Aveanna Healthcare Holdings Inc.
- Open
- 13.26
- Day high
- 13.56
- Day low
- 12.97
- Prev close
- 13.32
- Volume
- 4.0M
- Mkt cap
- $2.9B
- P/E (TTM)
- 10.1
- EPS (TTM)
- $1.33
- P/B
- 10.2
- P/S
- 1.1
- Yield
- —
- Per share
- —
- ▼Insiders net selling -$349.7M over the last 3 months (0 open-market buys, 33 sales)
- 🏛Institutions accumulating (13F)
Aveanna Healthcare Holdings Inc. (AVAH) is a Healthcare company listed on NASDAQ. The stock is up 60% over the past year. Over the trailing 3 months, insiders filed 0 open-market buys and 33 sales (SEC Form 4). Drillr has 5 published research articles covering AVAH.
Aveanna Healthcare Holdings Inc. (AVAH) financials & analyst ratings
Fundamentals (TTM)
Analyst consensus · 6 analysts
Source: exchange market data + company filings. Figures are trailing-twelve-month or as most recently reported. For informational purposes only — not investment advice.
AVAH earnings date, history & EPS estimates
| Report date | EPS est | EPS actual | Surprise | Revenue | Rev. surprise |
|---|---|---|---|---|---|
| Aug 13, 2026 | $0.17 | $0.22 | +30.7% | $670M | +4.4% |
| May 14, 2026 | $0.13 | $0.18 | +38.5% | $648M | +5.2% |
| Mar 19, 2026 | $0.15 | $0.17 | +10.5% | $662M | +3.4% |
| Nov 6, 2025 | $0.08 | $0.15 | +87.5% | $622M | -3.6% |
| Aug 7, 2025 | $0.04 | $0.18 | +350.0% | $590M | +9.0% |
| May 8, 2025 | $0.03 | $0.10 | +216.8% | $559M | +6.1% |
| Mar 13, 2025 | $0.00 | $0.05 | +1178.8% | $520M | +0.8% |
| Nov 7, 2024 | $0.01 | $0.02 | +254.0% | $509M | +1.8% |
| Aug 8, 2024 | $0.00 | $0.01 | +150.0% | $505M | +2.3% |
| May 9, 2024 | $-0.05 | $-0.03 | +40.0% | $491M | +1.4% |
| Mar 14, 2024 | $-0.01 | $-0.01 | -15.7% | $479M | +2.4% |
| Nov 9, 2023 | $-0.03 | $-0.03 | -12.5% | $478M | +2.6% |
AVAH insider trading activity (SEC Form 4)
| Date | Insider | Type | Shares | Price |
|---|---|---|---|---|
| Aug 24, 2026 | WILLIAMS ROBERT M JR10 percent owner | Sell | 2,250,000 | $11.50 |
| Aug 24, 2026 | VIGANO PAUL R10 percent owner | Sell | 190,130 | $11.50 |
| Aug 24, 2026 | VIGANO PAUL R10 percent owner | Sell | 957,918 | $11.50 |
| Aug 24, 2026 | VIGANO PAUL R10 percent owner | Sell | 2,250,000 | $11.50 |
| Aug 24, 2026 | Windley Rodney Ddirector | Sell | 180,000 | $11.50 |
| Aug 24, 2026 | Shaner Jeffofficer: Chief Executive Officer | Sell | 90,000 | $11.50 |
| Aug 24, 2026 | Reisz Edwin C.officer: Chief Administrative Officer | Sell | 50,000 | $11.50 |
| Aug 24, 2026 | J.H. Whitney Equity Partners VII, LLC10 percent owner | Sell | 1,426,034 | $11.50 |
| Aug 24, 2026 | J.H. Whitney Equity Partners VII, LLC10 percent owner | Sell | 957,918 | $11.50 |
| Aug 24, 2026 | J.H. Whitney Equity Partners VII, LLC10 percent owner | Sell | 2,250,000 | $11.50 |
| Aug 24, 2026 | WILLIAMS ROBERT M JR10 percent owner | Sell | 190,130 | $11.50 |
| Aug 24, 2026 | WILLIAMS ROBERT M JR10 percent owner | Sell | 957,918 | $11.50 |
| Jul 2, 2026 | VIGANO PAUL R10 percent owner | Sell | 525,844 | $8.01 |
| Jul 2, 2026 | VIGANO PAUL R10 percent owner | Sell | 55,121 | $8.01 |
| Jul 2, 2026 | J.H. Whitney Equity Partners VII, LLC10 percent owner | Sell | 2,419,035 | $8.01 |
Source: AVAH SEC Form 4 filings, latest Aug 24, 2026. For informational purposes only — not investment advice.
