Anyone with experience acquiring Medicaid-reimbursed businesses? Looking to pressure-test the model.
Hey everyone, I'm deep in diligence on a behavioral health business (licensed IOP / substance use disorder treatment) where roughly 96% of revenue flows through Medicaid managed care contracts — think major regional MCOs rather than fee-for-service government billing directly.
Before I move to LOI, I'm trying to find people who've bought, operated, or exited businesses in this revenue model and can give me an honest read on a few things:
1. Contract transferability on ownership change — How have managed care organizations (MCOs) actually handled credentialing during a CHOW in your experience? Are the horror stories about billing gaps real, or manageable with proper counsel?
2. Policy / regulatory risk — How do you think about underwriting a business whose revenue is ultimately set by state Medicaid rate schedules and federal waiver programs? What does a reasonable risk discount look like?
3. Lender / QofE experience — Have you financed one of these with SBA 7(a)? Any lenders you'd point me toward who actually understand behavioral health reimbursement? Also, any recommendations for QofE providers who are familiar with this space?
4. Operational reality — For those who've operated in this model post-acquisition, what blindsided you that you wish you'd dug into during diligence?
Not looking for a full thread on Medicaid policy — just trying to find people who've been in this seat.
Happy to trade notes privately. Thanks in advance.