Seller guide

How to sell a home health, hospice or PAS agency in the Rio Grande Valley

How RGV home health, hospice and PAS owners sell: who buys, what raises value, the HHSC and Medicare ownership rules, and a 24-month prep plan.

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By Spencer Gareiss, Delta BrokersLast reviewed November 12, 2026

Quick answer

Start 12 to 24 months out. Clean up three years of financials, close out any survey deficiencies, and confirm your HHSC license and Medicare status. Check whether the Medicare 36-month rule applies to you. Then run a confidential process with several buyer types at once. Your license does not transfer, so the buyer files its own change of ownership with HHSC before closing.

Who buys home health and hospice businesses in the Valley

  • National home care platforms backed by private equity or public markets. They want Texas density, PAS offices with managed care contracts, and certified agencies with clean surveys.
  • Regional Texas operators expanding south, who pay for referral relationships, trained staff and a licensed office.
  • Turnaround buyers that buy smaller or struggling agencies for the license and census, at lower prices.
  • Out-of-market buyers making their first Valley acquisition, who want a working team on day one.
  • Individual owner-operators, often clinicians, who usually need bank or SBA financing.

What raises your price

  • A clean state survey and federal certification history, with deficiencies closed and plans of correction accepted.
  • Medicare certification that is outside the 36-month window, or two full consecutive cost reports on file, so billing privileges can convey to the buyer.
  • Referral sources spread across many physicians and hospitals, documented in a referral log.
  • Medicare plus Medicaid managed care contracts in good standing.
  • For hospice, documented eligibility and length of stay and live discharge patterns you can explain.
  • A stable team: administrator, alternate administrator, director of nursing and field staff who will stay.
  • Clean billing, timely OASIS and EVV compliance, and books that tie to cost reports.
  • Every branch licensed correctly.

What lowers your price

  • Open survey deficiencies or an unresolved audit.
  • A change of ownership in the last 36 months without the cost report exception, which can force the buyer to enroll as a new Medicare provider (42 CFR 424.550(b)).
  • One referral source driving most admissions, especially with financial ties.
  • An owner who is also the administrator and main marketer.
  • Thin margins after CMS PDGM cuts of 3.925% in 2023 and 2.9% in 2024 (Arya Health).
  • Commingled, cash-basis books.

How deals are priced

Market commentary on 2024 deals put smaller home health agencies at roughly 4x to 8x EBITDA, with larger, higher-acuity providers reaching mid-teens multiples (Arya Health). Small deals vary widely. Survey history, payer mix, census quality and whether Medicare billing privileges can transfer often move price more than any rule of thumb.

Pricing sources: Arya Health: Executive brief, home health M&A in 2025

Licensing and closing risks

  • Home health, hospice and personal assistance agencies are licensed by HHSC as Home and Community Support Services Agencies under 26 TAC Chapter 558. The license cannot be transferred, so the buyer applies for its own license through a change of ownership (26 TAC 558.23).
  • When HHSC allows the change without a gap, the seller keeps its license active until HHSC issues the buyer's license (26 TAC 558.23). A September 2026 HHSC proposal would clarify that the seller stays responsible during that window (Texas Register, proposal only).
  • Medicare's 36-month rule: if a home health agency or hospice changes majority ownership within 36 months of enrollment or its last ownership change, the provider agreement and billing privileges do not convey unless an exception applies, such as two consecutive years of full cost reports (42 CFR 424.550(b)).
  • Medicaid managed care contracts for PAS and home health need the buyer credentialed under its own license, so build that time into the closing plan.
  • For the full change of ownership sequence, see Delta's guide, Selling a Texas home health or hospice agency.

Sale-readiness scorecard

Answer eight yes or no questions. Your score and the items to fix first update as you go. Nothing you click is saved or sent anywhere.

  1. Is your last Medicare ownership change over 36 months old, or are two full cost reports on file?

    Otherwise billing privileges may not convey.

  2. Are all survey deficiencies closed with accepted plans of correction?

    Open deficiencies scare buyers.

  3. Are your financials on accrual and reviewed by a CPA?

    Buyers price what they can verify.

  4. Does no single referral source drive more than a small share of admissions?

    Concentration is risk.

  5. Could your administrator and DON run the agency for 90 days without you?

    Owner dependence lowers price and adds earnouts.

  6. Are every branch and service area licensed correctly with HHSC?

    Gaps can stall the change of ownership.

  7. Are your managed care contracts current and in good standing?

    PAS value depends on those contracts.

