ModivCare (MODV) 10-Q 6 Nov 24 2024 Q3 Quarterly report Financial data

Cover Page

Cover Page - shares	9 Months Ended
	Sep. 30, 2024	Nov. 01, 2024
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2024
Document Transition Report	false
Entity File Number	001-34221
Entity Registrant Name	ModivCare Inc.
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	86-0845127
Entity Address, Address Line One	6900 E Layton Avenue
Entity Address, Address Line Two	12th Floor
Entity Address, City or Town	Denver
Entity Address, State or Province	CO
Entity Address, Postal Zip Code	80237
City Area Code	303
Local Phone Number	728-7012
Title of 12(b) Security	Common Stock, $0.001 par value per share
Trading Symbol	MODV
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		14,283,664
Entity Central Index Key	0001220754
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2024
Document Fiscal Period Focus	Q3
Amendment Flag	false

Unaudited Condensed Consolidate

Unaudited Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Current assets:
Cash and cash equivalents	$ 48,336	$ 2,217
Accounts receivable, net of allowance of $1,167 and $969, respectively	248,683	222,537
Contract receivables	110,431	143,960
Other receivables	16,803	8,616
Prepaid expenses and other current assets	38,648	27,028
Restricted cash	548	565
Total current assets	463,449	404,923
Property and equipment, net	84,451	85,629
Goodwill	680,252	785,554
Payor network, net	284,466	330,738
Other intangible assets, net	17,132	30,197
Equity investment	35,835	41,531
Operating lease right-of-use assets	39,839	39,776
Other assets	46,324	48,927
Total assets	1,651,748	1,767,275
Current liabilities:
Accounts payable	52,109	55,241
Accrued contract payables	47,300	117,488
Accrued transportation costs	95,023	97,245
Accrued expenses and other current liabilities	145,289	127,901
Current portion of operating lease liabilities	8,548	8,727
Short-term debt	233,250	113,800
Total current liabilities	581,519	520,402
Long-term debt, net of deferred financing costs of $32,313 and $16,243, respectively	986,125	983,757
Deferred tax liabilities	32,831	39,584
Operating lease liabilities, less current portion	34,364	33,784
Other long-term liabilities	33,905	33,553
Total liabilities	1,668,744	1,611,080
Commitments and contingencies (Note 13)
Stockholders’ equity (deficit)
Common stock: Authorized 40,000,000 shares; $0.001 par value; 19,872,875 and 19,775,041, respectively, issued and outstanding (including treasury shares)	20	20
Additional paid-in capital	455,714	450,945
Accumulated deficit	(202,225)	(24,437)
Treasury shares, at cost, 5,573,918 and 5,571,004 shares, respectively	(270,505)	(270,333)
Total stockholders’ equity (deficit)	(16,996)	156,195
Total liabilities and stockholders’ equity (deficit)	$ 1,651,748	$ 1,767,275

Unaudited Condensed Consolida_2

Unaudited Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Statement of Financial Position [Abstract]
Allowance for doubtful accounts	$ 1,167	$ 969
Deferred financing fees	$ 32,313	$ 16,243
Common stock, shares authorized (in shares)	40,000,000	40,000,000
Common stock, par (in dollars per share)	$ 0.001	$ 0.001
Common stock, shares, issued (in shares)	19,872,875	19,775,041
Common stock, shares, outstanding (in shares)	19,872,875	19,775,041
Treasury stock, shares (in shares)	5,573,918	5,571,004

Unaudited Condensed Consolida_3

Unaudited Condensed Consolidated Statements of Operations - USD ($)	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Income Statement [Abstract]
Service revenue, net	$ 702,037,000	$ 686,925,000	$ 2,084,787,000	$ 2,048,338,000
Grant income	0	551,000	0	4,649,000
Operating expenses:
Service expense	597,934,000	579,214,000	1,769,600,000	1,718,735,000
General and administrative expense	70,903,000	70,142,000	224,145,000	229,095,000
Depreciation and amortization	27,940,000	26,077,000	82,795,000	77,679,000
Impairment of goodwill	0	0	105,302,000	183,100,000
Total operating expenses	696,777,000	675,433,000	2,181,842,000	2,208,609,000
Operating income (loss)	5,260,000	12,043,000	(97,055,000)	(155,622,000)
Interest expense, net	28,493,000	17,844,000	67,129,000	50,769,000
Loss on debt extinguishment	11,797,000	0	11,797,000	0
Loss before income taxes and equity method investment	(35,030,000)	(5,801,000)	(175,981,000)	(206,391,000)
Income tax benefit	11,070,000	1,659,000	2,055,000	4,362,000
Equity in net income (loss) of investee, net of tax	(2,644,000)	(160,000)	(3,862,000)	2,821,000
Net loss	$ (26,604,000)	$ (4,302,000)	$ (177,788,000)	$ (199,208,000)
Loss per common share:
Basic (in dollars per share)	$ (1.87)	$ (0.30)	$ (12.50)	$ (14.06)
Diluted (in dollars per share)	$ (1.87)	$ (0.30)	$ (12.50)	$ (14.06)
Weighted-average number of common shares outstanding:
Basic (in shares)	14,253,192	14,182,839	14,224,155	14,169,537
Diluted (in shares)	14,253,192	14,182,839	14,224,155	14,169,537

Unaudited Condensed Consolida_4

Unaudited Condensed Consolidated Statements of Cash Flows - USD ($)	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Operating activities
Net loss	$ (26,604,000)	$ (4,302,000)	$ (177,788,000)	$ (199,208,000)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation			23,536,000	18,212,000
Amortization			59,259,000	59,467,000
Stock-based compensation			4,792,000	4,029,000
Deferred income taxes			(6,753,000)	(15,235,000)
Impairment of goodwill	0	0	105,302,000	183,100,000	$ 183,100,000
Loss on debt extinguishment	11,797,000	0	11,797,000	0
Amortization of deferred financing costs and debt discount			4,752,000	3,907,000
Equity in net (income) loss of investee			5,360,000	(3,915,000)
Reduction of right-of-use assets			7,289,000	9,875,000
Changes in operating assets and liabilities:
Accounts receivable and other receivables			(33,997,000)	14,242,000
Contract receivables			33,528,000	(58,143,000)
Prepaid expenses and other current assets			(11,382,000)	(4,499,000)
Accrued contract payables			(70,188,000)	(60,710,000)
Accounts payable and accrued expenses			14,256,000	(2,422,000)
Accrued transportation costs			(2,222,000)	6,123,000
Other changes in operating assets and liabilities			(3,994,000)	(12,150,000)
Net cash used in operating activities			(36,453,000)	(57,327,000)
Investing activities
Purchase of property and equipment			(22,281,000)	(31,143,000)
Net cash used in investing activities			(22,281,000)	(31,143,000)
Financing activities
Net proceeds from short-term debt			114,200,000	83,000,000
Issuance of long-term debt			525,000,000	0
Repayment of long-term debt			(508,657,000)	0
Payment of debt issuance costs			(25,512,000)	(376,000)
Restricted stock surrendered for employee tax payment			(591,000)	(861,000)
Other financing activities			396,000	346,000
Net cash provided by financing activities			104,836,000	82,109,000
Net change in cash, cash equivalents and restricted cash			46,102,000	(6,361,000)
Cash, cash equivalents and restricted cash at beginning of period			2,782,000	14,975,000	14,975,000
Cash, cash equivalents and restricted cash at end of period	$ 48,884,000	$ 8,614,000	48,884,000	8,614,000	$ 2,782,000
Supplemental cash flow information
Cash paid for interest			44,845,000	32,816,000
Cash paid for income taxes			7,226,000	8,348,000
Assets acquired under operating leases			$ 7,352,000	$ 10,214,000

Unaudited Condensed Consolida_5

Unaudited Condensed Consolidated Statements of Stockholders' Equity (Deficit) - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Retained Earnings (Accumulated Deficit)	Treasury Stock
Beginning balance (in shares) at Dec. 31, 2022		19,729,923
Beginning balance at Dec. 31, 2022	$ 354,556	$ 20	$ 444,255	$ 180,023	$ (269,742)
Beginning balance (in shares) at Dec. 31, 2022					5,573,529
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(3,962)			(3,962)
Stock-based compensation	1,039		1,039
Restricted stock issued (in shares)		24,903
Restricted stock issued	0
Restricted stock surrendered for employee tax payment (in shares)					6,000
Restricted stock surrendered for employee tax payment	(620)				$ (620)
Shares issued for bonus settlement and director stipends (in shares)		1,006
Shares issued for director stipends	85		85
Ending balance (in shares) at Mar. 31, 2023		19,755,832
Ending balance at Mar. 31, 2023	351,098	$ 20	445,379	176,061	$ (270,362)
Ending balance (in shares) at Mar. 31, 2023					5,579,529
Beginning balance (in shares) at Dec. 31, 2022		19,729,923
Beginning balance at Dec. 31, 2022	354,556	$ 20	444,255	180,023	$ (269,742)
Beginning balance (in shares) at Dec. 31, 2022					5,573,529
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(199,208)
Ending balance (in shares) at Sep. 30, 2023		19,771,636
Ending balance at Sep. 30, 2023	158,861	$ 20	448,443	(19,185)	$ (270,417)
Ending balance (in shares) at Sep. 30, 2023					5,575,275
Beginning balance (in shares) at Mar. 31, 2023		19,755,832
Beginning balance at Mar. 31, 2023	351,098	$ 20	445,379	176,061	$ (270,362)
Beginning balance (in shares) at Mar. 31, 2023					5,579,529
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(190,944)			(190,944)
Stock-based compensation	1,021		1,021
Exercise of employee stock options (in shares)		549
Exercise of employee stock options	31		31
Restricted stock issued (in shares)		9,116
Restricted stock issued	0
Restricted stock surrendered for employee tax payment (in shares)					3,138
Restricted stock surrendered for employee tax payment	(221)				$ (221)
Shares issued for bonus settlement and director stipends (in shares)		1,871
Shares issued for director stipends	85		85
Shares issued for ESPP (in shares)					(7,874)
Shares issued for ESPP	371		178		$ 193
Ending balance (in shares) at Jun. 30, 2023		19,767,368
Ending balance at Jun. 30, 2023	161,441	$ 20	446,694	(14,883)	$ (270,390)
Ending balance (in shares) at Jun. 30, 2023					5,574,793
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(4,302)			(4,302)
Stock-based compensation	1,664		1,664
Restricted stock forfeited (in shares)		1,583
Restricted stock surrendered for employee tax payment (in shares)					482
Restricted stock surrendered for employee tax payment	(27)				$ (27)
Shares issued for bonus settlement and director stipends (in shares)		2,685
Shares issued for director stipends	85		85
Ending balance (in shares) at Sep. 30, 2023		19,771,636
Ending balance at Sep. 30, 2023	$ 158,861	$ 20	448,443	(19,185)	$ (270,417)
Ending balance (in shares) at Sep. 30, 2023					5,575,275
Beginning balance (in shares) at Dec. 31, 2023	19,775,041	19,775,041
Beginning balance at Dec. 31, 2023	$ 156,195	$ 20	450,945	(24,437)	$ (270,333)
Beginning balance (in shares) at Dec. 31, 2023	5,571,004				5,571,004
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	$ (22,300)			(22,300)
Stock-based compensation	1,973		1,973
Restricted stock issued (in shares)		22,577
Restricted stock issued	0
Restricted stock surrendered for employee tax payment (in shares)					1,607
Restricted stock surrendered for employee tax payment	(64)				$ (64)
Shares issued for bonus settlement and director stipends (in shares)		1,559
Shares issued for director stipends	37		37
Ending balance (in shares) at Mar. 31, 2024		19,799,177
Ending balance at Mar. 31, 2024	$ 135,841	$ 20	452,955	(46,737)	$ (270,397)
Ending balance (in shares) at Mar. 31, 2024					5,572,611
Beginning balance (in shares) at Dec. 31, 2023	19,775,041	19,775,041
Beginning balance at Dec. 31, 2023	$ 156,195	$ 20	450,945	(24,437)	$ (270,333)
Beginning balance (in shares) at Dec. 31, 2023	5,571,004				5,571,004
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	$ (177,788)
Ending balance (in shares) at Sep. 30, 2024	19,872,875	19,872,875
Ending balance at Sep. 30, 2024	$ (16,996)	$ 20	455,714	(202,225)	$ (270,505)
Ending balance (in shares) at Sep. 30, 2024	5,573,918				5,573,918
Beginning balance (in shares) at Mar. 31, 2024		19,799,177
Beginning balance at Mar. 31, 2024	$ 135,841	$ 20	452,955	(46,737)	$ (270,397)
Beginning balance (in shares) at Mar. 31, 2024					5,572,611
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(128,884)			(128,884)
Stock-based compensation	2,159		2,159
Restricted stock issued (in shares)		13,947
Restricted stock issued	0
Restricted stock surrendered for employee tax payment (in shares)					3,706
Restricted stock surrendered for employee tax payment	(92)				$ (92)
Shares issued for bonus settlement and director stipends (in shares)		881
Shares issued for director stipends	23		23
Shares issued for ESPP (in shares)					(17,798)
Shares issued for ESPP	468		48		$ 420
Ending balance (in shares) at Jun. 30, 2024		19,814,005
Ending balance at Jun. 30, 2024	9,515	$ 20	455,185	(175,621)	$ (270,069)
Ending balance (in shares) at Jun. 30, 2024					5,558,519
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Net loss	(26,604)			(26,604)
Stock-based compensation	506		506
Restricted stock issued (in shares)		57,251
Restricted stock issued	0
Restricted stock surrendered for employee tax payment (in shares)					15,399
Restricted stock surrendered for employee tax payment	(436)				$ (436)
Shares issued for bonus settlement and director stipends (in shares)		1,619
Shares issued for director stipends	$ 23		23
Ending balance (in shares) at Sep. 30, 2024	19,872,875	19,872,875
Ending balance at Sep. 30, 2024	$ (16,996)	$ 20	$ 455,714	$ (202,225)	$ (270,505)
Ending balance (in shares) at Sep. 30, 2024	5,573,918				5,573,918

