What McGuireWoods 2026 Means for ABA Platform Exits

Financing Came Back, Buyers Got Picky

CHICAGO – When several hundred healthcare investors, lenders, and advisers gathered for the 22nd McGuireWoods Healthcare Private Equity and Finance Conference on April 29 and 30, the mood was the most constructive it had been in two years. Financing had loosened, buyers and sellers had moved closer on price, and the deal pipeline had deepened. Havencrest Capital’s Christopher Kersey, in a fireside chat with McGuireWoods partner and Becker’s publisher Scott Becker, predicted the next 3 years would be the strongest stretch for healthcare private equity in at least a decade.

That optimism came with a filter. Buyers, the conference’s own recap reported, still prize operationally mature businesses with real compliance infrastructure, differentiated growth, and durable reimbursement. Premium assets draw crowded auctions; weaker platforms face valuation pressure and longer paths to close. For owners of applied behavior analysis businesses watching the autism-therapy M&A market, that filter is the whole story.

The Question Was Who Buys Next

The contrast with 2025 was sharp. A year ago, the room wanted to know when financing would return and how platforms would fix their staffing. In 2026, the recap noted, financing is no longer the bottleneck, and the headline question has shifted to “who buys the next wave of platforms.” By the authors’ account, it was the question that came up between sessions more than any other.

The answer is unsettled. Panelists agreed that exits remain choppy. The IPO window has barely cracked open, sponsor-to-sponsor sales sit well below their peak, and continuation funds and other sponsor-led structures are filling the gap. The platforms built in the early 2020s are expected to come to market over the next 18 to 24 months, a wave meant to supply both exit liquidity for current owners and fresh inventory for the next generation of buyers. For now, continuation vehicles let a sponsor move an asset from one of its own funds to another and reset the clock without a true sale, a sign of how thin genuine third-party demand has become at the top of the market.

Financing came back. The exits did not. Somebody still has to buy the platforms the last cycle built.

The mood music had a second motif: artificial intelligence. The recap’s authors reported that AI had moved from a future opportunity to an investable thesis and an operational imperative, with panelists describing its expanding role in clinical documentation, revenue cycle, labor efficiency, and administrative-burden reduction. One panelist’s framing, that AI fails at the strategy rather than the model, captured the caution: governance and clean data have to precede deployment. For ABA, a labor-intensive field that runs on documentation and authorization, the implication is that the operators who professionalize their data and billing infrastructure are the ones a disciplined buyer will reward.

ABA’s Boom Is the Bill Coming Due

No corner of healthcare fits that description more precisely than ABA. A study published in JAMA Pediatrics in January 2026, by researchers at Brown University, counted 574 private-equity-owned autism therapy centers across 42 states as of 2024, assembled through 142 separate deals, with nearly 80 percent of the acquisitions falling between 2018 and 2022. That is the boom the conference was describing, and ABA was one of its purest expressions.

The geography tracks the money. The Brown team found the heaviest concentrations in California, Texas, Colorado, Illinois, and Florida, the same states where rising diagnoses and generous coverage mandates made centers easiest to fill. Childhood autism diagnoses nearly tripled between 2011 and 2022, the researchers noted, which is what drew the capital in the first place and still underwrites the demand case.

The study’s authors framed the consolidation in terms of risk rather than verdict. Lead author Daniel Arnold and health economist Yashaswini Singh, of Brown’s School of Public Health, noted that because many children in these centers are insured by Medicaid, any private-equity push to increase the intensity of billable care would flow directly into state Medicaid budgets. That observation is the bridge between the academic finding and the conference’s caution: the same Medicaid exposure that made ABA easy to scale is what now makes a Medicaid-heavy platform harder to sell into a market bracing for rate pressure.

