t concentrated in one person, are two of the most valuable things a seller can do before going to market. For financial buyers (private equity groups or family offices looking for a platform to enter the space) risk is still important, but they’re also evaluating opportunity. They’re looking at: whether the platform can scale, whether the leadership team can support growth, and whether there’s overhead capacity to expand. In those situations, a financial buyer may be willing to pay a premium to get into the industry, especially if they see a path to meaningful returns over a four- to five-year horizon. Why Does Cultural Alignment Matter in a Home Health or Hospice Transaction? This is one of the areas that surprises people. Culture isn’t just a soft consideration, it can directly influence which offer a seller accepts and how the transition goes. When we run a competitive process and present a seller with multiple strong offers, it’s not unusual for the seller to choose an offer that isn’t the highest in terms of dollars. They choose the buyer they feel most confident will get the deal to closing without trying to renegotiate, who will treat their employees well, and who will take care of the legacy they’ve built. For many owners, this is their life’s work. The buyer who respects that often wins. From the employee perspective, a change in ownership can be unsettling. People worry about what it means for them, whether their roles will change, whether the culture they’ve been part of will survive. A thoughtful buyer plans for that. They work collaboratively with the seller on an employee communication strategy, helping ensure the right people are brought in at the right time and in the right way, without compromising confidentiality. There’s also a practical reason culture matters: every transaction involves a holdback for potential indemnification claims. If the relationship between buyer and seller is strong, the post-closing period tends to go smoothly. If it’s not, even minor disagreements can escalate. We’ve seen situations where buyers who felt things weren’t going well tried to place blame on the seller, even when the seller had done nothing wrong. It took time, energy, and legal costs to resolve. Choosing a buyer whose values align with yours isn’t just about feeling good. It’s about protecting yourself after the deal is done. When Should You Start Preparing for a Sale? Earlier than most owners expect. Some of our clients have engaged us years before they planned to go to market. In one case, a client first reached out with a six-year timeline. We started by understanding their objectives and running what we call a gap analysis: here’s where your valuation is today, here’s where you want it to be, and here’s what needs to happen to close that gap. Over time, month over month, quarter over quarter, we check in, update the analysis, and make recommendations. When both the value and the timing align, that’s when you go to market. Even if a sale is years away, getting a clear, honest picture of what your agency looks like through a buyer’s eyes is one of the best investments you can make. It gives you a roadmap for the improvements that will matter most when the time comes. If you’re thinking about a future sale of your home health, home care, or hospice agency, we’re happy to have a confidential conversation about how your agency would be received in the M&A marketplace. Reach out to us at info@mertztaggart.com or visit our Value Accelerator Program to learn how we help owners prepare. About the Author Cory Mertz, M&AMI, is a managing partner at Mertz Taggart, where he advises home health, home care, and hospice owners on selling their businesses. With nearly two decades in healthcare M&A and more than 160 completed transactions across the firm, Cory brings firsthand experience to every conversation.

By Cory Mertz, M&AMI, Managing Partner — Mertz Taggart | Updated March 2026 Executive Summary: Home-based care agency owners who may sell in the future can learn a lot from private equity firms. Three of the most useful lessons are to plan your exit early, track the right KPIs, and run a competitive sale process with professional guidance. These steps can help owners improve value, prepare more intentionally, and increase the likelihood of a stronger outcome when it is time to sell. If you own a home-based care agency and think you may sell your business someday, there is value in studying the people who do this for a living: private equity firms. Private equity firms (PE firms) acquire, grow, and exit businesses with one goal in mind: maximizing value. They are experienced at identifying what makes a company more attractive to buyers, improving performance over time, and preparing for a successful exit. That does not mean home-based care agency owners should operate like private equity investors. But it does mean there are a few practical habits worth borrowing. Here are three strategies agency owners can take from private equity firms when preparing for an eventual sale. 1. Plan your exit early One of the clearest lessons from private equity is this: they do not wait until the last minute to think about an exit. PE firms usually plan their exit strategy before they even close on purchasing a platform company, or as soon as possible after acquiring it. They think early about likely buyers, key value drivers, timing, and what the business will need to show in order to be attractive in the market. They also align business strategy and performance improvement efforts with that exit plan. As one private equity executive said at a recent conference, “We make our money when we sell, not when we buy.” In some cases, private equity firms will even overpay for an initial platform acquisition just to establish a foothold in the industry. What this means for agency owners: The best exits aren’t rushed, they’re the result of intentional preparation. Early exit planning can help you make better decisions long before you go to market. Your exit plan doesn’t need to be a 50-page document. Start with three things: your target sale price, your ideal buyer type (strategic acquirer or PE firm), and a realistic timeline. Then revisit it quarterly. Adjust as your business grows, as the market shifts, and as your personal goals evolve. Planning early gives you time to address the things that could otherwise reduce your value at closing, things like owner-dependence, client concentration, or financials that need organizing. It also gives you the freedom to sell on your own timeline, when you’re ready, on your terms. → Mertz Taggart’s Value Accelerator Program helps agency owners build a roadmap to maximize value before going to market. 2. Be serious about KPIs PE firms are meticulous about metrics. They track KPIs not just to manage performance, but to build a compelling story for the next buyer. If you want to sell your agency at top-of-market value, understanding which numbers matter most gives you a real advantage. What this means for agency owners: Buyers are looking for agencies with predictable, recurring cash flow and low owner-dependence. The right KPIs can help you improve current performance while also making your business more attractive when the time comes to sell. Don’t just track these numbers; trend them over time. Clean financials and clear KPI dashboards signal operational maturity. They also give confidence in negotiations because we can show exactly what the business is worth and why. If you’re not sure which metrics matter most for your specific agency type, that’s worth a conversation with an advisor who specializes in healthcare M&A. The KPIs that drive valuation in home health may be different from hospice, or from behavioral health. 3. Run a banker-led competitive auction process when you sell We’ll be upfront: as M&A advisors, we have a perspective here. But we’ve also seen firsthand how much the process matters to the outcome. Private equity firms usually do not sell their businesses quietly to a single buyer without competition. Instead, they usually hire investment bankers to run a structured, competitive auction process. The reason is straightforward: when multiple qualified buyers are at the table, the seller gets better pricing, better terms, and more control over the process. A competitive auction process involves: preparing professional marketing materials, identifying and qualifying the right buyers, managing confidentiality, soliciting multiple offers, and negotiating not just price but the full deal structure including working capital targets, representations, and post-close transition terms. What this means for agency owners: Healthcare M&A has unique dynamics, and sector experience matters. An advisor who knows what buyers in this market look for, how they value agencies, and where issues tend to surface can position the business more credibly, anticipate concerns early, and run a process that is built to drive the strongest outcome. A well-run process with multiple qualified buyers also creates healthy momentum. Buyers who know others are interested tend to move more decisively, put forward stronger offers, and stay committed through due diligence. → See how Mertz Taggart has helped agency owners achieve successful exits on our Transactions page. The Bottom Line: Your Agency Deserves a Thoughtful Exit Selling your home care agency is about more than a number. It’s about protecting the team you’ve built, the patients you serve, and the legacy you’ve created. It can also be one of the most financially rewarding decisions of your career, if you approach it with the same discipline that the professionals use. Plan early. Know your numbers. Surround yourself with the right people. These are the same principles PE firms rely on, and they’re at the heart of every successful exit we’ve had the privilege of being part of. Considering an exit? Mertz Taggart offers confidential, no-obligation consultations for home care, home health, hospice, and behavioral health agency owners. Start a conversation →