Organization and Basis of Prese

Organization and Basis of Presentation	9 Months Ended
	Sep. 30, 2024
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Basis of Presentation	Organization and Basis of Presentation Description of Business ModivCare Inc. ("ModivCare" or the "Company") is a technology-enabled healthcare services company that provides a suite of integrated supportive care solutions for public and private payors and their members. Its value-based solutions address the social determinants of health ("SDoH") by connecting members to essential care services. By doing so, ModivCare helps health plans manage risks, reduce costs, and improve health outcomes. ModivCare is a provider of non-emergency medical transportation ("NEMT"), personal care services ("PCS"), and remote patient monitoring solutions ("RPM"), which serve similar, highly vulnerable patient populations. The technology-enabled operating model in its NEMT segment includes the coordination of non-emergency medical transportation services supported by an infrastructure of core competencies in risk underwriting, contact center management, network credentialing and claims management. Additionally, its personal care services in its PCS segment include placements of non-medical personal care assistants, home health aides and nurses primarily to Medicaid patient populations in need of care monitoring and assistance performing daily living activities in the home setting. ModivCare’s remote patient monitoring solutions in its RPM segment include the monitoring of personal emergency response systems, vitals monitoring and data-driven patient engagement solutions. ModivCare also holds a 43.6% minority interest in CCHN Group Holdings, Inc. and its subsidiaries, which operate under the Matrix Medical Network brand (“Matrix”). Matrix, which is included in the Corporate and Other segment, maintains a national network of community-based clinicians who deliver in-home and on-site services. Basis of Presentation The Company follows accounting standards established by the Financial Accounting Standards Board (“FASB”). The FASB establishes accounting principles generally accepted in the United States (“GAAP”). Rules and interpretive releases of the Securities and Exchange Commission (“SEC”) under the authority of federal securities laws are also sources of authoritative GAAP for SEC registrants. References to GAAP issued by FASB in these notes are to the FASB Accounting Standards Codification (“ASC”), which serves as the single source of authoritative accounting and applicable reporting standards to be applied for non-governmental entities. All amounts are presented in U.S. dollars unless otherwise noted. The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with GAAP for interim financial information, and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all the information and disclosures required by GAAP for complete financial statements. In the opinion of management, all adjustments considered necessary for the fair presentation of the results of the interim periods have been included. The Company has made estimates relating to the reporting of assets and liabilities, revenues and expenses, and certain disclosures in the preparation of these unaudited condensed consolidated financial statements in conformity with GAAP. Actual results could differ from those estimates. Operating results for the three and nine months ended September 30, 2024 are not necessarily indicative of the results that may be expected for the fiscal year ending December 31, 2024. Management has evaluated events and transactions that occurred after the balance sheet date and through the date these unaudited condensed consolidated financial statements were filed with the SEC and considered the effect of such events in the preparation of these unaudited condensed consolidated financial statements. The unaudited condensed consolidated balance sheet at December 31, 2023 included in this Form 10-Q has been derived from audited financial statements at that date, but does not include all the information and footnotes required by GAAP for complete financial statements. The unaudited condensed consolidated financial statements contained herein should be read in conjunction with the audited financial statements and notes included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2023. Reclassifications: Certain prior year amounts have been reclassified to conform to current year presentation. Management's Liquidity Plans and Going Concern Considerations ASC 205-40, Presentation of Financial Statements – Going Concern , requires Management to assess a Company’s ability to continue as a going concern for a period of one year from the date of financial statement issuance and to provide related footnote disclosures in certain circumstances. The accompanying unaudited condensed consolidated financial statements are prepared in accordance with U.S. GAAP assuming the Company will continue as a going concern, which contemplates the realization of assets and the satisfaction of liabilities in the normal course of business. Since February 26, 2024, the date the Annual Report on Form 10-K was filed with the SEC, the Company has faced a lengthened time interval between earning revenue and collecting receivables under outstanding contracts with some customers due to complexities in Medicare, Medicaid, and nongovernmental payor arrangements. This prolonged interval between the Company fulfilling its performance obligations and collecting the cash owed for its services from its customers, which the Company historically has not experienced to this extent, has lengthened collection periods and increased the uncertainty concerning the timing of the collection of these corresponding outstanding contract receivables. As of the issuance date of these unaudited condensed consolidated financial statements, Management determined that the extended collection periods and uncertainty concerning the timing of the collection of outstanding contract receivables has changed the Company’s forecasts of its ability to meet certain financial covenants in its debt instruments, specifically related to the Total Net Leverage Ratio covenant in the amended Credit Agreement (as defined in Note 9, Debt ). As a result, it has been determined that substantial doubt exists about the Company’s ability to meet its obligations as they come due within one year from the date of issuance of these unaudited condensed consolidated financial statements. While the Company continues to monitor cash generated from operations, available credit, and other liquid assets, sustaining operations relies heavily on the timely collection of contract receivables, which were approximately $110.4 million at September 30, 2024, and compliance with the Total Net Leverage Ratio covenant in its Credit Agreement, as amended to date. Failure to meet this covenant or others could cause obligations under the Revolving Credit Facility (as defined in Note 9, Debt ), the Term Loan Facility (as defined in Note 9, Debt ), and the Company’s Notes due 2029 (as defined in Note 9, Debt ), to become immediately due and payable, and the Company may not have sufficient liquidity to satisfy such obligations. In such event, the Company would expect to be required to restructure its existing debt or seek additional equity or debt financing to meet its obligations and maintain its existence as a going concern. To address compliance with the financial covenants in the Company's debt instruments for the quarter ended September 30, 2024, the Company entered into Amendment No. 4 (the "Fourth Amendment") to its Credit Agreement on September 30, 2024. This amendment increased the maximum permitted Total Net Leverage Ratio under the amended Credit Agreement for the fiscal quarter ended September 30, 2024 (the "Relief Period") to 6.50:1.00 from 5.25:1.00. As a result of the Fourth Amendment, the Company was in compliance with all of its covenants under the Credit Agreement for the quarter ended September 30, 2024, at which time the Company's Total Net Leverage Ratio was 5.59:1.00. The Company did not amend its Total Net Leverage Ratio for periods beyond September 30, 2024 and may need to do so in order to remain compliant with its covenants for the quarter ended December 31, 2024 and beyond. Management intends to undertake additional actions including continued discussions with its bank group on a collaborative long-term relief amendment to support ongoing compliance with its financial covenants and take other measures to further address these issues, support the funding of operations and improve liquidity. There can be no assurance, however, that any long-term relief amendment or additional funds will be available when needed on terms acceptable to the Company, or at all, or in an amount sufficient to enable the Company to satisfy its obligations or sustain operations in the future. Impact of the COVID-19 Pandemic On May 11, 2023, the Department of Health and Human Services ("HHS") declared the end of the public health emergency ("PHE") for the COVID-19 pandemic. While the Company has continued to experience increased trip volume, service hours, and caregiver visits each year following the pandemic, structural changes in the industry as a result of the pandemic, as well as ongoing constraints on the labor market, specifically related to the strain on healthcare professionals, could continue to have an adverse impact on the Company's financial statements. The Company continues to actively monitor the structural changes to the industry and the impact these have on the business and results of operations with emphasis on protecting the health and safety of its employees, maximizing the availability of its services and products to support SDoH, and supporting the operational and financial stability of its business. Federal, state, and local authorities have taken several actions designed to assist healthcare providers in providing care to COVID-19 and other patients and to mitigate the adverse economic impact of the COVID-19 pandemic. Legislative actions taken by the federal government include the CARES Act and the American Rescue Plan Act of 2021 ("ARPA"). Through the CARES Act, the federal government has authorized payments to be distributed to healthcare providers through the Public Health and Social Services Emergency Fund ("Provider Relief Fund" or "PRF"). Through ARPA the Coronavirus State and Local Fiscal Recovery Fund ("SLFRF") was established to send relief payments to state and local governments impacted by the pandemic to assist with responding to the PHE including the economic hardships that continue to impact communities and to respond to workers performing essential work during the COVID-19 PHE, including providers. These funds are not subject to repayment provided the Company is able to attest to and comply with any terms and conditions of such funding, as applicable. See discussion of government grants at Note 2, Significant Accounting Policies and Recent Accounting Pronouncements .

Significant Accounting Policies

Significant Accounting Policies and Recent Accounting Pronouncements	9 Months Ended
	Sep. 30, 2024
Accounting Policies [Abstract]
Significant Accounting Policies and Recent Accounting Pronouncements	Significant Accounting Policies and Recent Accounting Pronouncements Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, including disclosure of contingencies, at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates. Fair Value Measurements The Company follows FASB ASC Topic 820, Fair Value Measurement (“ASC 820”) which establishes a three-level valuation hierarchy for disclosure of fair value measurements. The valuation hierarchy categorizes assets and liabilities measured at fair value into one of three different levels depending on the observability of the inputs employed in the measurement. The three levels based on the observability of inputs are defined as follows: – Level 1: Quoted Prices in Active Markets for Identical Assets – inputs to the valuation methodology are quoted prices in active markets as of the measurement date for identical assets or liabilities. – Level 2: Significant Other Observable Inputs – inputs to the valuation methodology are based upon quoted prices for similar assets and liabilities in active markets, quoted prices for identical or similar assets and liabilities in markets that are not active, and inputs other than quoted prices that are observable for the asset or liability, either directly or indirectly, for substantially the full term of the financial instrument. – Level 3: Significant Unobservable Inputs – inputs to the valuation methodology are unobservable and significant to the fair value measurement. A financial instrument’s categorization within the valuation hierarchy is based upon the lowest level of input that is significant to the fair value measurement. The Company’s assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment and considers factors specific to the asset or liability. As of September 30, 2024 and December 31, 2023, the carrying amount for cash and cash equivalents, accounts receivable (net of allowance for credit losses), current assets and current liabilities was equal to or approximated fair value due to their short-term nature or proximity to current market rates. Fair values for the Company's publicly traded debt securities are based on quoted market prices, when available, and for the Company's nonpublic debt are based on lender quotes, when available. See Note 9, Debt , for the fair value of the Company's long-term debt. Goodwill and Intangible Assets In accordance with ASC 350, Intangibles-Goodwill and Other , the Company reviews goodwill for impairment annually, and more frequently if events and circumstances indicate that an asset may be impaired. Such circumstances could include, but are not limited to: (1) the loss or modification of significant contracts, (2) a significant adverse change in legal factors or in business climate, (3) unanticipated competition, (4) an adverse action or assessment by a regulator, or (5) a significant decline in the Company’s stock price. When evaluating goodwill for impairment, the Company first performs qualitative assessments for each reporting unit to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying value. If the qualitative assessment suggests that it is more likely than not that the fair value of a reporting unit is less than its carrying value, then the Company performs a quantitative assessment and compares the fair value of the reporting unit to its carrying value and to the extent the carrying value is greater than the fair value, the difference is recorded as an impairment in the consolidated statements of operations. The Company completed its annual goodwill test on July 1 during which it performed a quantitative test comparing the carrying value of the Company's reporting units with their respective fair value. The fair value of the Company's reporting units was estimated using both the income approach and the market valuation approach. The income approach produces an estimated fair value of a reporting unit based on the present value of the cash flows the Company expects the reporting unit to generate in the future. Estimates included in the discounted cash flow model are primarily Level 3 inputs and include the discount rate, which the Company determines based on adjusting an industry-wide weighted-average cost of capital for size, geography, and company specific risk factors, long-term rates of growth and profitability of the Company’s business, working capital effects and planned capital expenditures. The market approach produces an estimated fair value of a reporting unit based on a comparison of the reporting unit to comparable publicly traded entities in similar lines of business. The Company’s significant estimates in the market approach include the selected similar companies with comparable business factors such as size, growth, profitability, risk and return on investment and the multiples the Company applies to earnings before interest, taxes, depreciation and amortization (“EBITDA”) to estimate the fair value of the reporting unit. During the second quarter of 2024 and 2023, the Company recorded a $105.3 million impairment of goodwill within its RPM reporting unit and an aggregate $183.1 million impairment of goodwill within its PCS and RPM reporting units, respectively. For both periods, the Company determined that based on its qualitative assessment for each reporting unit, factors existed which required the Company to test its goodwill and indefinite-lived intangible assets for impairment. See Note 7, Goodwill and Intangible Assets , for additional details. Internal-use Software and Cloud Computing Arrangements The Company develops and implements software for internal use to enhance the performance and capabilities of the technology infrastructure. The costs incurred for the development of the internal-use software are capitalized when they meet the internal-use software capitalization criteria outlined in ASC 350-40 and are included within "Property and equipment, net" on the unaudited condensed consolidated balance sheets. The capitalized costs are amortized using the straight-line method over the estimated useful lives of the software, ranging from 3 to 10 years. As of September 30, 2024 and December 31, 2023, capitalized costs associated with the internal-use software, net of accumulated amortization were $26.3 million and $21.3 million, respectively. The amount of accumulated amortization as of September 30, 2024 and December 31, 2023 was $6.7 million and $2.6 million, respectively. Amortization expense during the three months ended September 30, 2024 and 2023 totaled $1.5 million and $0.7 million, respectively, and during the nine months ended September 30, 2024 and 2023, totaled $4.0 million and $1.5 million, respectively. In addition to acquired software, the Company capitalizes costs associated with cloud computing arrangements (“CCA”) that are service contracts. The CCA include services which are used to support certain internal corporate functions as well as technology associated with revenue-generating activities. The capitalized costs are amortized using the straight-line method over the term of the related CCA. As of September 30, 2024 and December 31, 2023, capitalized costs associated with CCA, net of accumulated amortization were $12.4 million and $14.6 million, respectively. The amount of accumulated amortization as of September 30, 2024 and December 31, 2023 was $9.0 million and $5.2 million, respectively. Amortization expense during the three months ended September 30, 2024 and 2023, totaled $1.5 million and $0.6 million, respectively, and during the nine months ended September 30, 2024 and 2023, totaled $3.8 million and $1.8 million, respectively. Revenue Recognition Under ASC 606, the Company recognizes revenue as it transfers promised services directly to its customers at the amount that reflects the consideration to which the Company expects to be entitled in exchange for providing these services. The Company's performance obligations are driven by its different segments of business and primarily consist of integrated service offerings to provide non-emergency medical transportation, personal care services, or remote monitoring services directly to its customers. The Company receives payment for providing these services from third-party payors that include federal, state, and local governmental agencies, managed care organizations, and private consumers. In the NEMT segment, the Company's performance obligation is to stand ready to perform transportation-related activities, including the management, fulfillment, and recordkeeping activities associated with such services. In the PCS segment, the Company's performance obligation is to deliver patient care services in accordance with the nature and frequency of services outlined in each contract. In the RPM segment, the Company's performance obligation is to stand ready to perform monitoring services in the form of personal emergency response system monitoring, vitals monitoring, and other monitoring services, as contractually agreed upon. The Company satisfies substantially all of its performance obligations over time and recognizes revenue over time instead of at points in time which aligns the pattern of transfer of promised services with the value received by the customer for the performance completed to date. The Company holds different contract types under its different segments of business. In the NEMT segment, there are both capitated contracts, under which payors pay a fixed amount monthly per eligible member and revenue is recognized over each distinct service period, and fee-for-service ("FFS") contracts, under which the Company bills and collects a specified amount for each service that is provided and revenue is recognized using the right to invoice practical expedient. In the PCS segment, contracts are also FFS and service revenue is reported at the estimated net realizable amount from patients and third-party payors for services rendered and revenue is recognized using the right to invoice practical expedient. Under RPM contracts, payors pay per-enrolled-member-per-month, based on enrolled membership, and revenue is recognized ratably over the contract term. For each contract type, the Company determines the transaction price based on the gross charges for services provided, reduced by estimates for contractual adjustments due to settlements of audits and payment reviews from third-party payors. The Company determines the estimated revenue adjustments at each segment based on its historical experience with various third-party payors and previous results from the claims and adjudication process. The PCS segment uses the portfolio approach to determine the estimated revenue adjustments. See further information in Note 4, Revenue Recognition . Government Grants The Company periodically receives government grants and other forms of government assistance which are not generated from the Company's contractual performance obligations under ASC 606, Revenue from Contracts with Customers . Funding received from governmental entities under government programs generally requires that the recipient attests to and complies with certain terms and conditions of receiving the funding. Government grant distributions have been received primarily under the CARES Act PRF and the ARPA SLFRF to provide economic relief and stimulus to address the health and economic impacts of the COVID-19 pandemic, as well as from other entities that provide funds with specific stipulations on the usage of these funds. Distributions received are targeted to assist with incremental health care related expenses or lost revenue attributable to the COVID-19 pandemic and provide stimulus to support long-term growth and recovery. When received, these government grants are generally recorded on the unaudited condensed consolidated balance sheets in "Accrued expenses and other current liabilities" until the time at which there is reasonable assurance the conditions of the grant will be met, at which point they can be recognized on the unaudited condensed consolidated statement of operations. Once recognized, the Company records the funds as "Grant income" if the grant is related to the loss of revenues or as an offset to "Service expense" if the grant is used to offset certain costs for which the grants are intended to compensate. The Company received grant distributions of $2.2 million and $6.5 million during the three months ended September 30, 2024 and 2023, respectively. The Company received grant distributions of $16.2 million and $21.0 million during the nine months ended September 30, 2024 and 2023, respectively. During the three and nine months ended September 30, 2024, no funds were recognized as grant income and $1.2 million and $19.1 million, respectively, were recognized as an offset to "Service expense." During the three and nine months ended September 30, 2023, $0.6 million and $4.6 million, respectively, were recognized as grant income and $0.9 million and $7.1 million, respectively, were recognized as an offset to "Service expense". The remaining balance is recorded on the unaudited condensed consolidated balance sheets in the "Accrued expenses and other current liabilities" line item until the conditions for recognition have been met. See further information in Note 8, Accrued Expenses and Other Current Liabilities . The payments from these acts are subject to certain restrictions and possible recoupment if not used for designated purposes. As a condition to receiving PRF distributions, providers must agree to certain terms and conditions, including, among other things, that the funds are being used for healthcare related expenses and lost revenues attributable to COVID-19, as defined by HHS. All recipients of PRF payments are required to comply with the reporting requirements described in the terms and conditions and as determined by HHS. The Company has submitted the required documents to meet reporting requirements for the applicable reporting periods. The Company received an audit inquiry letter from HHS related to one of the business units that received PRF payments. In response, the Company has submitted all requested information and believes that the payments received are substantiated and within the terms and conditions defined by HHS. The Company continues to recognize these amounts as grant income. At this time, the Company is unaware of any other pending or upcoming audits or inquiries related to amounts received under PRF. As a condition of receiving SLFRF distributions, providers must agree to use the funds to respond to the PHE or its negative economic impacts, to respond to workers performing essential work by providing premium pay to eligible workers, and to offset reductions in revenue due to the COVID-19 PHE as stipulated by the states in which the funds were received. All recipients of SLFRF distributions are required to comply with the reporting requirements that the state in which the funds originated requests, in order for the states to meet the requirements as described in the terms and conditions as determined by the Department of the Treasury. The Company is in the process of complying with all known reporting requirements to date. Recent Accounting Pronouncements Recent accounting pronouncements that the Company has yet to adopt are as follows: In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures ("ASU 2023-07"). This update improves reportable segment disclosure requirements, primarily through enhanced disclosure about significant segment expenses. The enhancements under this update require disclosure of significant segment expenses that are regularly provided to the Chief Operating Decision Maker ("CODM") and included within each reported measure of segment profit or loss, require disclosure of other segment items by reportable segment and a description of the composition of other segment items , require annual disclosures under ASC 280 to be provided in interim periods, clarify use of more than one measure of segment profit or loss by the CODM, require that the title of the CODM be disclosed with an explanation of how the CODM uses the reported measures of segment profit or loss to make decisions, and require that entities with a single reportable segment provide all disclosures required by this update and required under ASC 280. ASU 2023-07 is effective for public business entities for fiscal years beginning after December 15, 2023, with early adoption permitted. In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures

