SBA lenders do finance home health agencies, but they price them above the average business: 1,563 7(a) loans between October 2023 and June 2026, about $723 million from 210 lenders, at a median of $182,000 and a median rate of 10.5%, against 10.25% nationally. Acquisitions were 14.3% of loans, at a median of $700,000. Approval depends on who pays the agency (Medicare, Medicaid, managed care or private clients), whether its licenses and certifications transfer cleanly, and whether cash flow covers payroll and loan payments while claims are waiting to be paid.
| Measure | Home Health Care Services | All industries |
|---|---|---|
| SBA 7(a) loans approved | 1,563 | 162,355 |
| Median loan | $182,000 | $150,300 |
| Middle half of loans | $80,000 – $450,000 | $50,000 – $500,000 |
| Loans of $1 million or more | 12.3% | 12.9% |
| Median rate at approval | 10.5% | 10.25% |
| Middle half of rates | 9.5% – 11.25% | 9.3% – 11.25% |
| Acquisitions (change of ownership) | 224 (14.3%) | 16,849 (10.4%) |
| Median acquisition loan | $700,000 | $693,000 |
| Lenders that made these loans | 210 | 1,648 |
| SBA 504 loans (real estate, equipment) | 89 | 16,714 |
Approvals FY2024 – FY2026 to date (1 Oct 2023 – 30 Jun 2026), cancelled loans excluded. Source: SBA 7(a) and 504 FOIA loan records, as of June 30, 2026.
- SBA 7(a) loans approved
- 1,563 (Oct 2023 – Jun 2026)
- Median loan
- $182,000
- Median rate at approval
- 10.5%
- Acquisitions
- 224 loans (14.3%), median $700,000
- Franchises
- 26.1% of loans
- Median jobs supported
- 12
What SBA lenders approved for home health
Home health care services (NAICS 621610) took 1,563 SBA 7(a) loans from FY2024 through June 2026, worth $722,645,100, from 210 lenders. The median loan was $182,000, a little above the national $150,300, and the middle half ran from $80,000 to $450,000. The top tenth started at $1,180,000, and 193 loans (12.3%) were $1 million or more.
The rate is the figure to notice. The median of 10.5% sits above the national 10.25%, and the middle half ran from 9.5% to 11.25%. Size does not explain it: SBA caps variable rates at the base rate plus 6% from $50,001 to $250,000, and both the home health median and the national median sit in that band. Where a lender prices inside the cap reflects its view of the credit, and here it is pricing a business with few hard assets and revenue that depends on government payers. A median of 12 jobs supported per loan says what the business is: payroll.
| Figure | Home health agencies | What it tells you |
|---|---|---|
| Median loan | $182,000 | Working capital, systems and small purchases |
| Middle half of loans | $80,000 to $450,000 | Most loans are modest; purchases sit at the top |
| Loans of $1 million or more | 193 (12.3%) | Agency acquisitions and multi-location operators |
| Median rate at approval | 10.5% (middle half 9.5% to 11.25%) | Above the national 10.25% |
| Fixed-rate share | 8% | Most loans float |
| Acquisitions | 224 loans (14.3%), median $700,000 at 9.5% | Above the national 10.4%: agencies change hands |
| Start-ups | 19.1% of loans | New agencies, including franchised home care |
| Franchises | 26.1% of loans | Branded home care systems are a large share |
| SBA Express | 32% of loans | Smaller needs on the lender's own credit process |
Two businesses under one code
Lenders do not treat every agency in this category alike. The code is defined around skilled care in the home, but in the loan data it also holds agencies that provide only non-medical care, which are otherwise classed with services for the elderly and persons with disabilities. A skilled home health agency sends nurses and therapists into patients' homes under a physician's order and bills Medicare, Medicaid and managed care plans. A non-medical home care agency sends caregivers to help with bathing, meals and daily living, and is paid by families, long-term care insurance and, in many states, Medicaid waiver programs. Franchise systems are more common on the non-medical side, which helps explain the franchise share of 26.1%.
| Skilled home health | Non-medical home care | |
|---|---|---|
| Who pays | Medicare, Medicaid, managed care | Private-pay clients, long-term care insurance, Medicaid waivers |
| What licenses the business | State license and Medicare certification | State license where required |
| How revenue is earned | Episodes of care, billed after documentation | Hours of care, billed weekly or monthly |
| What worries the lender | Reimbursement changes, audits and repayment demands, survey results | Caregiver turnover, private-pay collections, wage rules |
| What a buyer is paying for | The certification, referral relationships and clinical staff | The client roster, caregivers and the franchise territory |
The collateral problem, and how lenders get past it
An agency's balance sheet is mostly receivables and cash. There is little equipment and usually no real estate: SBA 504 financed just 89 home health projects, at a median of $717,000. SBA does not decline a loan only because collateral falls short, but on larger loans it expects the lender to take the collateral that is available, which can mean a lien on the owner's home, and every owner of 20% or more personally guarantees the loan. See personal residence collateral.
