Acadia Healthcare's Q2 2026 revenue was flat at $865.8M and EPS fell to $0.12 from $0.33 as a $28.6M liability-claims reserve charge and a tough year-ago state-payment comparison masked 6.4% same-facility admissions growth; 2026 guidance was nudged up.
Revenue
$866M
-0.4% YoY
Net income
$11M
-63.7% YoY
Diluted EPS
$0.12
-63.6% YoY
Operating margin
7.0%
This period vs a year ago
Same period last year
This period
Revenue▼-0.4%
≈$869M
$866M
Net income▼-63.7%
≈$30M
$11M
Diluted EPS▼-63.6%
≈$0.33
$0.12
Year-ago figures (≈) are worked out from the growth rate the company reported. Each row has its own scale.
Acadia Healthcare, the largest stand-alone operator of psychiatric hospitals and addiction-treatment clinics in the US, reported second-quarter 2026 revenue of $865.8 million, down 0.4% from a year earlier, and profit that fell by almost two-thirds to $10.9 million, or $0.12 per diluted share (from $0.33). Patient demand held up: admissions at facilities open more than a year rose 6.4%. The drop came from two other places. The year-ago quarter was inflated by a $48.7 million back-payment from a Tennessee state program, which made the comparison hard. And this quarter Acadia added $28.6 million to its reserve for malpractice and liability claims. Management still raised the low end of its full-year guidance and lifted its cash-flow forecast, which says the core business did not deteriorate the way the headline suggests.
At a glance
Admissions +6.4%, revenue per patient day −0.8% (same facilities). More patients came through the door, and shorter stays plus fewer state catch-up payments meant each day of care brought in slightly less.
$28.6 million liability-reserve charge. On its own this is about 19% of the quarter's $149.2 million adjusted EBITDA, and it is the main reason that figure fell 26%.
Operating cash flow $162.1 million vs $38.6 million capex. After three years of heavy building, Acadia now generates cash beyond what it spends on facilities. First-half free cash flow was about +$108 million, against about −$197 million a year earlier.
The numbers
Acadia does not report an "operating income" line. The margin below is our calculation from its income statement: pre-tax income plus net interest expense, as a share of revenue. That is roughly profit from running the facilities, after depreciation, before financing costs and tax.
Metric
Q2 2026
Q2 2025
YoY Change
Revenue
$865.8M
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$869.2M
−0.4%
Net income attributable to Acadia
$10.9M
$30.1M
−63.7%
Diluted EPS (GAAP)
$0.12
$0.33
−63.6%
Operating margin (pre-tax income + net interest)
7.0%
9.8%
−2.8 pts
Adjusted EBITDA
$149.2M
$201.8M
−26.1%
Adjusted EPS
$0.38
$0.83
−54.2%
Same-facility revenue
$856.4M
$856.8M
−0.1%
Same-facility patient days
794,177
787,930
+0.8%
Same-facility admissions
54,141
50,880
+6.4%
Same-facility revenue per patient day
$1,078
$1,087
−0.8%
Average length of stay (same-facility, days)
14.7
15.5
−5.3%
Same-facility figures cover only facilities Acadia has run for more than a year. They strip out new openings and closures, so they are the cleanest read on whether the existing business is growing. Adjusted EBITDA is the company's own profit measure: earnings before interest, tax, depreciation and amortization, with legal, investigation, restructuring and stock-compensation costs also removed.
For the first half, revenue was $1,694.6 million (+3.3%) and diluted EPS was $0.16 (vs $0.42).
Why revenue was flat: a timing problem
Some state Medicaid programs pay hospitals extra "supplemental payments" on top of normal rates. These are often approved months late, and the money for past periods is booked all at once when that happens. The 10-Q says Q2 2025 included $65.6 million from one state program, $48.7 million of it for services in prior periods (Tennessee, per the earnings release). Q2 2026 included $22.3 million of prior-period money from Florida. Take both catch-up amounts out and, by the company's own calculation, total revenue grew 2.8% and same-facility revenue grew 3.2%. Closed facilities also cut 1.4 percentage points off reported growth.
Acute psychiatric volumes rose 5.5%, which the company attributes "primarily [to] expanded capacity from both newly constructed and existing facilities." Specialty treatment is the weak spot: the decline came from facilities in Pennsylvania and from closing several Specialty sites after Q2 2025.
The payer mix is also moving. Commercial-insurance revenue fell 9.0%, to $185.8 million (21.5% of revenue, from 23.5%). Medicaid, the state-federal program for low-income patients, rose 3.6% to $540.2 million and now makes up 62.4% of revenue. That matters because Medicaid usually pays less than private insurance, and the 10-Q notes that the 2025 federal budget law (the OBBBA) caps some state supplemental-payment programs and restricts new provider taxes after October 1, 2026.
Where the profit went
Revenue was flat, so the profit decline was a cost story:
Liability claims. Other operating expenses rose to $155.7 million from $134.4 million. The 10-Q says that includes "an unfavorable adjustment of $28.6 million to our estimated liability for self-insured professional and general liability claims relating to the settlement or expected settlement of certain prior year claims." Acadia insures itself for a large share of malpractice-type claims, so when old claims settle for more than it set aside, the difference hits current profit. The release puts the total rise in these claim costs at $39.3 million, which means about $10.7 million came on top of the one-off reserve top-up.