Segments

Segments	9 Months Ended
	Sep. 30, 2024
Segment Reporting [Abstract]
Segments	Segments The Company’s reportable segments are identified based on a number of factors related to how its CODM determines the allocation of resources and assesses the performance of the Company’s operations. The CODM uses service revenue, net, and operating income or loss as the measures of gross revenue and profit or loss to assess segment performance and allocate resources, and uses total assets as the measure of assets attributable to each segment. The Company's operating income for the reportable segments includes an allocated portion of corporate expenses to the respective segments and includes revenues and all other costs directly attributable to the specific segment. The Company’s reportable segments are strategic units that offer different services under different financial and operating models to the Company’s customers. The segments are managed separately because each segment has its own revenue generating activities and core business processes in order to serve the varying needs of its members, which requires different technology and strategies to execute. The Company's CODM manages the Company under four reportable segments. • NEMT - The Company's NEMT segment is the largest manager of non-emergency medical transportation programs for state governments and managed care organizations, or MCOs, in the U.S. This segment also holds the results of the Company's captive insurance program; • PCS - The Company's PCS segment provides in home personal care services to State and Managed Medicaid, Medicare, and Private Pay patient populations in need of care monitoring and assistance performing activities of daily living; • RPM - The Company's RPM segment is a provider of remote patient monitoring solutions, including personal emergency response systems monitoring, vitals monitoring and data-driven patient engagement solutions; • Corporate and Other - The Company's Corporate and Other segment includes the costs associated with the Company's corporate operations as well as the results of an investment in innovation related to data analytics capabilities that the Company made at the end of the first quarter of 2023, which contributes to service revenue and service expense. The operating results of the Corporate and Other segment include activities related to executive, accounting, finance, internal audit, tax, legal and certain strategic and corporate development functions for each segment, the results of this investment in innovation, as well as the results of the Company's Matrix investment. The following table sets forth certain financial information from operations attributable to the Company’s business segments for the three and nine months ended September 30, 2024 and 2023 (in thousands): Three months ended September 30, 2024 NEMT PCS RPM Corporate and Other Total Service revenue, net $ 492,253 $ 188,518 $ 19,448 $ 1,818 $ 702,037 Service expense 436,549 151,745 8,018 1,622 597,934 General and administrative expense 30,758 23,823 4,332 11,990 70,903 Depreciation and amortization 7,645 12,918 7,073 304 27,940 Operating income (loss) $ 17,301 $ 32 $ 25 $ (12,098) $ 5,260 Equity in net income (loss) of investee, net of tax $ 151 $ — $ — $ (2,795) $ (2,644) Equity investment $ 2,026 $ — $ — $ 33,809 $ 35,835 Goodwill $ 135,186 $ 415,444 $ 129,592 $ 30 $ 680,252 Total assets $ 525,768 $ 736,854 $ 232,633 $ 156,493 $ 1,651,748 Nine months ended September 30, 2024 NEMT PCS RPM Corporate and Other Total Service revenue, net $ 1,462,236 $ 558,696 $ 58,575 $ 5,280 $ 2,084,787 Service expense 1,288,162 451,049 24,556 5,833 1,769,600 General and administrative expense 95,701 72,152 15,780 40,512 224,145 Depreciation and amortization 22,602 38,506 20,834 853 82,795 Impairment of goodwill — — 105,302 — 105,302 Operating income (loss) $ 55,771 $ (3,011) $ (107,897) $ (41,918) $ (97,055) Equity in net income (loss) of investee, net of tax $ 269 $ — $ — $ (4,131) $ (3,862) Equity investment $ 2,026 $ — $ — $ 33,809 $ 35,835 Goodwill $ 135,186 $ 415,444 $ 129,592 $ 30 $ 680,252 Total assets $ 525,768 $ 736,854 $ 232,633 $ 156,493 $ 1,651,748 Three months ended September 30, 2023 NEMT PCS RPM Corporate and Other Total Service revenue, net $ 485,951 $ 179,979 $ 19,779 $ 1,216 $ 686,925 Grant income (1) — 551 — — 551 Service expense 428,021 143,078 6,934 1,181 579,214 General and administrative expense 25,433 20,252 5,685 18,772 70,142 Depreciation and amortization 6,814 12,850 6,174 239 26,077 Operating income (loss) $ 25,683 $ 4,350 $ 986 $ (18,976) $ 12,043 Equity in net income (loss) of investee, net of tax $ 142 $ — $ — $ (302) $ (160) Equity investment $ 1,552 $ — $ — $ 43,655 $ 45,207 Goodwill $ 135,186 $ 415,444 $ 234,894 $ 30 $ 785,554 Total assets $ 512,032 $ 774,731 $ 346,257 $ 130,066 $ 1,763,086 Nine months ended September 30, 2023 NEMT PCS RPM Corporate and Other Total Service revenue, net $ 1,452,389 $ 534,435 $ 57,702 $ 3,812 $ 2,048,338 Grant income (1) — 4,649 — — 4,649 Service expense 1,277,604 417,636 20,129 3,366 1,718,735 General and administrative expense 87,645 63,480 16,781 61,189 229,095 Depreciation and amortization 20,319 38,590 18,087 683 77,679 Impairment of goodwill — 137,331 45,769 — 183,100 Operating income (loss) $ 66,821 $ (117,953) $ (43,064) $ (61,426) $ (155,622) Equity in net income of investee, net of tax $ 984 $ — $ — $ 1,837 $ 2,821 Equity investment $ 1,552 $ — $ — $ 43,655 $ 45,207 Goodwill $ 135,186 $ 415,444 $ 234,894 $ 30 $ 785,554 Total assets $ 512,032 $ 774,731 $ 346,257 $ 130,066 $ 1,763,086 (1) Grant income for the PCS segment includes funding received on a periodic basis from the PRF in relation to relief under the CARES Act and funding received from the SLFRF under ARPA in relation to economic recovery to combat health and economic impacts of the COVID-19 pandemic. See Note 2, Significant Accounting Policies and Recent Accounting Pronouncements.

Revenue Recognition

Revenue Recognition	9 Months Ended
	Sep. 30, 2024
Revenue from Contract with Customer [Abstract]
Revenue Recognition	Revenue Recognition Under ASC 606, the Company recognizes revenue as it transfers promised services to its customers and generates all of its revenue from contracts with customers. The amount of revenue recognized reflects the consideration to which the Company expects to be entitled in exchange for these services. The Company satisfies substantially all of its performance obligations over time and recognizes revenue over time instead of at points in time. Revenue Contract Structure NEMT Capitated Contracts (per-member-per-month) Under capitated contracts, payors pay a fixed amount per eligible member per month. Capitation rates are generally based on expected costs and volume of services. The Company assumes the responsibility of meeting the covered healthcare related transportation requirements based on per-member per-month fees for the number of eligible members in the payor’s program. Revenue is recognized based on the population served during the period. Certain capitated contracts have provisions for reconciliations, risk corridors or profit rebates. For contracts with reconciliation provisions, capitation payment is received as a prepayment during the month service is provided. These prepayments are reconciled based on actual cost and/or trip volume and may result in refunds to the payor, or additional payments due from the payor. Contracts with risk corridor or profit rebate provisions allow for profit within a certain corridor and once the Company reaches profit level thresholds or maximums, it discontinues recognizing revenue and instead records a liability within the accrued contract payable account. This liability may be reduced through future increases in trip volume or periodic settlements with the payor. While a profit rebate provision could only result in a liability from this profit threshold, a risk corridor provision could potentially result in a receivable if the Company does not reach certain profit minimums, which would be recorded in the reconciliation contract receivables account. NEMT Fee-for-service Contracts Fee-for-service ("FFS") revenue represents revenue earned under non-capitated contracts in which the Company bills and collects a specified amount for each service that it provides. FFS revenue is recognized in the period in which the services are rendered and is reduced by the estimated impact of contractual allowances. PCS Fee-for-service Contracts PCS FFS revenue is reported at the estimated net realizable amount from clients, patients and third-party payors for services rendered based on actual personal care hours provided. Payment for services received from third-party payors includes, but is not limited to, insurance companies, hospitals, governmental agencies and other home health care providers who subcontract work to the Company. Certain contracts are subject to retroactive audit and possible adjustment by those payors based on the nature of the contract or costs incurred. The Company makes estimates of adjustments and considers these in the recognition of revenue in the period in which the related services are rendered. The difference between estimated settlement and actual settlement is reported in net service revenues as adjustments become known or as years are no longer subject to such audits, reviews, or investigations. RPM per-member-per-month Contracts RPM per-member-per-month ("PMPM") revenue consists of revenue from monitoring services provided to the customer. Under RPM contracts, payors pay per-enrolled-member-per-month based on enrolled membership. Consideration is generally fixed for each type of monitoring service and revenue is recognized ratably over the contract term based on the monthly fee paid by customers. Disaggregation of Revenue by Contract Type The following table summarizes disaggregated revenue from contracts with customers by contract type for the three and nine months ended September 30, 2024 and September 30, 2023 (in thousands): Three months ended September 30, Nine months ended September 30, 2024 2023 2024 2023 NEMT capitated contracts $ 389,110 $ 412,762 $ 1,199,506 $ 1,239,957 NEMT FFS contracts 103,143 73,189 262,730 212,432 Total NEMT service revenue, net $ 492,253 $ 485,951 $ 1,462,236 $ 1,452,389 PCS FFS contracts 188,518 179,979 558,696 534,435 RPM PMPM contracts 19,448 19,779 58,575 57,702 Other service revenue 1,818 1,216 5,280 3,812 Total service revenue, net $ 702,037 $ 686,925 $ 2,084,787 $ 2,048,338 Payor Information Service revenue, net, is derived from state and managed Medicaid contracts, managed Medicare contracts, as well as a small amount from private pay and other contracts. Of the NEMT segment’s revenue, 10.7% and 11.4% were derived from one payor for the three months ended September 30, 2024 and 2023, respectively, and 11.2% and 11.2% were derived from one payor for the nine months ended September 30, 2024 and 2023, respectively. Of the PCS segment's revenue, 12.4% and 11.4% were derived from one payor for the three months ended September 30, 2024 and 2023, respectively, and 12.2% and 11.3% were derived from one payor for the nine months ended September 30, 2024 and 2023, respectively. Of the RPM segment's revenue, 18.6% and 19.3% were derived from one payor for the three months ended September 30, 2024 and 2023, respectively, and 18.7% and 17.4% were derived from one payor for the nine months ended September 30, 2024 and 2023, respectively. Revenue Adjustments During the three months ended September 30, 2024 and 2023, the Company recognized a reduction of $4.1 million and a reduction of $2.9 million in service revenue, respectively, from contractual adjustments relating to performance obligations satisfied in previous periods to which the payor agreed. During the nine months ended September 30, 2024 and 2023, the Company recognized an increase of $7.1 million and a reduction of $3.9 million in service revenue, respectively, from contractual adjustments related to performance obligations satisfied in previous periods to which the payor agreed. Related Balance Sheet Accounts The following table provides information about accounts receivable, net (in thousands): September 30, 2024 December 31, 2023 Accounts receivable $ 249,850 $ 223,506 Allowance for credit losses (1,167) (969) Accounts receivable, net $ 248,683 $ 222,537 The following table provides information about other revenue related accounts included on the accompanying unaudited condensed consolidated balance sheets (in thousands): September 30, 2024 December 31, 2023 Accrued contract payables (1) $ 47,300 $ 117,488 Contract receivables (2) $ 110,431 $ 143,960 Deferred revenue, current $ 3,155 $ 2,629 (1) Accrued contract payables primarily represent overpayments and liability reserves on certain risk corridor, profit rebate and reconciliation contracts. See the contract payables and receivables activity below. (2) Contract receivables primarily represent underpayments and receivables on certain risk corridor, profit rebate, and reconciliation contracts. See the contract payables and receivables activity below. The following table provides the summary activity of total contract payables and receivables as reported within the unaudited condensed consolidated balance sheets (in thousands): December 31, 2023 Additional Amounts Recorded Amounts Paid or Settled March 31, 2024 Reconciliation contract payables $ 12,294 $ 14,097 $ (2,010) $ 24,381 Profit rebate/corridor contract payables 94,775 (5,221) (1,992) 87,562 Overpayments and other cash items 10,419 8,319 (2,282) 16,456 Total contract payables $ 117,488 $ 17,195 $ (6,284) $ 128,399 Reconciliation contract receivables $ 57,002 $ 26,294 $ (10,919) $ 72,377 Corridor contract receivables 86,958 20,443 (25,500) 81,901 Total contract receivables (1) $ 143,960 $ 46,737 $ (36,419) $ 154,278 March 31, 2024 Additional Amounts Recorded Amounts Paid or Settled June 30, 2024 Reconciliation contract payables $ 24,381 $ 2,680 $ (2,333) $ 24,728 Profit rebate/corridor contract payables 87,562 (11,364) (25,990) 50,208 Overpayments and other cash items 16,456 7,024 (11,522) 11,958 Total contract payables $ 128,399 $ (1,660) $ (39,845) $ 86,894 Reconciliation contract receivables $ 72,377 $ 31,996 $ (29,788) $ 74,585 Corridor contract receivables 81,901 19,734 (10,363) 91,272 Total contract receivables (1) $ 154,278 $ 51,730 $ (40,151) $ 165,857 June 30, 2024 Additional Amounts Recorded Amounts Paid or Settled September 30, 2024 Reconciliation contract payables $ 24,728 $ (12,978) $ (935) $ 10,815 Profit rebate/corridor contract payables 50,208 (942) (40,107) 9,159 Overpayments and other cash items 11,958 17,982 (2,614) 27,326 Total contract payables $ 86,894 $ 4,062 $ (43,656) $ 47,300 Reconciliation contract receivables $ 74,585 $ 30,916 $ (52,712) $ 52,789 Corridor contract receivables 91,272 18,459 (52,089) 57,642 Total contract receivables $ 165,857 $ 49,375 $ (104,801) $ 110,431 (1) Total contract receivables is comprised of the current and long-term contract receivables balances, which are broken out separately on the unaudited condensed consolidated balance sheets. As of September 30, 2024, no portion of the contract receivables balance was classified as long-term. Long-term contract receivables primarily represent future receivable balances on certain risk corridor, profit rebate and reconciliation contracts that may be received in greater than 12 months.