That leaves cash flow to carry the decision. SBA requires debt service coverage of at least 1.15x, and 1.0x globally once the owners' personal obligations are counted. In home health, lenders build that figure carefully:
- Payroll timing. Caregivers are paid every week or two; payers pay after claims are processed. The agency is always financing the gap, and a growing agency finances more of it.
- Payer concentration. An agency that takes most of its revenue from one Medicaid program or one managed care plan carries that payer's rate decisions in its own margin.
- Referral sources. Hospitals, discharge planners and physician groups send skilled patients. Lenders ask where referrals come from and whether any one source dominates.
- Compliance history. Survey deficiencies, payer audits and repayment demands can take cash out of the business years after the revenue was earned.
For the working capital itself, a line of credit against receivables often fits better than a term loan. See lines of credit for home health agencies and SBA CAPLines.
Buying an agency
Acquisitions were 224 loans, 14.3% of home health lending, at a median of $700,000 and 9.5%. Because so little of the price is tangible, nearly every agency purchase above a small size needs an independent business valuation: SBA requires one where the amount financed, less appraised real estate and equipment, exceeds $250,000, and the loan for the purchase cannot exceed it. From 1 October 2026 every change of ownership also needs financial due diligence.
The licenses decide the timetable. State licenses and Medicare certification do not always transfer with a sale, and a change of ownership may need approval from the state and from Medicare before the buyer can bill. Medicare also adds requirements when a home health agency changes majority ownership soon after it was certified or last sold, so a buyer should confirm the agency's history before signing a letter of intent. A lender will want the transfer path mapped before it commits.
SBA's usual acquisition rules apply: at least 10% of total project costs as equity, a seller note counted toward half of it only on full standby for the life of the loan, and no earnout. The seller may consult for up to 12 months, or up to 24 months under SOP 50 10 8.1 from 1 October 2026, and in an agency where the referral relationships sit with the seller or the director of nursing, that transition period is worth planning. See financing a home health agency acquisition and financing goodwill.
In an agency purchase, confirm the licenses and certification can move to the buyer before anything else in the deal is negotiated.
Preparing a home health file
The SBA list: 2–3 years of business tax returns, a P&L and balance sheet with a year-to-date P&L through last month-end, a debt schedule with copies of any notes being refinanced, and personal tax returns and a personal financial statement for each owner of 20% or more, with the owner's resume for Form 1919. Lenders look for clinical or operational experience in home care, or a director of nursing or administrator who brings it.
A home health file should add revenue by payer by month, a receivables aging by payer, census or billed hours by month, the licenses and certification, recent survey results, any audit or repayment correspondence, and the franchise agreement if there is one. An agency that has leaned on merchant cash advances to meet payroll should know that SBA will not refinance an active advance. See refinancing cash advances for healthcare providers.
Transparent builds the file into a full lender package — financing model, lender presentation, blind teaser and underwriting memo — in a day once the documents are in, and takes it to the lenders in its book that write SBA 7(a) and 504, 278 of them, and to the 235 that write asset-based loans and lines where a receivables line fits better. On SBA loans the lender pays Transparent, not the borrower.
Common questions
- Can I get an SBA loan to buy a home health agency?
- Yes. 224 SBA 7(a) loans financed home health acquisitions between October 2023 and June 2026, at a median of $700,000. Expect a business valuation, at least 10% equity, a personal guarantee, and a lender that wants the license and certification transfer mapped before it commits.
- Why are home health SBA rates higher than average?
- The median rate was 10.5% against 10.25% nationally. Loan size is not the reason, since the typical home health loan and the typical loan nationally fall under the same SBA rate cap. Lenders are pricing a business with few hard assets and revenue tied to government payers.
- Can I start a home care agency with an SBA loan?
- Yes. 19.1% of home health SBA loans went to start-ups, and 26.1% to franchises. Lenders look at the owner's experience in care or operations, the franchise system, the local market and an equity injection of at least 10% of total project costs.
- Is a term loan or a line of credit better for a home health agency?
- It depends on the need. A term loan fits a purchase or a fixed investment. The gap between paying caregivers and collecting from payers is a working capital need, and a line against receivables usually fits it better.