The Ensign Group, Inc.
- Open
- 170.69
- Day high
- 172.46
- Day low
- 170.00
- Prev close
- 172.98
- Volume
- 357K
- Mkt cap
- $10.0B
- P/E (TTM)
- 26.2
- EPS (TTM)
- $6.57
- P/B
- 4.1
- P/S
- 1.8
- Yield
- 0.15%
- Per share
- $0.26
- ▼Insiders net selling -$268K over the last 3 months (0 open-market buys, 5 sales)
- 🏛Institutions mixed (13F)
The Ensign Group, Inc. (ENSG) is a Healthcare company listed on NASDAQ. The stock is down 0% over the past year. Over the trailing 3 months, insiders filed 0 open-market buys and 5 sales (SEC Form 4). Drillr has 5 published research articles covering ENSG.
The Ensign Group, Inc. (ENSG) financials & analyst ratings
Fundamentals (TTM)
Source: exchange market data + company filings. Figures are trailing-twelve-month or as most recently reported. For informational purposes only — not investment advice.
ENSG earnings date, history & EPS estimates
| Report date | EPS est | EPS actual | Surprise | Revenue | Rev. surprise |
|---|---|---|---|---|---|
| Jul 29, 2026 | $1.80 | $1.92 | +6.7% | $1.4B | -0.1% |
| May 1, 2026 | $1.79 | $1.85 | +3.4% | $1.4B | -0.5% |
| Feb 4, 2026 | $1.75 | $1.82 | +4.0% | $1.4B | -0.6% |
| Jul 24, 2025 | $1.55 | $1.59 | +2.6% | $1.2B | +0.7% |
| Feb 5, 2025 | $1.47 | $1.49 | +1.4% | $1.1B | +0.3% |
| Oct 24, 2024 | $1.38 | $1.39 | +0.7% | $1.1B | +1.1% |
| Jul 25, 2024 | $1.30 | $1.32 | +1.5% | $1.0B | +1.5% |
| May 1, 2024 | $1.29 | $1.30 | +0.8% | $983M | -2.1% |
| Feb 1, 2024 | $1.27 | $1.28 | +0.8% | $980M | +0.5% |
| Oct 25, 2023 | $1.19 | $1.20 | +0.8% | $941M | +0.2% |
| Jul 27, 2023 | $1.14 | $1.16 | +1.8% | $921M | +0.4% |
| Feb 2, 2023 | $1.10 | $1.10 | +0.0% | $810M | +0.9% |
ENSG insider trading activity (SEC Form 4)
| Date | Insider | Type | Shares | Price |
|---|---|---|---|---|
| Jul 29, 2026 | Blouin Ann Scottdirector | Sell | 175 | $181.88 |
| Jul 29, 2026 | Blouin Ann Scottdirector | Sell | 200 | $185.00 |
| Jul 22, 2026 | Agwunobi John Odirector | Sell | 392 | $171.06 |
| Jul 17, 2026 | Abbott Swati Bargotradirector | Grant | 600 | — |
| Jul 17, 2026 | Agwunobi John Odirector | Grant | 600 | — |
| Jul 17, 2026 | Parkinson Mark Vincentdirector | Sell | 100 | $168.12 |
| Jul 17, 2026 | Shaw Darendirector | Grant | 600 | — |
| Jul 17, 2026 | SMITH BARRY Mdirector | Grant | 600 | — |
| Jul 17, 2026 | Blouin Ann Scottdirector | Grant | 600 | — |
| Jul 17, 2026 | Parkinson Mark Vincentdirector | Grant | 600 | — |
| Jun 4, 2026 | SMITH BARRY Mdirector | Sell | 700 | $164.28 |
| May 28, 2026 | Wittekind Beverly B.officer: VP and Chief Legal Officer | Tax | 102 | $171.97 |
| May 28, 2026 | Burton Spencerofficer: President and COO | Tax | 281 | $172.42 |
| May 28, 2026 | Port Barrydirector, officer: Chief Executive Officer | Tax | 509 | $172.42 |
| May 28, 2026 | Wittekind Beverly B.officer: VP and Chief Legal Officer | Tax | 123 | $172.42 |
Source: ENSG SEC Form 4 filings, latest Jul 29, 2026. For informational purposes only — not investment advice.