Equity Investment

Equity Investment	9 Months Ended
	Sep. 30, 2024
Equity Method Investment, Summarized Financial Information [Abstract]
Equity Investment	Equity Investment As of September 30, 2024 and December 31, 2023, the Company owned a 43.6% non-controlling interest in Matrix. Pursuant to a Shareholder’s Agreement, affiliates of Frazier Healthcare Partners hold rights necessary to control the fundamental operations of Matrix. The Company accounts for its investment in Matrix under the equity method of accounting and the Company’s share of Matrix’s income or loss is recorded as “Equity in net income (loss) of investee, net of tax” in the accompanying unaudited condensed consolidated statements of operations within its Corporate and Other segment. The Company's gross share of Matrix's operations for the three months ended September 30, 2024 and 2023 was a loss of $3.9 million and a loss of $0.4 million, respectively, which is presented net of tax on the unaudited condensed consolidated statements of operations for a loss of $2.8 million and a loss of $0.3 million, respectively. The Company's gross share of Matrix's operations for the nine months ended September 30, 2024 and 2023, was a loss of $5.7 million and income of $2.5 million, respectively, which is presented net of tax on the unaudited condensed consolidated statements of operations for a loss of $4.1 million and income of $1.8 million, respectively. The carrying amount of the assets included in the Company’s unaudited condensed consolidated balance sheets and the maximum loss exposure related to the Company’s interest in Matrix as of September 30, 2024 and December 31, 2023 totaled $33.8 million and $39.9 million, respectively. Summary financial information for Matrix on a standalone basis is as follows (in thousands): September 30, 2024 December 31, 2023 Current assets $ 49,951 $ 112,090 Long-term assets $ 349,593 $ 351,143 Current liabilities $ 31,174 $ 41,584 Long-term liabilities $ 273,311 $ 314,316 Three months ended September 30, Nine months ended September 30, 2024 2023 2024 2023 Revenue $ 67,654 $ 84,395 $ 235,032 $ 252,973 Operating income (loss) $ (2,467) $ 7,593 $ 11,821 $ 32,196 Net income (loss) $ (8,524) $ (239) $ (10,190) $ 6,976

Prepaid Expenses and Other Curr

Prepaid Expenses and Other Current Assets	9 Months Ended
	Sep. 30, 2024
Prepaid Expense and Other Assets, Current [Abstract]
Prepaid Expenses and Other Current Assets	Prepaid Expenses and Other Current Assets Prepaid expenses and other current assets were comprised of the following (in thousands): September 30, 2024 December 31, 2023 Prepaid insurance $ 8,650 $ 7,231 Prepaid income taxes 8,618 2,418 Deferred ERP implementation costs 4,408 2,875 Deferred financing costs on credit facility 2,876 2,638 Other prepaid expenses 14,096 11,866 Total prepaid expenses and other current assets $ 38,648 $ 27,028

Goodwill and Intangible Assets

Goodwill and Intangible Assets	9 Months Ended
	Sep. 30, 2024
Goodwill and Intangible Assets Disclosure [Abstract]
Goodwill and Intangible Assets	Goodwill and Intangible Assets The Company tests goodwill for impairment for its reporting units annually as of July 1, or more frequently when events or changes in circumstances indicate that impairment may have occurred. The Company reviews its intangible assets for impairment whenever events or changes in circumstances indicate that the carrying value of an asset group may not be recoverable. Goodwill During the second quarter of 2024, the Company determined that based on its qualitative assessment for each reporting unit, factors existed which required the Company to test its goodwill and indefinite-lived intangible assets for impairment. These factors included changes in key assumptions from the prior year annual goodwill assessment as a result of lower than anticipated operating results during the first half of 2024 as compared to forecast which resulted in a decrease in the fair value of the Company's RPM reporting unit such that the fair value was less than its carrying value. As a result, during the second quarter of 2024, the Company recorded a non-cash goodwill impairment charge of $105.3 million in the RPM reporting unit. This impairment is recorded in “Impairment of goodwill” on the Company’s unaudited condensed consolidated statement of operations. No further impairment was taken during the three months ended September 30, 2024. During the second quarter of 2023, the Company determined that based on its qualitative assessment for each reporting unit, factors existed which required the Company to test its goodwill and indefinite-lived intangible assets for impairment. These factors included a decline in the market price of the Company's common stock, industry specific regulatory pressures such as Medicaid redetermination and the Centers for Medicare and Medicaid Services ("CMS") proposed ruling on Ensuring Access to Medicaid Services , and general economic and market volatility. As a result, the Company performed a quantitative assessment and determined that the goodwill at its PCS and RPM reporting units was impaired. As such, during the second quarter of 2023, the Company recorded a non-cash goodwill impairment charge of $183.1 million, of which $137.3 million was recorded in the PCS reporting unit and $45.8 million was recorded in the RPM reporting unit. No further impairment was taken during the three months ended September 30, 2023. After recording the respective impairments of goodwill, the associated reporting units had a combined $545.0 million of goodwill remaining as of September 30, 2024 and $650.3 million as of December 31, 2023. If, among other factors, (i) the Company's equity values were to decline significantly, (ii) the Company experienced additional adverse impacts associated with macroeconomic factors, including increases in the estimated weighted average cost of capital, or (iii) the adverse impacts stemming from competition, economic, regulatory or other factors were to cause the Company's results of operations or cash flows to be worse than currently anticipated, the Company could conclude in future periods that additional impairment charges of certain reporting units are required in order to reduce the carrying values of goodwill. Any such impairment charges could be significant. Changes in the carrying value of goodwill by reportable segment are presented in the following table (in thousands): NEMT PCS RPM Corporate and Other Total Goodwill balance as of December 31, 2022, before cumulative loss $ 231,186 $ 552,775 $ 280,663 $ 30 $ 1,064,654 Accumulated loss on impairment (96,000) — — — (96,000) Goodwill balance as of December 31, 2022, after cumulative loss 135,186 552,775 280,663 30 968,654 Impairment of goodwill — (137,331) (45,769) — (183,100) Balance at December 31, 2023 135,186 415,444 234,894 30 785,554 Impairment of goodwill — — (105,302) — (105,302) Balance at September 30, 2024 $ 135,186 $ 415,444 $ 129,592 $ 30 $ 680,252 The accumulated impairment losses on goodwill totaled $384.4 million as of September 30, 2024 and $279.1 million as of December 31, 2023. Intangible Assets Intangible assets are comprised of acquired payor networks, trademarks and trade names, developed technology, non-compete agreements, licenses, and an assembled workforce. Finite-lived intangible assets are amortized using the straight-line method over the estimated economic lives of the assets. These finite-lived intangible assets are reviewed for impairment whenever events or changes in circumstances indicate that the carrying value of such assets may not be recoverable. Indefinite-lived intangible assets are not amortized, but are tested for impairment annually and more frequently if events occur or circumstances change that indicate an asset may be impaired. Based on the continued value of the definite-lived and indefinite-lived intangible assets acquired, the Company did not identify any circumstances during the three and nine months ended September 30, 2024 that would require an impairment test for the intangible assets.

Accrued Expenses and Other Curr

Accrued Expenses and Other Current Liabilities	9 Months Ended
	Sep. 30, 2024
Payables and Accruals [Abstract]
Accrued Expenses and Other Current Liabilities	Accrued Expenses and Other Current Liabilities Accrued expenses and other current liabilities were comprised of the following (in thousands): September 30, 2024 December 31, 2023 Accrued compensation and related liabilities $ 39,834 $ 48,033 Insurance reserves 30,336 22,014 Accrued interest 28,073 10,498 Accrued legal fees 16,158 10,148 Accrued operating expenses 9,188 15,884 Accrued government grants (1) 7,920 9,156 Deferred revenue 3,155 2,629 Union pension obligation 428 1,573 Other 10,197 7,966 Total accrued expenses and other current liabilities $ 145,289 $ 127,901 (1) Accrued government grants include payments received from government entities, such as SLFRF or other government assistance funds, to offset increased expenditures for which the related expenditure has not yet been incurred and thus the related payments are deferred as of September 30, 2024 and December 31, 2023.