Those platforms are now aging into the exact window panelists flagged. One M&A adviser’s year-end 2025 tally found more than 35 pediatric-therapy platforms sitting past the normal 4-to-5-year hold, 13 of them held for more than 7 years, a backlog the firm called a pressure cooker. Private equity owners owe their investors a return, and the clock on that obligation does not reset. The price has moved against them, too: ABA multiples that touched 10 to 15 times earnings in the 2017 to 2019 frenzy have settled into the high single digits, closer to 6 to 8 times.

What the Next Buyer Will Pay For

The conference was clear about which assets clear the market. Behavioral health stayed a focal point, with panelists citing durable demand, chronic provider shortages, and growing payer support as a long runway for consolidation, and they singled out intellectual and developmental disability platforms as especially attractive. The caution was just as clear: subsectors with heavy direct reimbursement exposure, particularly anything with material Medicaid concentration, drew warier commentary as investors brace for rate pressure. Lenders said the same in their own language, reserving the best terms for stable operators and underwriting subsectors with reimbursement or regulatory uncertainty more strictly.

ABA sits on both sides of that ledger. Its demand and workforce shortage are real, but it is labor-intensive, often heavily Medicaid-funded, and increasingly under enforcement and revalidation scrutiny in states from Minnesota to Florida. The recap’s through-line was that the next buyer underwrites operational maturity, not topline growth: scalable integration, professionalized finance and data, embedded compliance, a defensible payer mix. Selling well, panelists said, now means building those capabilities early in the hold rather than scrambling during the sale process.

The market is already sorting on that basis. In January 2026, Webster Equity Partners sold InBloom Autism Services to Elysium Management, the family office of Leon Black, in a deal worth about $75 million, the kind of clean exit a differentiated asset can still command. Even the largest operators have pruned: Charlesbank-backed Action Behavior Centers restructured in early 2025, closing centers and cutting regional staff, while in January 2026 General Atlantic-backed ACES folded Ally Pediatric Therapy into a 92-location, ABA-focused platform. Two other threads bear on ABA. Investors are paying up for the technology layer the sector runs on, the billing, documentation, and data tooling, after Roper’s $1.65 billion purchase of the ABA software platform CentralReach put a marker on the category. And panelists returned repeatedly to widening state review of healthcare transactions, which is lengthening timelines and reshaping diligence, a particular concern for a field already living under fraud enforcement.

Lenders described the financing backdrop in matching terms. The debt-market participants on the conference’s panels reported more liquidity and sharper competition, with the strongest appetite reserved for scaled platforms throwing off predictable cash flow, even as leverage in some subsectors stayed below historical highs. The recap also noted that sponsors who once stuck to services are now willing to underwrite the technology layer outright, blurring the line between healthcare services and healthcare technology. That shift is why a tooling deal like Roper’s CentralReach purchase reads as a signal about ABA rather than a sideshow: the data and billing infrastructure has become an asset class of its own, and the operators plugged into it look more financeable than those running on spreadsheets.

A scaled, compliance-ready platform sells. A subscale, Medicaid-heavy one waits.

The Clock for Clinic Owners

For a clinic owner, the translation is direct. The platforms most likely to trade well in the coming wave are scaled, operationally professionalized, compliance-ready, and diversified across payers. The ones most likely to stall, or to sell at a discount to a better-capitalized consolidator, are subscale, debt-heavy, undifferentiated, or concentrated in Medicaid markets facing rate cuts. A separate conference recap noted investors specifically eyeing fragmented segments where overextended roll-ups had stumbled, the openings that let stronger sponsors consolidate at more reasonable multiples. Lower-middle-market deals drew interest precisely because buyers could create value through integration and technology rather than betting on the multiple expansion that is no longer coming.

That is both a warning and an opening. Owners who spend the next year and a half standing up real finance, compliance, and integration functions improve their odds of being bought rather than absorbed. The next 18 to 24 months will answer the question the room in Chicago kept asking. When McGuireWoods reconvenes in Arizona on April 13 and 14, 2027, the ABA names that changed hands, and the multiples they fetched, will show which side of that line operational maturity actually put them on.

AT A GLANCE

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