See the full ENSG insider & 13F page →ENSG research & analysis
Texas Medicaid Directed Payment Freeze: $9.8 Billion Withheld
CMS is withholding about $9.8 billion of Texas directed payments from September 1, 2026, costing hospitals $27 million a day, and the loss can travel past the hospitals.
MDUHTCMS 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.
AVAHAMEDCan 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.
AVAHAMEDIf 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.
AVAHSHCUNHHow 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.
AVAH
The Ensign Group, Inc. company profile
Overview
The Ensign Group, Inc. (NASDAQ:ENSG) is a healthcare services company founded in 1999 and based in San Juan Capistrano, California. The company went public in November 2007 and has grown to become a significant operator in the post-acute care sector. Ensign operates across 14 states in the western and central United States, providing skilled nursing, rehabilitation services, and senior living care through a network of over 250 healthcare facilities. The company has built its reputation on a decentralized management model that emphasizes local leadership and operational excellence, while pursuing strategic acquisitions of underperforming facilities that can be transformed through its proven turnaround methodology.
Business
The Ensign Group operates in the post-acute care continuum, which serves as a critical bridge between hospital care and home recovery for patients who need extended medical attention but don't require intensive hospital-level treatment. Post-acute care facilities provide skilled nursing services, rehabilitation therapies, and long-term care for patients recovering from surgeries, managing chronic conditions, or requiring end-of-life care. The company operates through two primary business segments. The Skilled Services segment represents the vast majority of revenue and includes skilled nursing facilities that provide short-term rehabilitation services for patients recovering from hospital stays, as well as long-term care for elderly patients and those with chronic conditions. These facilities offer physical, occupational, and speech therapies, wound care, medication management, and specialized care for conditions like dementia and Alzheimer's disease. The skilled services also encompass ancillary services such as mobile diagnostics, digital x-ray, ultrasound, laboratory services, and patient transportation. The Real Estate segment operates through Standard Bearer REIT, Ensign's affiliated real estate investment trust, which owns and leases healthcare properties. This segment generates revenue by owning the real estate underlying many of Ensign's operations and leasing properties to both Ensign-operated facilities and third-party operators. As of recent reports, Standard Bearer REIT owns 129 properties, providing stable rental income and strategic control over key facility locations. The company also operates senior living facilities that provide assisted living services, memory care, and independent living options for seniors who need some assistance with daily activities but don't require skilled nursing care. Additionally, Ensign provides various ancillary healthcare services including sub-acute care, dialysis services, and home healthcare support.
Revenue model
Ensign generates revenue primarily through reimbursement from government and private insurance programs for the healthcare services it provides. The largest revenue sources are Medicare and Medicaid programs, which reimburse facilities for skilled nursing care, rehabilitation services, and long-term care based on patient acuity levels and length of stay. Medicare typically covers short-term skilled nursing and rehabilitation services following hospital stays, while Medicaid covers long-term care for eligible low-income patients. The company also receives payments from managed care organizations (private insurance companies and Medicare Advantage plans), which has become an increasingly important revenue stream. Managed care contracts often provide higher reimbursement rates than traditional government programs and represent a growing portion of Ensign's patient mix, with managed care census growing over 15% in recent periods. Private pay patients represent another revenue source, where individuals or families directly pay for services, typically at higher rates than government reimbursement. The Real Estate segment generates revenue through lease payments from healthcare operators who rent properties owned by Standard Bearer REIT. Several factors influence Ensign's profitability margins. Labor costs represent the largest expense category, and the company's margins are significantly affected by wage inflation, employee turnover rates, and the use of expensive temporary staffing agencies. The company has focused heavily on reducing agency staffing usage and improving employee retention to control these costs. Occupancy rates are crucial since fixed costs remain constant regardless of patient census, making higher occupancy directly translate to improved margins. Reimbursement rate changes from government programs can significantly impact profitability, as Medicare and Medicaid rate adjustments directly affect revenue per patient day. The company benefits from its focus on higher-acuity patients who generate higher reimbursement rates. Regulatory compliance costs can pressure margins, particularly with potential federal minimum staffing requirements that could mandate higher labor costs across the industry.