See the full AVAH insider & 13F page →AVAH research & analysis
CMS Proposes 6.4% Home Health Cut — Three Operators Most at Risk
CMS has proposed a 6.4% aggregate payment cut for home health agencies in CY2026, creating material risk for operators with high Medicare home health exposure. Aveanna Healthcare (AVAH) faces the greatest financial risk due to 5.1x debt/EBITDA leverage and thin interest coverage, while Ensign Group (ENSG) is best positioned to absorb the impact given its SNF-dominated revenue mix and strong growth trajectory. Amedisys (AMED), now part of Optum/UnitedHealth, is no longer independently exposed.
AMEDENSGCan home health companies offset the CMS 6.4% cut through volume growth and labor efficiency?
The CMS 6.4% home health payment cut for CY2026 represents a manageable headwind for leading operators. Aveanna Healthcare's 22% revenue growth, expanding preferred payer network of 30 agreements, and EBITDA margin recovery from 2.1% to over 12% provide substantial buffer, while Ensign Group's acquisition-driven 19% growth and all-time high occupancy rates insulate its primarily skilled nursing business. The effective revenue impact — estimated at 2–3% for diversified operators — appears absorbable, though compounding Medicaid rate pressure remains the key risk to watch.
AMEDENSGIf CMS finalizes the 6.4% home health payment cut, which operators face the steepest margin compression?
Among publicly traded operators, Aveanna Healthcare (AVAH) faces the steepest margin compression from a potential 6.4% CMS home health payment cut, given its leveraged balance sheet (5.1x debt/EBITDA) and thin free cash flow ($26M), despite home health representing only ~10% of revenue. Ensign Group has minimal direct exposure as a SNF-focused operator, while Sotera Health has no home health revenue and Amedisys was acquired by UnitedHealth in 2024.
ENSGSHCUNHWhat integration risks does Aveanna face with Family First given its leveraged balance sheet?
Aveanna Healthcare's agreement to acquire Family First Homecare layers additional integration complexity onto a balance sheet carrying $1.35 billion in debt at 4.5x net leverage, with the Thrive Skilled Pediatric Care integration still completing. While operating momentum is strong — with 2025 adjusted EBITDA guidance raised to >$300 million — interest coverage of just 1.6x and potential revolver covenant triggers leave limited margin for execution missteps during parallel integrations.
How does Family First Homecare's margin profile compare to Aveanna's existing segments?
Aveanna Healthcare's three segments show wide margin dispersion — PDS at ~29-31% gross margin, HHH at ~54%, and MS at ~45%. Family First Homecare, as a pediatric PDN operator, would flow into the PDS segment and likely carries gross margins in the 28-32% range based on the Thrive Skilled Pediatrics acquisition precedent. The real accretion opportunity lies in leveraging Aveanna's 30 preferred payer agreements and corporate infrastructure to compress the target's standalone SG&A.
ENSG
Aveanna Healthcare Holdings Inc. company profile
Overview
Aveanna Healthcare Holdings Inc. (NASDAQ:AVAH) is a diversified home care platform company that went public in April 2021. Founded in 2016 and headquartered in Atlanta, Georgia, the company has grown to become one of the largest providers of home-based healthcare services in the United States. Aveanna operates through three primary business segments, serving medically fragile patients who require specialized care in their homes rather than expensive institutional settings like hospitals or nursing facilities.
Business
Aveanna Healthcare operates in the home healthcare industry, which serves as an alternative to costly hospital and institutional care settings. The company's mission centers on enabling patients to receive medical care in the comfort of their homes while reducing overall healthcare system costs. The company operates through three distinct business segments: 1. Private Duty Services (PDS) represents the largest segment, generating approximately 82% of total revenue ($460 million in Q1 2025). This segment provides private duty nursing services primarily to medically fragile children who require skilled nursing care at home. The services include in-home skilled nursing, school-based nursing where caregivers accompany patients to educational settings, care at pediatric day healthcare centers, and home-based pediatric therapy services including physical, occupational, and speech therapy. The segment also offers employer of record support and personal care services. 2. Home Health & Hospice (HHH) accounts for approximately 10% of revenue ($56.7 million in Q1 2025). This segment provides traditional home health services including skilled nursing, physical and occupational therapy, medical social services, and aide services for adult patients. It also offers hospice care for patients and families dealing with life-limiting illnesses that no longer respond to curative treatments. The segment focuses heavily on episodic care, with 77% of admissions being episodic rather than routine. 3. Medical Solutions (MS) represents about 8% of revenue ($42.5 million in Q1 2025). This segment delivers enteral nutrition supplies and other medical products to both adult and pediatric patients on a periodic or as-needed basis, serving approximately 89,000 unique patients.