  8. Has counsel reviewed medical director and marketing arrangements?

    Buyers will.

0 of 8 ready (0 answered)

Answer the questions above to see where you stand.

Your preparation checklist

  1. 24 months out: pull your HHSC license, every branch license and your Medicare enrollment dates, and confirm whether the 36-month rule applies.
  2. Close every open survey deficiency and keep the plan of correction file organized.
  3. Move to accrual accounting and have a CPA review or compile the last two to three years.
  4. Reconcile cost reports to your books and bank deposits.
  5. Build a referral log by source, month and payer.
  6. Document census, length of stay and live discharges, and explain outliers.
  7. Name and train an alternate administrator who can run the agency without you.
  8. Collect every payer contract and note change of control clauses.
  9. Have health care counsel review medical director and marketing arrangements.
  10. 6 to 12 months out: build a confidential buyer list across platform, regional and owner-operator buyers, then go to market.

How long a sale takes

As a planning assumption, expect about 6 to 12 months from going to market to closing. Licensing often sets the pace, because the buyer's HHSC change of ownership and any Medicare steps must line up with closing.

The Rio Grande Valley angle

Hidalgo County had about 921,549 residents in 2025, up from 872,753 in 2020, and Cameron County had about 433,946 (U.S. Census Bureau estimates via FRED). Buyers have completed home health and hospice deals here recently, and they diligence census and billing hard, so a well-documented agency stands out.

Thinking about selling? Start with a free, confidential consultation

Talk with a Delta partner about your home health and hospice business. We will tell you plainly what buyers will look at, what your business may be worth, and what to fix first. No obligation, and nothing you share leaves us.

This guide is general information, not legal or tax advice. Delta Brokers is a business brokerage, not a law firm or CPA firm. Rules, agency practice and market multiples change, and small deals vary widely; confirm every requirement with the agency named and with your own attorney and CPA before you act. Last reviewed November 12, 2026.

Sources

Sources reviewed November 12, 2026
  1. Arya Health: Executive brief, home health M&A in 2025
  2. 26 TAC 558.23, Change of Ownership (Cornell LII)
  3. 42 CFR 424.550, Prohibitions on the sale or transfer of billing privileges (Cornell LII)
  4. Texas Register, Sept 18 2026, proposed HHSC rules (26 TAC Chapter 558)
  5. U.S. Census Bureau via FRED: Resident Population in Hidalgo County, TX
  6. U.S. Census Bureau via FRED: Resident Population in Cameron County, TX
  7. Coleman Report: SBA procedural notice on citizenship and residency requirements for 7(a) and 504 loans (Feb 2026)

Related guides

Closing-risk guides:

FAQ

Frequently asked questions

How long does the HHSC change of ownership take?
It depends on how complete the buyer's application is and whether HHSC inspects. Your license does not transfer, so the buyer applies for its own while you keep yours active. Delta's guide, Selling a Texas home health or hospice agency, covers the filings.
What is the Medicare 36-month rule?
If a home health agency or hospice changes majority ownership within 36 months of its Medicare enrollment or its last ownership change, the provider agreement and billing privileges generally do not convey to the buyer. The main exception is two consecutive years of full cost reports. Check your dates before you talk to buyers (42 CFR 424.550(b)).
Can I sell a PAS agency that is mostly Medicaid?
Yes. National and regional platforms buy Medicaid personal care agencies, especially where they have Texas density. They focus on managed care contracts, EVV compliance, caregiver retention and margins, so have those numbers clean and explained before you go to market.
Will my nurses and office staff keep their jobs?
Most buyers want your team, since staff and referrals are much of what they pay for. You can ask for employment commitments in the letter of intent, and more buyers at the table gives you more leverage on those terms.
Can a buyer use an SBA loan to buy my business?
Often, and SBA loans are common for smaller deals, but the rules changed. Since March 1, 2026, SBA 7(a) and 504 loans require every direct and indirect owner of the borrower to be a U.S. citizen or U.S. national living in the U.S., so green card holders can no longer use SBA financing (Coleman Report on the SBA notice). Smaller agency deals often depend on it. Delta's guide on the SBA citizenship rule and your buyer explains what this means for your buyer pool.
What does Delta Brokers charge, and are you my lawyer or CPA?
Delta Brokers is a veteran-owned sell-side M&A firm in McAllen. Our fee is tied to the sale of the business only, and we never earn real estate commissions. We are not a law firm or a CPA firm, so you will still want your own attorney and tax advisor. Our job is to prepare the business, find and qualify buyers, create competition, and manage the process to closing.