Competitive moat
Ensign's competitive moat is moderately strong and primarily built around its operational expertise in facility turnarounds and its decentralized management model. The company has developed a proven methodology for acquiring underperforming skilled nursing facilities and transforming them into profitable operations through local leadership development, clinical excellence programs, and operational improvements. This turnaround capability creates a sustainable competitive advantage as it allows Ensign to acquire assets at attractive valuations that competitors might avoid. The company's local leadership model serves as a significant differentiator in an industry where many operators use centralized management structures. By empowering local administrators and clinical leaders, Ensign can respond more quickly to market conditions, build stronger relationships with referral sources like hospitals, and maintain higher employee satisfaction and retention rates. This approach has consistently delivered superior occupancy rates and operational metrics compared to industry averages. Ensign's growing relationships with managed care organizations provide some protection against commoditization, as these partnerships often involve preferred provider arrangements that can generate steady patient referrals and premium reimbursement rates. The company's focus on clinical quality metrics and patient outcomes helps maintain these valuable relationships. However, the moat faces several challenges. The skilled nursing industry is highly regulated and subject to significant regulatory risks, including potential federal minimum staffing requirements that could increase costs industry-wide. Reimbursement pressure from government programs remains constant, as Medicare and Medicaid seek to control healthcare costs. The industry also faces demographic headwinds as alternative care models like home healthcare and assisted living compete for the same patient population. Competition comes from large national operators like Genesis Healthcare and Skilled Healthcare Group, as well as regional players and non-profit organizations. While barriers to entry are high due to regulatory requirements and capital intensity, the fragmented nature of the industry means competitive pressure remains significant in local markets.
Risks & safety
Ensign demonstrates a solid margin of safety with strong liquidity and manageable debt levels, though trading at premium valuations. **Liquidity and Solvency:** - Cash and short-term investments: $282.7 million as of Q1 2025 - Strong operating cash flow generation: $72.2 million in Q1 2025 - Available credit facilities: Over $1 billion in available capital for growth - Current ratio: 1.40x indicating adequate short-term liquidity - No immediate solvency concerns with steady cash generation **Debt Profile:** - Debt-to-equity ratio: 1.04x, representing moderate leverage - Lease-adjusted net debt-to-EBITDA: 2.13x, within reasonable range for healthcare operators - Interest coverage appears adequate based on EBITDA levels **Valuation Metrics:** - P/E ratio: 23.0x, representing premium valuation - EV/EBITDA: 17.7x, elevated compared to historical averages - Price-to-book: 3.83x, indicating market premium for growth prospects - Graham number suggests potential overvaluation at current levels **Other Considerations:** - Consistent profitability and dividend payments provide income cushion - Regulatory risks in healthcare sector require premium for uncertainty - Strong free cash flow generation supports dividend sustainability
Recent development
Over the past few years, Ensign has executed an aggressive growth strategy centered on strategic acquisitions and geographic expansion. The company has added over 100 new operations since 2022, significantly expanding its footprint through both individual facility acquisitions and larger portfolio deals. This expansion has been particularly notable in 2024, where Ensign added 57 new operations and entered new markets including Alabama, with planned expansion into Alaska and Oregon. A key strategic development has been the company's focus on real estate ownership through Standard Bearer REIT, which has grown to own 129 properties. This strategy provides greater control over facility operations, stable rental income, and potential appreciation benefits. The REIT structure also allows Ensign to partner with affiliated operators, creating a pipeline for future acquisitions and operational improvements. Ensign has made significant progress in addressing labor challenges that plagued the industry during and after the COVID-19 pandemic. The company has achieved 11 consecutive quarters of improved employee turnover and substantially reduced its reliance on expensive temporary staffing agencies by 58% from peak levels. This operational improvement has been crucial for margin expansion and service quality enhancement. The company has strategically emphasized managed care relationships, with managed care census growing over 15% in recent periods. These partnerships typically provide higher reimbursement rates than traditional government programs and offer more predictable patient flow, representing a strategic shift toward higher-value revenue streams. Recent quarters have shown strong occupancy recovery, with same-store occupancy reaching 82.6% in Q1 2025, approaching pre-pandemic levels. The company has also focused on increasing patient acuity levels and skilled service revenue, which generate higher reimbursement rates than basic custodial care. Clinical excellence initiatives and quality metric improvements have supported these efforts while strengthening relationships with hospital referral sources.
ENSG company profile · for informational purposes only — not investment advice.
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