Debt

Debt	9 Months Ended
	Sep. 30, 2024
Debt Disclosure [Abstract]
Debt	Debt The Company's long-term debt and short-term debt as of September 30, 2024 and December 31, 2023 consisted of the following (in thousands): Description Date of Issuance September 30, 2024 December 31, 2023 Senior Unsecured Notes $500.0 million 5.875% due November 15, 2025 11/4/2020 $ — $ 494,011 $500.0 million 5.000% due October 1, 2029 (effective interest rate 5.386%) 8/24/2021 490,910 489,746 Term Loan Facility $525.0 million SOFR + 4.750% due July 1, 2031 (1) 7/1/2024 495,215 — Total long-term debt $ 986,125 $ 983,757 Revolving Credit Facility 2/3/2022 $ 228,000 $ 113,800 Current Portion of Term Loan Facility (2) 7/1/2024 5,250 — Total short-term debt $ 233,250 $ 113,800 (1) The $525.0 million Term Loan Facility bears interest at (i) a SOFR-based benchmark plus 4.75% or (ii) a prime rate (or other alternate base rate) benchmark plus 3.75% in the case of ABR Loans (as such terms are defined in the amended Credit Agreement) and matures on the earlier of (a) July 1, 2031 and (b) July 2, 2029 if any of the Company's 2029 Notes (as defined below) remain outstanding on that date. (2) The Term Loan Facility requires principal payments of $1.3 million on a quarterly basis and accordingly, a portion of the Term Loan Facility in the amount of $5.3 million is classified as a current liability within the "Short-term debt" line item on the unaudited condensed balance sheets as of September 30, 2024. Senior Unsecured Notes The Company pays interest on the senior unsecured notes semi-annually in arrears. Principal payments are not required until the maturity date. Debt issuance costs of $14.5 million in relation to the issuance of the senior unsecured notes due 2025 (the "2025 Notes") were incurred and these costs were deferred and are amortized to interest cost over the term of the 2025 Notes. In connection with the redemption of the 2025 Notes on July 1, 2024 (discussed below), the remaining unamortized debt issuance costs were recognized in the loss on debt extinguishment that was recorded during the third quarter of 2024. Debt issuance costs of $13.5 million were incurred in relation to the issuance of the senior unsecured notes due 2029 (the "2029 Notes" and, together with the 2025 Notes, the "Notes") and these costs were deferred and are amortized to interest cost over the term of the 2029 Notes. As of September 30, 2024, the 2029 Notes had $9.1 million of unamortized deferred issuance costs that were netted against the long-term debt balance on the unaudited condensed consolidated balance sheets. As of September 30, 2024, the 2025 Notes were fully redeemed and thus had no associated fair value as of that date and as of December 31, 2023, had a fair value of $499.2 million. The fair value of the 2029 Notes as of September 30, 2024 and December 31, 2023 was $315.0 million and $410.0 million, respectively. The fair value of the Notes was determined based on quoted prices in active markets, and therefore designated as Level 1 within the fair value hierarchy. The indenture covering the Notes also contains a cross-default provision in the event any of the Company’s other indebtedness having a principal amount that aggregates $50.0 million or more is accelerated prior to its express maturity. The Company was in compliance with all covenants, as amended by the Fourth Amendment to the Credit Agreement discussed in detail in the Revolving Credit Facility section below, as of September 30, 2024. The 2025 Notes were redeemed in full on July 1, 2024 prior to contractual maturity, at a redemption premium of 1.469% on the aggregate original principal amount of the 2025 Notes for a total redemption of $507.3 million, plus the payment of approximately $3.8 million in accrued and unpaid interest on the 2025 Notes. As a result of the early redemption of the 2025 Notes, the Company recorded a loss on debt extinguishment of $11.8 million on the unaudited condensed consolidated statements of operations. This loss consisted of the redemption premium of 1.469% on the aggregate original principal amount of the 2025 Notes for $7.3 million plus the recognition of the unamortized deferred issuance costs on the 2025 Notes for $4.5 million. The 2025 Notes were redeemed in connection with the funding of the Term Loan Facility discussed below. Credit Agreement Revolving Credit Facility The Company is a party to the amended and restated credit agreement, dated as of February 3, 2022 (the “Credit Agreement”) with JPMorgan Chase Bank, N.A., as administrative agent, swing line lender and an issuing bank, Wells Fargo Bank, National Association, as an issuing bank, Truist Bank and Wells Fargo Bank, National Association, as co-syndication agents, Deutsche Bank AG New York Branch, Bank of America, N.A., Regions Bank, Bank of Montreal and Capital One, National Association, as co-documentation agents, and JPMorgan Chase Bank, N.A., Truist Securities, Inc. and Wells Fargo Securities, LLC, as joint bookrunners and joint lead arrangers, and the other lenders party thereto. The Credit Agreement provides the Company with a senior secured revolving credit facility (the “Revolving Credit Facility”) in an aggregate principal amount of $325.0 million and sublimits for swingline loans, letters of credit and alternative currency loans in amounts of up to $25.0 million, $60.0 million and $75.0 million, respectively. The Revolving Credit Facility under the Credit Agreement was scheduled to mature on February 3, 2027 and the proceeds that may be drawn under the Revolving Credit Facility from time to time prior to maturity may be used (i) to finance working capital needs of the Company and its subsidiaries and (ii) for general corporate purposes of the Company and its subsidiaries (including to finance capital expenditures, permitted acquisitions and investments). On June 26, 2023, the Company entered into Amendment No. 1 (the "First Amendment") to the Credit Agreement, which amended and restated the maximum permitted Total Net Leverage Ratio (as defined in the Credit Agreement as amended by the First Amendment) under the Credit Agreement as follows: for the fiscal quarters ending June 30, 2023 through September 30, 2023, 5.25:1.00; for the fiscal quarters ending December 31, 2023 through March 31, 2024, 5.00:1.00; for the fiscal quarter ending June 30, 2024, 4.75:1.00; and for the fiscal quarters ending September 30, 2024 and for the fiscal quarters ending thereafter, 4.50:1.00. On February 22, 2024, the Company entered into Amendment No. 2 (the "Second Amendment") to the Credit Agreement, which amended the maximum permitted Total Net Leverage Ratio under the amended Credit Agreement as follows: for the fiscal quarters ending March 31, 2024 through June 30, 2024, 5.50:1.00; for the fiscal quarters ending September 30, 2024 through December 31, 2024, 5.25:1.00; for the fiscal quarters ending March 31, 2025 through September 30, 2025, 5.00:1.00, and for the fiscal quarters ending December 31, 2025 through March 31, 2026, 4.75:1.00. The Second Amendment also included a restriction on the Company's Liquidity (as defined in the Second Amendment and which is determined generally to be, as of any date of determination, the sum of the Company's borrowing capacity under the Revolving Credit Facility plus the amount of its unencumbered cash), requiring it to be less than $100.0 million as of the last day of each fiscal quarter (the "Liquidity Covenant"). On July 1, 2024, the Company entered into Amendment No. 3 (the "Third Amendment") to the Credit Agreement, which, among other things, extended with respect to the lenders identified in the Third Amendment the maturity date covering $255.0 million in the aggregate principal amount of the commitments under the Revolving Credit Facility to February 3, 2028. The existing financial covenants under the amended Credit Agreement were retained for the benefit solely of the Revolving Credit Facility lenders, and the minimum liquidity level required by the Liquidity Covenant was decreased from $100.0 million to $75.0 million. Certain other financial covenants and restrictions were also modified under the amended Credit Agreement, as previously disclosed. The fees associated with the Third Amendment of $0.3 million will be amortized over the life of the Revolving Credit Facility. On September 30, 2024, the Company entered into Amendment No. 4 (the "Fourth Amendment") to its Credit Agreement, which increased the maximum permitted Total Net Leverage Ratio under the amended Credit Agreement for the fiscal quarter ended September 30, 2024 (the "Relief Period") to 6.50:1.00 from 5.25:1.00. In addition, the Fourth Amendment reduced the minimum interest coverage ratio for the quarter ended September 30, 2024 to 2.00:1.00 and increased the applicable margin on the Revolving Credit Facility by 0.25% until the Company delivers the required financial statements and compliance certificate for the fiscal year ending December 31, 2024. As of September 30, 2024, the Company had $228.0 million of short-term borrowings outstanding under the Revolving Credit Facility and had $55.6 million of outstanding letters of credit under the Revolving Credit Facility. The weighted average interest rate for borrowings outstanding as of September 30, 2024 was 9.3% per annum. As of December 31, 2023, the Company had $113.8 million of short-term borrowings outstanding under the Revolving Credit Facility and had $40.4 million of outstanding letters of credit under the Revolving Credit Facility. Under the amended Credit Agreement, the Company has an option to request an increase in the amount of the Revolving Credit Facility so long as, after giving effect to the incremental facility, the pro forma secured net leverage ratio does not exceed 2.70:1.00. The Company may prepay the Revolving Credit Facility in whole or in part, at any time without premium or penalty, subject to reimbursement of the lenders’ breakage and redeployment costs in connection with prepayments. The unutilized portion of the commitments under the Revolving Credit Facility may be irrevocably reduced or terminated by the Company at any time without penalty. Interest on the outstanding principal amount of the loans under the Revolving Credit Facility accrues at a per annum rate equal to the Alternate Base Rate, the Adjusted Term SOFR Rate, the Adjusted Daily Simple SOFR Rate, the Adjusted EURIBOR Rate or the Adjusted Daily Simple SONIA Rate, as applicable and each as defined in the amended Credit Agreement, in each case, plus an applicable margin. With respect to the loans under the Revolving Credit Facility during the Relief Period as stipulated by the Fourth Amendment, the applicable margin ranges from 2.50% to 4.25% in the case of RFR loans, as defined in the amended Credit Agreement, and 1.50% to 3.25% in the case of the Alternate Base Rate loans, as defined in the amended Credit Agreement, in each case, based on the Company’s Total Net Leverage Ratio. Interest on the loans is payable quarterly in arrears in the case of Alternate Base Rate loans. In addition, the Company is obligated to pay a quarterly commitment fee based on a percentage of the unused portion of the Revolving Credit Facility and quarterly letter of credit fees based on a percentage of the maximum amount available to be drawn under each outstanding letter of credit. The commitment fee and letter of credit fee range from 0.30% to 0.50% and 2.50% to 4.25%, respectively, in each case, based on the Company’s Total Net Leverage Ratio. The amended Credit Agreement contains customary representations and warranties, affirmative and negative covenants and events of default. The negative covenants include restrictions on the Company’s ability to, among other things, incur additional indebtedness, create liens, make investments, give guarantees, pay dividends, sell assets and merge and consolidate. The Company's borrowing capacity under the Revolving Credit Facility is currently limited by, among other covenants, compliance with the Total Net Leverage Ratio covenant and the Liquidity Covenant for each fiscal period. The Company was in compliance with all covenants, as amended by the Fourth Amendment to the Credit Agreement, as of September 30, 2024. The Company’s obligations under the Revolving Credit Facility are guaranteed by all of the Company’s present and future material domestic subsidiaries, excluding certain material domestic subsidiaries that are excluded from being guarantors pursuant to the terms of the amended Credit Agreement. The Company’s obligations under, and each guarantor’s obligations under its guaranty of, the Revolving Credit Facility are secured by a first priority lien on substantially all of the Company’s or such guarantor’s respective assets. If an event of default occurs, the required lenders may cause the administrative agent to declare all unpaid principal and any accrued and unpaid interest and all fees and expenses under the Revolving Credit Facility to be immediately due and payable. All amounts outstanding under the Revolving Credit Facility will automatically become due and payable upon the commencement of any bankruptcy, insolvency or similar proceedings. The amended Credit Agreement, as it relates to the Revolving Credit Facility, also contains a cross-default to any of the Company’s indebtedness having a principal amount in excess of $40.0 million. Term Loan Facility On July 1, 2024, the Company, pursuant to the Third Amendment, established a new term loan facility (the "Term Loan Facility") in the aggregate principal amount of $525.0 million with the Term Loan Facility lenders named therein. The proceeds of the Term Loan Facility were used to (i) redeem the Company's 2025 Notes, (ii) repay a portion of the Revolving Credit Facility outstanding immediately prior to the effective date of the Third Amendment, and (iii) pay fees and expenses associated with such transactions. The Company paid approximately $24.4 million of deferred issuance costs with respect to the Term Loan Facility. As of September 30, 2024, the Term Loan Facility had $23.2 million of unamortized deferred issuance costs that were netted against the long-term balance on the unaudited condensed consolidated balance sheets. The fair value of the Term Loan Facility as of September 30, 2024 was $523.7 million, which was determined based on lender quotes for the Company's debt, and therefore designated as Level 2 within the fair value hierarchy. The Term Loan Facility matures on the earlier of (a) July 1, 2031 and (b) July 2, 2029 if any of the Company's 2029 Notes remain outstanding on that date. Principal payments on the Term Loan Facility are required on a quarterly basis, commencing with the quarter ending September 30, 2024, in the amount equal to 0.25% of the aggregate principal amount of the Term Loan Facility outstanding on the date of issuance. All unpaid amounts of the Term Loan Facility shall be paid in full on the maturity date. The Term Loan Facility requires annual prepayments of a percentage of Excess Cash Flow (as defined in the amended Credit Agreement); commencing with the year ending December 31, 2025 as follows: (i) 75.0% if the Total Net Leverage Ratio as of the last day of such period was greater than 4.40:1.00, (ii) 50.0% if the Total Net Leverage Ratio as of the last day of such period was greater than 3.90:1:00, but less than or equal to 4.40:1.00, (iii) 25.0% if the Total Net Leverage Ratio as of the last day of such period was greater than 3.40:1.00, but less than or equal to 3.90:1.00, and (iv) 0.0% if the Total Net Leverage Ratio as of the last day of such period was less than or equal to 3.40:1.00. The Term Loan Facility also requires mandatory prepayments in the event of certain asset dispositions or casualty events. In addition, the Term Loan Facility is subject to a prepayment premium for the first six months after entering into the Third Amendment in the event of any repricing transaction. Interest on the Term Loan Facility is generally payable quarterly, in arrears, on the outstanding principal amount of the Term Loan Facility at the following rates for the interest period in effect for such borrowing: (i) a SOFR-based benchmark plus 4.75% or (ii) a prime rate (or other alternate base rate) benchmark plus 3.75% in the case of ABR Loans (as such terms are defined in the amended Credit Agreement). The Term Loan Facility is subject to customary representations and warranties, affirmative and negative covenants, and events of default, as defined in the amended Credit Agreement. As of September 30, 2024, the weighted average interest rate on the Term Loan Facility was 10.08%. The amended Credit Agreement, as it relates to the Term Loan Facility, also contains a cross-default to any of the Company’s indebtedness having a principal amount in excess of $40.0 million. The Company was in compliance with all covenants, as amended by the Fourth Amendment to the Credit Agreement, as of September 30, 2024.

Stock-Based Compensation and Si

Stock-Based Compensation and Similar Arrangements	9 Months Ended
	Sep. 30, 2024
Share-Based Payment Arrangement, Noncash Expense [Abstract]
Stock-Based Compensation and Similar Arrangements	Stock-Based Compensation and Similar Arrangements The Company provides stock-based compensation to employees, non-employee directors, consultants and advisors under the Company’s 2006 Long-Term Incentive Plan (“2006 Plan”). The 2006 Plan allows the flexibility to grant or award stock options, stock appreciation rights, restricted stock, unrestricted stock, stock units including restricted stock units and performance awards to eligible persons. Stock options. The Company recognized immaterial stock-based compensation expense for non-qualified stock options (“NQs”) for the three months and nine months ended September 30, 2024, and 2023, in general and administrative expense. At September 30, 2024, the Company had 50,096 stock options outstanding with a weighted-average exercise price of $116.62. Restricted stock awards and restricted stock units. The Company recognized stock-based compensation expense for restricted stock awards ("RSAs") and restricted stock units ("RSUs"), collectively, of $1.3 million and $1.1 million for the three months ended September 30, 2024 and 2023, respectively, and $4.4 million and $2.9 million for the nine months ended September 30, 2024 and 2023, respectively, in general and administrative expense. The Company had 15,948 unvested RSAs and 287,947 unvested RSUs outstanding at September 30, 2024 with a weighted-average grant date fair value of $48.90 and $42.28, respectively. Performance-based share awards. The Company grants performance-based restricted stock units ("PRSUs") to align management’s compensation with the Company's financial performance and other operational objectives and to retain key employees. Awards granted under this category are based on the achievement of various targeted metrics as approved by the Compensation Committee and defined in the related PRSU Agreement. Stock-based compensation expense for PRSUs is recognized over the 3-year vesting period under the straight-line attribution method. The Company recorded a reversal of stock-based compensation expense related to PRSUs of $0.8 million in general and administrative expense for the three months ended September 30, 2024 due to forfeitures that occurred during the period and recorded $0.4 million of stock-based compensation expense for the three months ended September 30, 2023. The Company recorded an immaterial amount of stock-based compensation expense related to PRSUs for the nine months ended September 30, 2024 due to the impact of the reversal of previously recognized stock-based compensation expense during the period from forfeitures and recorded $0.5 million of stock-based compensation expense for the nine months ended September 30, 2023. The remaining expense is expected to be recognized over the remainder of the 3-year requisite service period. The Company had 267,345 unvested PRSUs outstanding at September 30, 2024 with a weighted-average grant date fair value of $46.53. Employee Stock Purchase Plan

Loss Per Share

Loss Per Share	9 Months Ended
	Sep. 30, 2024
Earnings Per Share [Abstract]
Loss Per Share	Loss Per Share The following table details the computation of basic and diluted loss per share (in thousands, except share and per share data): Three months ended September 30, Nine months ended September 30, 2024 2023 2024 2023 Numerator: Net loss $ (26,604) $ (4,302) $ (177,788) $ (199,208) Denominator: Denominator for basic and diluted earnings per share -- weighted-average shares 14,253,192 14,182,839 14,224,155 14,169,537 Loss per share: Basic loss per share $ (1.87) $ (0.30) $ (12.50) $ (14.06) Diluted loss per share $ (1.87) $ (0.30) $ (12.50) $ (14.06) In a period when a net loss is reported, all common stock equivalents are excluded from the calculation because they would have an anti-dilutive effect, meaning the loss per share would be reduced. Therefore, in periods where a loss is reported, there is no difference in basic and diluted loss per share. The following weighted-average shares were not included in the computation of diluted loss per share as the effect of their inclusion would have been anti-dilutive: Three months ended September 30, Nine months ended September 30, 2024 2023 2024 2023 Stock options to purchase common stock 58,948 90,579 70,183 96,725 Restricted stock awards and restricted stock units 300,752 141,712 290,693 97,719

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2024
Income Tax Disclosure [Abstract]
Income Taxes	Income TaxesThe Company’s effective tax rate to arrive at the tax benefit for the three months ended September 30, 2024 and 2023 was 31.6% and 28.6%, respectively, and for the nine months ended September 30, 2024 and 2023 was 1.2% and 2.1%, respectively. For the three and nine months ended September 30, 2024, the effective tax rate differed from the U.S. federal statutory rate, primarily due to various tax credits, increased reserves on deferred tax assets, nondeductible expenses and nondeductible goodwill impairment. For the three and nine months ended September 30, 2023, the effective tax rate differed from the U.S. federal statutory rate primarily due to state income taxes, nondeductible expenses, and the nondeductible goodwill impairment.