Wages. Salaries, wages and benefits rose 4.8% to $474.1 million, which the company attributes to new facility openings and routine annual raises. At existing facilities, labor rose to 49.2% of revenue from 47.1%.
New facilities not yet profitable. Newly opened, acquired and closed facilities reduced adjusted EBITDA by $13.3 million, against $5.2 million a year ago. That is the start-up cost of the building program before new hospitals fill up.
Tax. The effective tax rate jumped to 44.3% from 24.1%, which the 10-Q attributes to "an increase in nondeductible legal settlements and an increase in valuation allowances against certain state deferred tax assets."
Joint-venture partners also took a much smaller share of profit ($1.3 million vs $7.8 million), which cushioned the fall in profit attributable to Acadia's own shareholders.
Takeaway: Patient demand is not the problem. Admissions rose 6.4% and revenue grew about 3% once the state catch-up payments are removed. Profit fell because of legal risk that recurs. Liability claims cost $39.3 million more than a year ago, government-investigation costs are still being booked every quarter, and some older claims now exceed the company's insurance cover. Watch whether claims costs settle back down in the second half. Guidance assumes they do.
What the headline numbers hide
Both years had one-offs, and they point in opposite directions. The $28.6 million reserve charge hurt this quarter. The adjusted EBITDA figure also includes a $26.1 million benefit from the Florida supplemental program and provider-tax adjustments, and the year-ago figure included a $39.5 million Tennessee benefit. If you net out all three (our arithmetic on the company's stated figures), adjusted EBITDA was roughly $151.7 million against roughly $162.3 million. That is a decline of about 6.5%, well short of the headline 26%, but still a decline.
The GAAP-to-adjusted gap is large, and it is mostly legal costs. Adjusted EPS of $0.38 is more than three times GAAP EPS of $0.12. The main exclusion is $22.6 million of "transaction, legal and other costs": $7.5 million for government investigations (down from $53.5 million a year ago), $9.1 million in other litigation and settlement costs, and $5.8 million in restructuring and closures. The DOJ Criminal Division and the SEC are still investigating Acadia's admissions, length-of-stay and billing practices, and the 10-Q says the company "cannot reasonably estimate the amount or range of the ultimate liability, if any." For the first half there was also a $13.8 million legal-settlement charge for the Sandoval wrongful-death case, the part of a $15.0 million settlement not covered by insurance because the excess policy for that year was "exhausted in its entirety by prior losses." These costs keep coming back, so treat "adjusted" profit with some caution.
Cash conversion looks very strong, partly for one-time reasons. First-half operating cash flow was $223.6 million against net income of $16.7 million. The 10-Q credits the increase partly to "collection of the insurance proceeds for the 2019 Securities Litigation" and to higher state supplemental-payment receipts, and neither will repeat on the same scale. The bigger lasting change is capital spending: $115.1 million in the first half, down from $342.4 million.
Older receivables are growing. Accounts receivable rose 6.8% since December to $470.8 million, against 3.3% first-half revenue growth. Days sales outstanding (how long customers take to pay) were unchanged at 49. But the share of receivables older than 150 days rose to 23.2% from 19.3%, with Medicaid and commercial balances both ageing. Worth watching, not yet alarming.
No help from buybacks. Acadia repurchased no stock in the first half (it spent $50.0 million on buybacks a year ago). Diluted shares rose to 91.4 million from 90.4 million, so share count slightly diluted per-share results.
Debt is coming down. Total debt fell about $85 million since December, to $2.41 billion, as the company repaid its revolving credit line. Net leverage under its credit agreement is 4.1 times adjusted EBITDA, below the covenant limit of 5.0 times.
Guidance and outlook
Management narrowed its 2026 guidance upward and raised the cash forecast sharply:
2026 guidance
July
April
Revenue
$3.40–$3.45B
$3.37–$3.45B
Adjusted EBITDA
$590–$615M
$580–$615M
Adjusted EPS
$1.45–$1.60
$1.35–$1.60
Operating cash flow
$350–$400M
$285–$325M
Capital expenditures
$235–$255M
$255–$280M
First-half adjusted EBITDA was $293.4 million and adjusted EPS $0.75. To hit guidance, the second half needs $297–$322 million of adjusted EBITDA and $0.70–$0.85 of adjusted EPS. That is at least as much as the first half, even though the first half included the $28.6 million reserve charge. The target looks reachable if claims costs normalize and the new beds keep filling. Acadia added 322 beds in the first half, including 240 at joint-venture hospitals opened in June with Orlando Health (144 beds) and Methodist Jennie Edmundson (96 beds).
Our read: the business is growing modestly underneath a lot of noise. The same-facility admissions trend (+6.4%) is healthy. The shift from building to harvesting cash is real: capex is guided about $20–25 million lower and operating cash flow about $65–75 million higher than in April. The risks are outside the day-to-day operations: the unresolved DOJ/SEC investigation, liability claims that have already exhausted some insurance layers, and OBBBA-driven pressure on the state supplemental payments that make up a meaningful share of Acadia's revenue. The next test is the Q3 report, likely in late October. Look for whether same-facility revenue per patient day turns positive again without a state catch-up payment, and whether other operating expenses fall back toward roughly 15–16% of revenue.
Source: Acadia Healthcare Form 10-Q for the quarter ended June 30, 2026 (filed July 28, 2026). Segment revenue, adjusted figures, same-facility adjusted EBITDA and guidance are from the company's Q2 2026 earnings release (Form 8-K Exhibit 99.1, filed the same day).