Revenue model
Aveanna generates revenue through multiple healthcare reimbursement models depending on the service segment. The Private Duty Services segment operates primarily on an hourly billing model, charging approximately $42.25 per hour of care provided. Revenue comes from both government payers (primarily Medicaid) and private managed care organizations (MCOs). The company has been strategically shifting toward "preferred payer" relationships with MCOs that offer higher reimbursement rates than traditional Medicaid. The Home Health & Hospice segment operates under Medicare's episodic payment system, where the company receives a fixed payment per episode of care rather than fee-for-service. Medicare revenue per episode averages around $3,152, with the company focusing on maintaining a high episodic mix (77% of admissions) as these typically provide better margins than routine care. The Medical Solutions segment generates revenue through product sales of medical supplies, particularly enteral nutrition products, with revenue per unique patient served averaging $477. Several factors significantly impact the company's margins. Labor costs represent the largest expense, as the company employs thousands of nurses and caregivers in a highly competitive labor market. Nursing shortages drive up wage costs, making state Medicaid rate increases crucial for maintaining margins. Payer mix optimization through preferred payer relationships can improve margins by 10-15% compared to traditional Medicaid rates. Regulatory changes in Medicaid reimbursement rates at the state level directly impact profitability, as the company actively lobbies for rate increases across its operating states. Operational efficiency gains through technology implementation and care coordination can reduce administrative costs, while patient acuity levels affect the complexity and cost of care delivery.
Competitive moat
Aveanna's competitive moat is relatively modest but derives from several operational advantages. The company benefits from regulatory barriers to entry in the form of state licensing requirements, Medicare certification processes, and complex compliance standards that create hurdles for new entrants. Its scale advantages as one of the largest home healthcare providers enable better negotiating power with payers and suppliers, particularly evident in securing preferred payer agreements that smaller competitors cannot obtain. The company has built specialized expertise in serving medically fragile pediatric patients, a complex and underserved market segment that requires specific clinical capabilities and caregiver training. This specialization creates some customer stickiness, as families with medically complex children often prefer continuity of care. However, the moat faces significant challenges. The home healthcare industry remains highly fragmented with low barriers to switching between providers. Labor market competition is intense, with nurses and caregivers able to move between employers relatively easily, especially during periods of wage inflation. Payer concentration risk exists as government programs (primarily Medicaid) represent a large portion of revenue, making the company vulnerable to reimbursement rate cuts or policy changes. The business model is also susceptible to regulatory disruption, as evidenced by various state and federal policy proposals that could impact reimbursement structures or operational requirements. The competitive landscape includes both large national players like Amedisys and LHC Group (now part of UnitedHealth) as well as numerous smaller regional providers, limiting pricing power and creating ongoing pressure for operational efficiency improvements.
Risks & safety
The margin of safety appears limited with several concerning financial metrics: • Solvency concerns: Total liabilities ($1.76 billion) exceed total assets ($1.66 billion), creating negative book value of approximately -$99 million • Cash position: $71.5 million in cash and short-term investments provides modest liquidity buffer • Current ratio: 1.05 indicates tight working capital management with current assets barely exceeding current liabilities • Negative free cash flow: -$11 million in Q1 2025, though the company has generated positive free cash flow in recent quarters • Debt burden: High leverage with negative equity position limits financial flexibility • Valuation metrics: Trading at 17.3x P/E ratio based on recent positive earnings, though EBITDA was negative in Q1 2025 at -$24 million • Enterprise value: Negative EV/EBITDA ratio due to negative EBITDA makes traditional valuation metrics difficult to interpret • Other considerations: Heavy dependence on government reimbursement rates creates regulatory risk, while tight labor markets continue pressuring wage costs faster than reimbursement rate increases.
Recent development
Over the past few years, Aveanna has executed a strategic transformation focused on improving payer relationships and operational efficiency. The company's most significant initiative has been its "preferred payer strategy," systematically shifting from traditional Medicaid reimbursement toward higher-paying managed care organization contracts. This strategy has increased preferred payer volume from 10% to 54% of Private Duty Services revenue, with the goal of reaching 30 preferred payer agreements by 2025. The company has also pursued aggressive rate increase advocacy, securing double-digit rate improvements in key states including Georgia, Massachusetts, Texas, and California. These rate increases are typically passed through directly to caregiver wages to improve recruitment and retention in the challenging labor market. Operational modernization efforts include implementing the Homecare Homebase system across operations and exploring family caregiver models in multiple states. The company completed a strategic acquisition in Q1 2025 with Thrive Skilled Pediatrics, adding 23 locations across seven states to expand geographic density and enter new markets. Cost reduction initiatives have been implemented across all segments, with management indicating that most efficiency gains in Home Health & Hospice and Private Duty Services have been completed, with Medical Solutions modernization planned for 2025. The company has also focused on improving its episodic mix in Home Health & Hospice, maintaining above 75% episodic admissions to optimize reimbursement rates.
AVAH company profile · for informational purposes only — not investment advice.
Track AVAH with Drillr
SEC filings, earnings calls, insider activity, alt-data signals — all queryable through Drillr's AI terminal and MCP API.
Try Drillr for free