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2024
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies Surveys, Audits and Governmental Investigations In the ordinary course of business, the Company may from time to time be or become subject to surveys, audits and governmental investigations under or with respect to various governmental programs and state and federal laws. Agencies associated with the programs and other third-party commercial payors periodically conduct extensive pre-payment or post-payment medical reviews or other audits of claims data to identify possible payments made or authorized other than in compliance with the requirements of Medicare or Medicaid. In order to conduct these reviews, documentation is requested from the Company and then that documentation is reviewed to determine compliance with applicable rules and regulations, including the eligibility of clients to receive benefits, the appropriateness of the care provided to those clients, and the documentation of that care. Similarly, other state and federal governmental agencies conduct reviews and investigations to confirm the Company's compliance with applicable laws where it operates, including regarding employment and wage related regulations and matters. The Company cannot predict the ultimate outcome of any regulatory reviews or other governmental surveys, audits or investigations, but management does not expect any ongoing surveys, audits or investigations involving the Company to have a material adverse effect on the business, liquidity, financial condition, or results of operations of the Company. Regardless of the Company's expectations, however, surveys and audits are subject to inherent uncertainties and can have a material adverse impact on the Company due to, among other reasons, potential regulatory orders that inhibit its ability to operate its business, amounts paid as reimbursement or in settlement of any such matter, diversion of management resources and investigative costs. Legal Proceedings In the ordinary course of business, the Company may from time to time be or become involved in various lawsuits, some of which may seek monetary damages, including claims for punitive damages. Management does not expect any ongoing lawsuits involving the Company to have a material impact on the business, liquidity, financial condition, or results of operations of the Company. Legal proceedings are subject to inherent uncertainties, however, and unfavorable rulings or other events could occur. Unfavorable resolutions could involve substantial monetary damages. In addition, in matters for which conduct remedies are sought, unfavorable resolutions could include an injunction or other order precluding particular business practices or requiring other remedies. An unfavorable outcome might result in a material adverse impact on the business, liquidity, financial position, or results of operations. The Company records accruals for loss contingencies related to legal matters when it is probable that a liability will be incurred and the amount of the loss can be reasonably estimated. If the Company determines that a range of reasonably possible losses can be estimated, the Company records an accrual for the most probable amount in the range. Due to the inherent difficulty in predicting the outcome of any legal proceeding, it may not be reasonably possible to estimate a range of potential liability until the matter is closer to resolution. Legal fees related to all legal matters are expensed as incurred. Since 2017, one of the Company's PCS segment subsidiaries, All Metro Home Care Services of New York, Inc. d/b/a All Metro Health Care (“All Metro”), has been subject to a class action lawsuit in state court claiming that, among other things, All Metro failed to properly pay live-in caregivers who stay in patients’ homes for 24 hours per day (“live-ins”). The Company pays live-ins for 13 hours per day as supported through a written opinion letter from the New York State Department of Labor (“NYSDOL”). The New York Court of Appeals (New York's highest court) in a similar case involving this issue issued an order in 2019 that agreed with the NYSDOL’s interpretation to pay live-ins for 13 hours per day instead of 24 hours if certain conditions were being met. Notwithstanding the court of appeals' order in the similar case, the parties to date have been unable to settle their dispute through mediation or otherwise, and therefore discovery in the matter is continuing. If the plaintiffs prove successful in this class action lawsuit, All Metro may be liable for back wages and liquidated damages dating back to November 2011. All Metro believes that it is and has been in compliance in all material respects with the laws and regulations covering pay for live-in caregivers (including the conditions described by the New York Court of Appeals in its order), intends to continue to defend itself vigorously with respect to this matter, and the Company does not believe in any event that the ultimate outcome of this matter will have a material adverse effect on the Company’s business, liquidity, financial condition or results of operations.

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2024	Sep. 30, 2023
Pay vs Performance Disclosure
Net loss	$ (26,604)	$ (128,884)	$ (22,300)	$ (4,302)	$ (190,944)	$ (3,962)	$ (177,788)	$ (199,208)

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended
	Sep. 30, 2024
Trading Arrangements, by Individual
Rule 10b5-1 Arrangement Adopted	false
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false

Significant Accounting Polici_2

Significant Accounting Policies and Recent Accounting Pronouncements (Policies)	9 Months Ended
	Sep. 30, 2024
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The Company follows accounting standards established by the Financial Accounting Standards Board (“FASB”). The FASB establishes accounting principles generally accepted in the United States (“GAAP”). Rules and interpretive releases of the Securities and Exchange Commission (“SEC”) under the authority of federal securities laws are also sources of authoritative GAAP for SEC registrants. References to GAAP issued by FASB in these notes are to the FASB Accounting Standards Codification (“ASC”), which serves as the single source of authoritative accounting and applicable reporting standards to be applied for non-governmental entities. All amounts are presented in U.S. dollars unless otherwise noted. The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with GAAP for interim financial information, and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all the information and disclosures required by GAAP for complete financial statements. In the opinion of management, all adjustments considered necessary for the fair presentation of the results of the interim periods have been included. The Company has made estimates relating to the reporting of assets and liabilities, revenues and expenses, and certain disclosures in the preparation of these unaudited condensed consolidated financial statements in conformity with GAAP. Actual results could differ from those estimates. Operating results for the three and nine months ended September 30, 2024 are not necessarily indicative of the results that may be expected for the fiscal year ending December 31, 2024. Management has evaluated events and transactions that occurred after the balance sheet date and through the date these unaudited condensed consolidated financial statements were filed with the SEC and considered the effect of such events in the preparation of these unaudited condensed consolidated financial statements. The unaudited condensed consolidated balance sheet at December 31, 2023 included in this Form 10-Q has been derived from audited financial statements at that date, but does not include all the information and footnotes required by GAAP for complete financial statements. The unaudited condensed consolidated financial statements contained herein should be read in conjunction with the audited financial statements and notes included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2023.
Reclassifications	Reclassifications:
Use of Estimates	Use of Estimates The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities, including disclosure of contingencies, at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ from those estimates.
Fair Value Measurements	Fair Value Measurements The Company follows FASB ASC Topic 820, Fair Value Measurement (“ASC 820”) which establishes a three-level valuation hierarchy for disclosure of fair value measurements. The valuation hierarchy categorizes assets and liabilities measured at fair value into one of three different levels depending on the observability of the inputs employed in the measurement. The three levels based on the observability of inputs are defined as follows: – Level 1: Quoted Prices in Active Markets for Identical Assets – inputs to the valuation methodology are quoted prices in active markets as of the measurement date for identical assets or liabilities. – Level 2: Significant Other Observable Inputs – inputs to the valuation methodology are based upon quoted prices for similar assets and liabilities in active markets, quoted prices for identical or similar assets and liabilities in markets that are not active, and inputs other than quoted prices that are observable for the asset or liability, either directly or indirectly, for substantially the full term of the financial instrument. – Level 3: Significant Unobservable Inputs – inputs to the valuation methodology are unobservable and significant to the fair value measurement. A financial instrument’s categorization within the valuation hierarchy is based upon the lowest level of input that is significant to the fair value measurement. The Company’s assessment of the significance of a particular input to the fair value measurement in its entirety requires judgment and considers factors specific to the asset or liability. As of September 30, 2024 and December 31, 2023, the carrying amount for cash and cash equivalents, accounts receivable (net of allowance for credit losses), current assets and current liabilities was equal to or approximated fair value due to their short-term nature or proximity to current market rates. Fair values for the Company's publicly traded debt securities are based on quoted market prices, when available, and for the Company's nonpublic debt are based on lender quotes, when available. See Note 9, Debt , for the fair value of the Company's long-term debt.
Goodwill and Intangible Assets	Goodwill and Intangible Assets In accordance with ASC 350, Intangibles-Goodwill and Other , the Company reviews goodwill for impairment annually, and more frequently if events and circumstances indicate that an asset may be impaired. Such circumstances could include, but are not limited to: (1) the loss or modification of significant contracts, (2) a significant adverse change in legal factors or in business climate, (3) unanticipated competition, (4) an adverse action or assessment by a regulator, or (5) a significant decline in the Company’s stock price. When evaluating goodwill for impairment, the Company first performs qualitative assessments for each reporting unit to determine whether it is more likely than not that the fair value of a reporting unit is less than its carrying value. If the qualitative assessment suggests that it is more likely than not that the fair value of a reporting unit is less than its carrying value, then the Company performs a quantitative assessment and compares the fair value of the reporting unit to its carrying value and to the extent the carrying value is greater than the fair value, the difference is recorded as an impairment in the consolidated statements of operations. The Company completed its annual goodwill test on July 1 during which it performed a quantitative test comparing the carrying value of the Company's reporting units with their respective fair value. The fair value of the Company's reporting units was estimated using both the income approach and the market valuation approach. The income approach produces an estimated fair value of a reporting unit based on the present value of the cash flows the Company expects the reporting unit to generate in the future. Estimates included in the discounted cash flow model are primarily Level 3 inputs and include the discount rate, which the Company determines based on adjusting an industry-wide weighted-average cost of capital for size, geography, and company specific risk factors, long-term rates of growth and profitability of the Company’s business, working capital effects and planned capital expenditures. The market approach produces an estimated fair value of a reporting unit based on a comparison of the reporting unit to comparable publicly traded entities in similar lines of business. The Company’s significant estimates in the market approach include the selected similar companies with comparable business factors such as size, growth, profitability, risk and return on investment and the multiples the Company applies to earnings before interest, taxes, depreciation and amortization (“EBITDA”) to estimate the fair value of the reporting unit. During the second quarter of 2024 and 2023, the Company recorded a $105.3 million impairment of goodwill within its RPM reporting unit and an aggregate $183.1 million impairment of goodwill within its PCS and RPM reporting units, respectively. For both periods, the Company determined that based on its qualitative assessment for each reporting unit, factors existed which required the Company to test its goodwill and indefinite-lived intangible assets for impairment. See Note 7, Goodwill and Intangible Assets , for additional details.
Internal-use Software and Cloud Computing Arrangements	Internal-use Software and Cloud Computing Arrangements
Revenue Recognition	Revenue Recognition Under ASC 606, the Company recognizes revenue as it transfers promised services directly to its customers at the amount that reflects the consideration to which the Company expects to be entitled in exchange for providing these services. The Company's performance obligations are driven by its different segments of business and primarily consist of integrated service offerings to provide non-emergency medical transportation, personal care services, or remote monitoring services directly to its customers. The Company receives payment for providing these services from third-party payors that include federal, state, and local governmental agencies, managed care organizations, and private consumers. In the NEMT segment, the Company's performance obligation is to stand ready to perform transportation-related activities, including the management, fulfillment, and recordkeeping activities associated with such services. In the PCS segment, the Company's performance obligation is to deliver patient care services in accordance with the nature and frequency of services outlined in each contract. In the RPM segment, the Company's performance obligation is to stand ready to perform monitoring services in the form of personal emergency response system monitoring, vitals monitoring, and other monitoring services, as contractually agreed upon. The Company satisfies substantially all of its performance obligations over time and recognizes revenue over time instead of at points in time which aligns the pattern of transfer of promised services with the value received by the customer for the performance completed to date. The Company holds different contract types under its different segments of business. In the NEMT segment, there are both capitated contracts, under which payors pay a fixed amount monthly per eligible member and revenue is recognized over each distinct service period, and fee-for-service ("FFS") contracts, under which the Company bills and collects a specified amount for each service that is provided and revenue is recognized using the right to invoice practical expedient. In the PCS segment, contracts are also FFS and service revenue is reported at the estimated net realizable amount from patients and third-party payors for services rendered and revenue is recognized using the right to invoice practical expedient. Under RPM contracts, payors pay per-enrolled-member-per-month, based on enrolled membership, and revenue is recognized ratably over the contract term. For each contract type, the Company determines the transaction price based on the gross charges for services provided, reduced by estimates for contractual adjustments due to settlements of audits and payment reviews from third-party payors. The Company determines the estimated revenue adjustments at each segment based on its historical experience with various third-party payors and previous results from the claims and adjudication process. The PCS segment uses the portfolio approach to determine the estimated revenue adjustments. See further information in Note 4, Revenue Recognition .
Government Grants	Government Grants The Company periodically receives government grants and other forms of government assistance which are not generated from the Company's contractual performance obligations under ASC 606, Revenue from Contracts with Customers . Funding received from governmental entities under government programs generally requires that the recipient attests to and complies with certain terms and conditions of receiving the funding. Government grant distributions have been received primarily under the CARES Act PRF and the ARPA SLFRF to provide economic relief and stimulus to address the health and economic impacts of the COVID-19 pandemic, as well as from other entities that provide funds with specific stipulations on the usage of these funds. Distributions received are targeted to assist with incremental health care related expenses or lost revenue attributable to the COVID-19 pandemic and provide stimulus to support long-term growth and recovery. When received, these government grants are generally recorded on the unaudited condensed consolidated balance sheets in "Accrued expenses and other current liabilities" until the time at which there is reasonable assurance the conditions of the grant will be met, at which point they can be recognized on the unaudited condensed consolidated statement of operations. Once recognized, the Company records the funds as "Grant income" if the grant is related to the loss of revenues or as an offset to "Service expense" if the grant is used to offset certain costs for which the grants are intended to compensate. The Company received grant distributions of $2.2 million and $6.5 million during the three months ended September 30, 2024 and 2023, respectively. The Company received grant distributions of $16.2 million and $21.0 million during the nine months ended September 30, 2024 and 2023, respectively. During the three and nine months ended September 30, 2024, no funds were recognized as grant income and $1.2 million and $19.1 million, respectively, were recognized as an offset to "Service expense." During the three and nine months ended September 30, 2023, $0.6 million and $4.6 million, respectively, were recognized as grant income and $0.9 million and $7.1 million, respectively, were recognized as an offset to "Service expense". The remaining balance is recorded on the unaudited condensed consolidated balance sheets in the "Accrued expenses and other current liabilities" line item until the conditions for recognition have been met. See further information in Note 8, Accrued Expenses and Other Current Liabilities . The payments from these acts are subject to certain restrictions and possible recoupment if not used for designated purposes. As a condition to receiving PRF distributions, providers must agree to certain terms and conditions, including, among other things, that the funds are being used for healthcare related expenses and lost revenues attributable to COVID-19, as defined by HHS. All recipients of PRF payments are required to comply with the reporting requirements described in the terms and conditions and as determined by HHS. The Company has submitted the required documents to meet reporting requirements for the applicable reporting periods. The Company received an audit inquiry letter from HHS related to one of the business units that received PRF payments. In response, the Company has submitted all requested information and believes that the payments received are substantiated and within the terms and conditions defined by HHS. The Company continues to recognize these amounts as grant income. At this time, the Company is unaware of any other pending or upcoming audits or inquiries related to amounts received under PRF. As a condition of receiving SLFRF distributions, providers must agree to use the funds to respond to the PHE or its negative economic impacts, to respond to workers performing essential work by providing premium pay to eligible workers, and to offset reductions in revenue due to the COVID-19 PHE as stipulated by the states in which the funds were received. All recipients of SLFRF distributions are required to comply with the reporting requirements that the state in which the funds originated requests, in order for the states to meet the requirements as described in the terms and conditions as determined by the Department of the Treasury. The Company is in the process of complying with all known reporting requirements to date.
Recent Accounting Pronouncements	Recent Accounting Pronouncements Recent accounting pronouncements that the Company has yet to adopt are as follows: In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment Disclosures ("ASU 2023-07"). This update improves reportable segment disclosure requirements, primarily through enhanced disclosure about significant segment expenses. The enhancements under this update require disclosure of significant segment expenses that are regularly provided to the Chief Operating Decision Maker ("CODM") and included within each reported measure of segment profit or loss, require disclosure of other segment items by reportable segment and a description of the composition of other segment items , require annual disclosures under ASC 280 to be provided in interim periods, clarify use of more than one measure of segment profit or loss by the CODM, require that the title of the CODM be disclosed with an explanation of how the CODM uses the reported measures of segment profit or loss to make decisions, and require that entities with a single reportable segment provide all disclosures required by this update and required under ASC 280. ASU 2023-07 is effective for public business entities for fiscal years beginning after December 15, 2023, with early adoption permitted. In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures

Segments (Tables)

Segments (Tables)	9 Months Ended
	Sep. 30, 2024
Segment Reporting [Abstract]
Schedule of Financial Information Attributable to the Company's Business Segments	The following table sets forth certain financial information from operations attributable to the Company’s business segments for the three and nine months ended September 30, 2024 and 2023 (in thousands): Three months ended September 30, 2024 NEMT PCS RPM Corporate and Other Total Service revenue, net $ 492,253 $ 188,518 $ 19,448 $ 1,818 $ 702,037 Service expense 436,549 151,745 8,018 1,622 597,934 General and administrative expense 30,758 23,823 4,332 11,990 70,903 Depreciation and amortization 7,645 12,918 7,073 304 27,940 Operating income (loss) $ 17,301 $ 32 $ 25 $ (12,098) $ 5,260 Equity in net income (loss) of investee, net of tax $ 151 $ — $ — $ (2,795) $ (2,644) Equity investment $ 2,026 $ — $ — $ 33,809 $ 35,835 Goodwill $ 135,186 $ 415,444 $ 129,592 $ 30 $ 680,252 Total assets $ 525,768 $ 736,854 $ 232,633 $ 156,493 $ 1,651,748 Nine months ended September 30, 2024 NEMT PCS RPM Corporate and Other Total Service revenue, net $ 1,462,236 $ 558,696 $ 58,575 $ 5,280 $ 2,084,787 Service expense 1,288,162 451,049 24,556 5,833 1,769,600 General and administrative expense 95,701 72,152 15,780 40,512 224,145 Depreciation and amortization 22,602 38,506 20,834 853 82,795 Impairment of goodwill — — 105,302 — 105,302 Operating income (loss) $ 55,771 $ (3,011) $ (107,897) $ (41,918) $ (97,055) Equity in net income (loss) of investee, net of tax $ 269 $ — $ — $ (4,131) $ (3,862) Equity investment $ 2,026 $ — $ — $ 33,809 $ 35,835 Goodwill $ 135,186 $ 415,444 $ 129,592 $ 30 $ 680,252 Total assets $ 525,768 $ 736,854 $ 232,633 $ 156,493 $ 1,651,748 Three months ended September 30, 2023 NEMT PCS RPM Corporate and Other Total Service revenue, net $ 485,951 $ 179,979 $ 19,779 $ 1,216 $ 686,925 Grant income (1) — 551 — — 551 Service expense 428,021 143,078 6,934 1,181 579,214 General and administrative expense 25,433 20,252 5,685 18,772 70,142 Depreciation and amortization 6,814 12,850 6,174 239 26,077 Operating income (loss) $ 25,683 $ 4,350 $ 986 $ (18,976) $ 12,043 Equity in net income (loss) of investee, net of tax $ 142 $ — $ — $ (302) $ (160) Equity investment $ 1,552 $ — $ — $ 43,655 $ 45,207 Goodwill $ 135,186 $ 415,444 $ 234,894 $ 30 $ 785,554 Total assets $ 512,032 $ 774,731 $ 346,257 $ 130,066 $ 1,763,086 Nine months ended September 30, 2023 NEMT PCS RPM Corporate and Other Total Service revenue, net $ 1,452,389 $ 534,435 $ 57,702 $ 3,812 $ 2,048,338 Grant income (1) — 4,649 — — 4,649 Service expense 1,277,604 417,636 20,129 3,366 1,718,735 General and administrative expense 87,645 63,480 16,781 61,189 229,095 Depreciation and amortization 20,319 38,590 18,087 683 77,679 Impairment of goodwill — 137,331 45,769 — 183,100 Operating income (loss) $ 66,821 $ (117,953) $ (43,064) $ (61,426) $ (155,622) Equity in net income of investee, net of tax $ 984 $ — $ — $ 1,837 $ 2,821 Equity investment $ 1,552 $ — $ — $ 43,655 $ 45,207 Goodwill $ 135,186 $ 415,444 $ 234,894 $ 30 $ 785,554 Total assets $ 512,032 $ 774,731 $ 346,257 $ 130,066 $ 1,763,086 (1) Grant income for the PCS segment includes funding received on a periodic basis from the PRF in relation to relief under the CARES Act and funding received from the SLFRF under ARPA in relation to economic recovery to combat health and economic impacts of the COVID-19 pandemic. See Note 2, Significant Accounting Policies and Recent Accounting Pronouncements.

Revenue Recognition (Tables)

Revenue Recognition (Tables)	9 Months Ended
	Sep. 30, 2024
Revenue from Contract with Customer [Abstract]
Schedule of Disaggregation of Revenue	The following table summarizes disaggregated revenue from contracts with customers by contract type for the three and nine months ended September 30, 2024 and September 30, 2023 (in thousands): Three months ended September 30, Nine months ended September 30, 2024 2023 2024 2023 NEMT capitated contracts $ 389,110 $ 412,762 $ 1,199,506 $ 1,239,957 NEMT FFS contracts 103,143 73,189 262,730 212,432 Total NEMT service revenue, net $ 492,253 $ 485,951 $ 1,462,236 $ 1,452,389 PCS FFS contracts 188,518 179,979 558,696 534,435 RPM PMPM contracts 19,448 19,779 58,575 57,702 Other service revenue 1,818 1,216 5,280 3,812 Total service revenue, net $ 702,037 $ 686,925 $ 2,084,787 $ 2,048,338
Schedule of Accounts Receivable	The following table provides information about accounts receivable, net (in thousands): September 30, 2024 December 31, 2023 Accounts receivable $ 249,850 $ 223,506 Allowance for credit losses (1,167) (969) Accounts receivable, net $ 248,683 $ 222,537
Schedule of Other Account Liabilities	The following table provides information about other revenue related accounts included on the accompanying unaudited condensed consolidated balance sheets (in thousands): September 30, 2024 December 31, 2023 Accrued contract payables (1) $ 47,300 $ 117,488 Contract receivables (2) $ 110,431 $ 143,960 Deferred revenue, current $ 3,155 $ 2,629 (1) Accrued contract payables primarily represent overpayments and liability reserves on certain risk corridor, profit rebate and reconciliation contracts. See the contract payables and receivables activity below. (2) Contract receivables primarily represent underpayments and receivables on certain risk corridor, profit rebate, and reconciliation contracts. See the contract payables and receivables activity below. The following table provides the summary activity of total contract payables and receivables as reported within the unaudited condensed consolidated balance sheets (in thousands): December 31, 2023 Additional Amounts Recorded Amounts Paid or Settled March 31, 2024 Reconciliation contract payables $ 12,294 $ 14,097 $ (2,010) $ 24,381 Profit rebate/corridor contract payables 94,775 (5,221) (1,992) 87,562 Overpayments and other cash items 10,419 8,319 (2,282) 16,456 Total contract payables $ 117,488 $ 17,195 $ (6,284) $ 128,399 Reconciliation contract receivables $ 57,002 $ 26,294 $ (10,919) $ 72,377 Corridor contract receivables 86,958 20,443 (25,500) 81,901 Total contract receivables (1) $ 143,960 $ 46,737 $ (36,419) $ 154,278 March 31, 2024 Additional Amounts Recorded Amounts Paid or Settled June 30, 2024 Reconciliation contract payables $ 24,381 $ 2,680 $ (2,333) $ 24,728 Profit rebate/corridor contract payables 87,562 (11,364) (25,990) 50,208 Overpayments and other cash items 16,456 7,024 (11,522) 11,958 Total contract payables $ 128,399 $ (1,660) $ (39,845) $ 86,894 Reconciliation contract receivables $ 72,377 $ 31,996 $ (29,788) $ 74,585 Corridor contract receivables 81,901 19,734 (10,363) 91,272 Total contract receivables (1) $ 154,278 $ 51,730 $ (40,151) $ 165,857 June 30, 2024 Additional Amounts Recorded Amounts Paid or Settled September 30, 2024 Reconciliation contract payables $ 24,728 $ (12,978) $ (935) $ 10,815 Profit rebate/corridor contract payables 50,208 (942) (40,107) 9,159 Overpayments and other cash items 11,958 17,982 (2,614) 27,326 Total contract payables $ 86,894 $ 4,062 $ (43,656) $ 47,300 Reconciliation contract receivables $ 74,585 $ 30,916 $ (52,712) $ 52,789 Corridor contract receivables 91,272 18,459 (52,089) 57,642 Total contract receivables $ 165,857 $ 49,375 $ (104,801) $ 110,431 (1) Total contract receivables is comprised of the current and long-term contract receivables balances, which are broken out separately on the unaudited condensed consolidated balance sheets. As of September 30, 2024, no portion of the contract receivables balance was classified as long-term. Long-term contract receivables primarily represent future receivable balances on certain risk corridor, profit rebate and reconciliation contracts that may be received in greater than 12 months.

Equity Investment (Tables)

Equity Investment (Tables)	9 Months Ended
	Sep. 30, 2024
Equity Method Investment, Summarized Financial Information [Abstract]
Schedule of Income Statement and Balance Sheet Disclosure	Summary financial information for Matrix on a standalone basis is as follows (in thousands): September 30, 2024 December 31, 2023 Current assets $ 49,951 $ 112,090 Long-term assets $ 349,593 $ 351,143 Current liabilities $ 31,174 $ 41,584 Long-term liabilities $ 273,311 $ 314,316 Three months ended September 30, Nine months ended September 30, 2024 2023 2024 2023 Revenue $ 67,654 $ 84,395 $ 235,032 $ 252,973 Operating income (loss) $ (2,467) $ 7,593 $ 11,821 $ 32,196 Net income (loss) $ (8,524) $ (239) $ (10,190) $ 6,976

Prepaid Expenses and Other Cu_2

Prepaid Expenses and Other Current Assets (Tables)	9 Months Ended
	Sep. 30, 2024
Prepaid Expense and Other Assets, Current [Abstract]
Schedule of Prepaid Expenses and Other Current Assets	Prepaid expenses and other current assets were comprised of the following (in thousands): September 30, 2024 December 31, 2023 Prepaid insurance $ 8,650 $ 7,231 Prepaid income taxes 8,618 2,418 Deferred ERP implementation costs 4,408 2,875 Deferred financing costs on credit facility 2,876 2,638 Other prepaid expenses 14,096 11,866 Total prepaid expenses and other current assets $ 38,648 $ 27,028

Goodwill and Intangible Assets

Goodwill and Intangible Assets (Tables)	9 Months Ended
	Sep. 30, 2024
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Goodwill	Changes in the carrying value of goodwill by reportable segment are presented in the following table (in thousands): NEMT PCS RPM Corporate and Other Total Goodwill balance as of December 31, 2022, before cumulative loss $ 231,186 $ 552,775 $ 280,663 $ 30 $ 1,064,654 Accumulated loss on impairment (96,000) — — — (96,000) Goodwill balance as of December 31, 2022, after cumulative loss 135,186 552,775 280,663 30 968,654 Impairment of goodwill — (137,331) (45,769) — (183,100) Balance at December 31, 2023 135,186 415,444 234,894 30 785,554 Impairment of goodwill — — (105,302) — (105,302) Balance at September 30, 2024 $ 135,186 $ 415,444 $ 129,592 $ 30 $ 680,252

Accrued Expenses and Other Cu_2

Accrued Expenses and Other Current Liabilities (Tables)	9 Months Ended
	Sep. 30, 2024
Payables and Accruals [Abstract]
Schedule of Accrued Expenses	Accrued expenses and other current liabilities were comprised of the following (in thousands): September 30, 2024 December 31, 2023 Accrued compensation and related liabilities $ 39,834 $ 48,033 Insurance reserves 30,336 22,014 Accrued interest 28,073 10,498 Accrued legal fees 16,158 10,148 Accrued operating expenses 9,188 15,884 Accrued government grants (1) 7,920 9,156 Deferred revenue 3,155 2,629 Union pension obligation 428 1,573 Other 10,197 7,966 Total accrued expenses and other current liabilities $ 145,289 $ 127,901 (1) Accrued government grants include payments received from government entities, such as SLFRF or other government assistance funds, to offset increased expenditures for which the related expenditure has not yet been incurred and thus the related payments are deferred as of September 30, 2024 and December 31, 2023.

Debt (Tables)

Debt (Tables)	9 Months Ended
	Sep. 30, 2024
Debt Disclosure [Abstract]
Schedule of Long-term Debt Instruments	The Company's long-term debt and short-term debt as of September 30, 2024 and December 31, 2023 consisted of the following (in thousands): Description Date of Issuance September 30, 2024 December 31, 2023 Senior Unsecured Notes $500.0 million 5.875% due November 15, 2025 11/4/2020 $ — $ 494,011 $500.0 million 5.000% due October 1, 2029 (effective interest rate 5.386%) 8/24/2021 490,910 489,746 Term Loan Facility $525.0 million SOFR + 4.750% due July 1, 2031 (1) 7/1/2024 495,215 — Total long-term debt $ 986,125 $ 983,757 Revolving Credit Facility 2/3/2022 $ 228,000 $ 113,800 Current Portion of Term Loan Facility (2) 7/1/2024 5,250 — Total short-term debt $ 233,250 $ 113,800 (1) The $525.0 million Term Loan Facility bears interest at (i) a SOFR-based benchmark plus 4.75% or (ii) a prime rate (or other alternate base rate) benchmark plus 3.75% in the case of ABR Loans (as such terms are defined in the amended Credit Agreement) and matures on the earlier of (a) July 1, 2031 and (b) July 2, 2029 if any of the Company's 2029 Notes (as defined below) remain outstanding on that date. (2) The Term Loan Facility requires principal payments of $1.3 million on a quarterly basis and accordingly, a portion of the Term Loan Facility in the amount of $5.3 million is classified as a current liability within the "Short-term debt" line item on the unaudited condensed balance sheets as of September 30, 2024.

Loss Per Share (Tables)

Loss Per Share (Tables)	9 Months Ended
	Sep. 30, 2024
Earnings Per Share [Abstract]
Schedule of Basic and Diluted Loss Per Share	The following table details the computation of basic and diluted loss per share (in thousands, except share and per share data): Three months ended September 30, Nine months ended September 30, 2024 2023 2024 2023 Numerator: Net loss $ (26,604) $ (4,302) $ (177,788) $ (199,208) Denominator: Denominator for basic and diluted earnings per share -- weighted-average shares 14,253,192 14,182,839 14,224,155 14,169,537 Loss per share: Basic loss per share $ (1.87) $ (0.30) $ (12.50) $ (14.06) Diluted loss per share $ (1.87) $ (0.30) $ (12.50) $ (14.06)
Schedule of Antidilutive Securities	The following weighted-average shares were not included in the computation of diluted loss per share as the effect of their inclusion would have been anti-dilutive: Three months ended September 30, Nine months ended September 30, 2024 2023 2024 2023 Stock options to purchase common stock 58,948 90,579 70,183 96,725 Restricted stock awards and restricted stock units 300,752 141,712 290,693 97,719

Organization and Basis of Pre_2

Organization and Basis of Presentation (Details) $ in Millions			3 Months Ended
	Sep. 30, 2024 USD ($)	Sep. 29, 2024	Sep. 30, 2024 USD ($)	Dec. 31, 2023
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items]
Working capital, contract receivable	$ 110.4		$ 110.4
Credit Agreement
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items]
Net leverage ratio			5.59
Maximum
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items]
Net leverage ratio		5.25
Maximum | Credit Agreement
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items]
Net leverage ratio	6.50	5.25
Matrix
Consolidation, Less than Wholly Owned Subsidiary, Parent Ownership Interest, Effects of Changes, Net [Line Items]
Equity method investment, ownership percentage	43.60%		43.60%	43.60%

Significant Accounting Polici_3

Significant Accounting Policies and Recent Accounting Pronouncements (Details) - USD ($)	3 Months Ended				9 Months Ended		12 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Sep. 30, 2023	Jun. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Disaggregation of Revenue [Line Items]
Impairment of goodwill	$ 0		$ 0	$ 183,100,000	$ 105,302,000	$ 183,100,000	$ 183,100,000
Government assistance, grant distribution amount	2,200,000		6,500,000		16,200,000	21,000,000
Government assistance, operating income, increase (decrease)	0		600,000		0	4,600,000
Government assistance, operating expense, increase (decrease)	1,200,000		900,000		19,100,000	7,100,000
Software Development
Disaggregation of Revenue [Line Items]
Capitalized costs, net of accumulated amortization	26,300,000				26,300,000		21,300,000
Capitalized costs, accumulated amortization	6,700,000				6,700,000		2,600,000
Capitalized costs, amortization expense	1,500,000		700,000		4,000,000	1,500,000
Cloud Computing Arrangements
Disaggregation of Revenue [Line Items]
Capitalized costs, net of accumulated amortization	12,400,000				12,400,000		14,600,000
Capitalized costs, accumulated amortization	9,000,000				9,000,000		5,200,000
Capitalized costs, amortization expense	$ 1,500,000		$ 600,000		$ 3,800,000	1,800,000
Minimum | Software Development
Disaggregation of Revenue [Line Items]
Finite-lived intangible asset, useful life (in years)	3 years				3 years
Maximum | Software Development
Disaggregation of Revenue [Line Items]
Finite-lived intangible asset, useful life (in years)	10 years				10 years
RPM
Disaggregation of Revenue [Line Items]
Impairment of goodwill		$ 105,300,000		45,800,000	$ 105,302,000	$ 45,769,000	$ 45,769,000
Personal Care and Remote Patient Monitoring
Disaggregation of Revenue [Line Items]
Impairment of goodwill		$ 183,100,000		$ 183,100,000

Segments - Narrative (Details)

Segments - Narrative (Details)	9 Months Ended
	Sep. 30, 2024 segment
Segment Reporting [Abstract]
Number of reportable segments	4

Segments - Schedule of Financia

Segments - Schedule of Financial Information Attributable to the Company's Business Segments (Details) - USD ($)	3 Months Ended				9 Months Ended		12 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Sep. 30, 2023	Jun. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023	Dec. 31, 2022
Segment Reporting Information [Line Items]
Service revenue, net	$ 702,037,000		$ 686,925,000		$ 2,084,787,000	$ 2,048,338,000
Grant income	0		551,000		0	4,649,000
Service expense	597,934,000		579,214,000		1,769,600,000	1,718,735,000
General and administrative expense	70,903,000		70,142,000		224,145,000	229,095,000
Depreciation and amortization	27,940,000		26,077,000		82,795,000	77,679,000
Impairment of goodwill	0		0	$ 183,100,000	105,302,000	183,100,000	$ 183,100,000
Operating income (loss)	5,260,000		12,043,000		(97,055,000)	(155,622,000)
Equity in net income (loss) of investee, net of tax	(2,644,000)		(160,000)		(3,862,000)	2,821,000
Equity investment	35,835,000		45,207,000		35,835,000	45,207,000	41,531,000
Goodwill	680,252,000		785,554,000		680,252,000	785,554,000	785,554,000	$ 968,654,000
Total assets	1,651,748,000		1,763,086,000		1,651,748,000	1,763,086,000	1,767,275,000
NEMT
Segment Reporting Information [Line Items]
Service revenue, net	492,253,000		485,951,000		1,462,236,000	1,452,389,000
Grant income			0			0
Service expense	436,549,000		428,021,000		1,288,162,000	1,277,604,000
General and administrative expense	30,758,000		25,433,000		95,701,000	87,645,000
Depreciation and amortization	7,645,000		6,814,000		22,602,000	20,319,000
Impairment of goodwill					0	0	0
Operating income (loss)	17,301,000		25,683,000		55,771,000	66,821,000
Equity in net income (loss) of investee, net of tax	151,000		142,000		269,000	984,000
Equity investment	2,026,000		1,552,000		2,026,000	1,552,000
Goodwill	135,186,000		135,186,000		135,186,000	135,186,000	135,186,000	135,186,000
Total assets	525,768,000		512,032,000		525,768,000	512,032,000
PCS
Segment Reporting Information [Line Items]
Service revenue, net	188,518,000		179,979,000		558,696,000	534,435,000
Grant income			551,000			4,649,000
Service expense	151,745,000		143,078,000		451,049,000	417,636,000
General and administrative expense	23,823,000		20,252,000		72,152,000	63,480,000
Depreciation and amortization	12,918,000		12,850,000		38,506,000	38,590,000
Impairment of goodwill				137,300,000	0	137,331,000	137,331,000
Operating income (loss)	32,000		4,350,000		(3,011,000)	(117,953,000)
Equity in net income (loss) of investee, net of tax	0		0		0	0
Equity investment	0		0		0	0
Goodwill	415,444,000		415,444,000		415,444,000	415,444,000	415,444,000	552,775,000
Total assets	736,854,000		774,731,000		736,854,000	774,731,000
RPM
Segment Reporting Information [Line Items]
Service revenue, net	19,448,000		19,779,000		58,575,000	57,702,000
Grant income			0			0
Service expense	8,018,000		6,934,000		24,556,000	20,129,000
General and administrative expense	4,332,000		5,685,000		15,780,000	16,781,000
Depreciation and amortization	7,073,000		6,174,000		20,834,000	18,087,000
Impairment of goodwill		$ 105,300,000		$ 45,800,000	105,302,000	45,769,000	45,769,000
Operating income (loss)	25,000		986,000		(107,897,000)	(43,064,000)
Equity in net income (loss) of investee, net of tax	0		0		0	0
Equity investment	0		0		0	0
Goodwill	129,592,000		234,894,000		129,592,000	234,894,000	234,894,000	280,663,000
Total assets	232,633,000		346,257,000		232,633,000	346,257,000
Corporate and Other
Segment Reporting Information [Line Items]
Service revenue, net	1,818,000		1,216,000		5,280,000	3,812,000
Grant income			0			0
Service expense	1,622,000		1,181,000		5,833,000	3,366,000
General and administrative expense	11,990,000		18,772,000		40,512,000	61,189,000
Depreciation and amortization	304,000		239,000		853,000	683,000
Impairment of goodwill					0	0	0
Operating income (loss)	(12,098,000)		(18,976,000)		(41,918,000)	(61,426,000)
Equity in net income (loss) of investee, net of tax	(2,795,000)		(302,000)		(4,131,000)	1,837,000
Equity investment	33,809,000		43,655,000		33,809,000	43,655,000
Goodwill	30,000		30,000		30,000	30,000	$ 30,000	$ 30,000
Total assets	$ 156,493,000		$ 130,066,000		$ 156,493,000	$ 130,066,000

Revenue Recognition - Schedule

Revenue Recognition - Schedule of Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Disaggregation of Revenue [Line Items]
Total service revenue, net	$ 702,037	$ 686,925	$ 2,084,787	$ 2,048,338
Other service revenue
Disaggregation of Revenue [Line Items]
Total service revenue, net	1,818	1,216	5,280	3,812
NEMT
Disaggregation of Revenue [Line Items]
Total service revenue, net	492,253	485,951	1,462,236	1,452,389
NEMT | Capitated Contracts
Disaggregation of Revenue [Line Items]
Total service revenue, net	389,110	412,762	1,199,506	1,239,957
NEMT | FFS Contracts
Disaggregation of Revenue [Line Items]
Total service revenue, net	103,143	73,189	262,730	212,432
PCS
Disaggregation of Revenue [Line Items]
Total service revenue, net	188,518	179,979	558,696	534,435
PCS | FFS Contracts
Disaggregation of Revenue [Line Items]
Total service revenue, net	188,518	179,979	558,696	534,435
RPM
Disaggregation of Revenue [Line Items]
Total service revenue, net	19,448	19,779	58,575	57,702
RPM | PMPM Contracts
Disaggregation of Revenue [Line Items]
Total service revenue, net	$ 19,448	$ 19,779	$ 58,575	$ 57,702

Revenue Recognition - Narrative

Revenue Recognition - Narrative (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
NEMT
Disaggregation of Revenue [Line Items]
Performance obligation satisfied in previous period, increase (decrease)	$ (4.1)	$ (2.9)	$ 7.1	$ (3.9)
NEMT | One US State | Sales Revenue, Net | Government Contracts Concentration Risk | Continuing Operations
Disaggregation of Revenue [Line Items]
Concentration risk, percentage	10.70%	11.40%	11.20%	11.20%
PCS | One US State | Sales Revenue, Net | Government Contracts Concentration Risk | Continuing Operations
Disaggregation of Revenue [Line Items]
Concentration risk, percentage	12.40%	11.40%	12.20%	11.30%
RPM | One US State | Sales Revenue, Net | Government Contracts Concentration Risk | Continuing Operations
Disaggregation of Revenue [Line Items]
Concentration risk, percentage	18.60%	19.30%	18.70%	17.40%

Revenue Recognition - Schedul_2

Revenue Recognition - Schedule of Accounts Receivable (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Revenue from Contract with Customer [Abstract]
Accounts receivable	$ 249,850	$ 223,506
Allowance for credit losses	(1,167)	(969)
Accounts receivable, net	$ 248,683	$ 222,537

Revenue Recognition - Schedul_3

Revenue Recognition - Schedule of Other Accounts (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Dec. 31, 2023
Revenue from Contract with Customer [Abstract]
Accrued contract payables	$ 47,300	$ 86,894	$ 128,399	$ 117,488
Contracts receivables	110,431			143,960
Deferred revenue, current	$ 3,155			$ 2,629

Revenue Recognition - Schedul_4

Revenue Recognition - Schedule of Contract Payables and Receivables (Details) - USD ($) $ in Thousands	3 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024
Reconciliation contract payables
Contract with customer, liability beginning of period	$ 86,894	$ 128,399	$ 117,488
Contract with customer, liability, additional amounts recorded	4,062	(1,660)	17,195
Contract with customer, liability, amounts paid or settled	(43,656)	(39,845)	(6,284)
Contract with customer, liability end of period	47,300	86,894	128,399
Reconciliation contract receivables
Contract with customer, asset, beginning of period	165,857	154,278	143,960
Contract with customer, asset, additional amounts recorded	49,375	51,730	46,737
Contract with customer, asset, amounts paid or settled	(104,801)	(40,151)	(36,419)
Contract with customer, asset, end of period	110,431	165,857	154,278
Reconciliation contract payables
Reconciliation contract payables
Contract with customer, liability beginning of period	24,728	24,381	12,294
Contract with customer, liability, additional amounts recorded	(12,978)	2,680	14,097
Contract with customer, liability, amounts paid or settled	(935)	(2,333)	(2,010)
Contract with customer, liability end of period	10,815	24,728	24,381
Reconciliation contract receivables
Contract with customer, asset, beginning of period	74,585	72,377	57,002
Contract with customer, asset, additional amounts recorded	30,916	31,996	26,294
Contract with customer, asset, amounts paid or settled	(52,712)	(29,788)	(10,919)
Contract with customer, asset, end of period	52,789	74,585	72,377
Profit rebate/corridor contract payables
Reconciliation contract payables
Contract with customer, liability beginning of period	50,208	87,562	94,775
Contract with customer, liability, additional amounts recorded	(942)	(11,364)	(5,221)
Contract with customer, liability, amounts paid or settled	(40,107)	(25,990)	(1,992)
Contract with customer, liability end of period	9,159	50,208	87,562
Reconciliation contract receivables
Contract with customer, asset, beginning of period	91,272	81,901	86,958
Contract with customer, asset, additional amounts recorded	18,459	19,734	20,443
Contract with customer, asset, amounts paid or settled	(52,089)	(10,363)	(25,500)
Contract with customer, asset, end of period	57,642	91,272	81,901
Overpayments and other cash items
Reconciliation contract payables
Contract with customer, liability beginning of period	11,958	16,456	10,419
Contract with customer, liability, additional amounts recorded	17,982	7,024	8,319
Contract with customer, liability, amounts paid or settled	(2,614)	(11,522)	(2,282)
Contract with customer, liability end of period	$ 27,326	$ 11,958	$ 16,456

Equity Investment - Narrative (

Equity Investment - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Schedule of Equity Method Investments [Line Items]
Operating income (loss)	$ 5,260	$ 12,043	$ (97,055)	$ (155,622)
Equity investments	35,835	45,207	35,835	45,207	$ 41,531
Matrix
Schedule of Equity Method Investments [Line Items]
Operating income (loss)	(2,467)	7,593	11,821	32,196
Net income (loss)	$ (2,800)	(300)	$ (4,100)	1,800
Matrix
Schedule of Equity Method Investments [Line Items]
Equity method investment, ownership percentage	43.60%		43.60%		43.60%
Operating income (loss)	$ (3,900)	$ (400)	$ (5,700)	$ 2,500
Equity investments	$ 33,800		$ 33,800		$ 39,900

Equity Investment - Schedule of

Equity Investment - Schedule of Income Statement and Balance Sheet Disclosure (Details) - USD ($) $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Schedule of Investments [Line Items]
Current assets	$ 463,449						$ 463,449		$ 404,923
Current liabilities	581,519						581,519		520,402
Operating income (loss)	5,260			$ 12,043			(97,055)	$ (155,622)
Net income (loss)	(26,604)	$ (128,884)	$ (22,300)	(4,302)	$ (190,944)	$ (3,962)	(177,788)	(199,208)
Matrix
Schedule of Investments [Line Items]
Current assets	49,951						49,951		112,090
Long-term assets	349,593						349,593		351,143
Current liabilities	31,174						31,174		41,584
Long-term liabilities	273,311						273,311		$ 314,316
Revenue	67,654			84,395			235,032	252,973
Operating income (loss)	(2,467)			7,593			11,821	32,196
Net income (loss)	$ (8,524)			$ (239)			$ (10,190)	$ 6,976

Prepaid Expenses and Other Cu_3

Prepaid Expenses and Other Current Assets (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Prepaid Expense and Other Assets, Current [Abstract]
Prepaid insurance	$ 8,650	$ 7,231
Prepaid income taxes	8,618	2,418
Deferred ERP implementation costs	4,408	2,875
Deferred financing costs on credit facility	2,876	2,638
Other prepaid expenses	14,096	11,866
Total prepaid expenses and other current assets	$ 38,648	$ 27,028

Goodwill and Intangible Asset_2

Goodwill and Intangible Assets - Narrative (Details) - USD ($)	3 Months Ended				9 Months Ended		12 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Sep. 30, 2023	Jun. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023	Dec. 31, 2022
GoodwillLineItems
Impairment of goodwill	$ 0		$ 0	$ 183,100,000	$ 105,302,000	$ 183,100,000	$ 183,100,000
Goodwill	680,252,000		785,554,000		680,252,000	785,554,000	785,554,000	$ 968,654,000
Accumulated impairment losses	384,400,000				384,400,000		279,100,000	96,000,000
Personal Care and Remote Patient Monitoring
GoodwillLineItems
Impairment of goodwill		$ 183,100,000		183,100,000
Goodwill	545,000,000				545,000,000		650,300,000
RPM
GoodwillLineItems
Impairment of goodwill		$ 105,300,000		45,800,000	105,302,000	45,769,000	45,769,000
Goodwill	129,592,000		234,894,000		129,592,000	234,894,000	234,894,000	280,663,000
Accumulated impairment losses								0
PCS
GoodwillLineItems
Impairment of goodwill				$ 137,300,000	0	137,331,000	137,331,000
Goodwill	$ 415,444,000		$ 415,444,000		$ 415,444,000	$ 415,444,000	$ 415,444,000	552,775,000
Accumulated impairment losses								$ 0

Goodwill and Intangible Asset_3

Goodwill and Intangible Assets - Schedule of Goodwill (Details) - USD ($)	3 Months Ended				9 Months Ended		12 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Sep. 30, 2023	Jun. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023	Dec. 31, 2022
Goodwill [Roll Forward]
Goodwill								$ 1,064,654,000
Accumulated loss on impairment	$ (384,400,000)				$ (384,400,000)		$ (279,100,000)	(96,000,000)
Goodwill - beginning balance					785,554,000	$ 968,654,000	968,654,000
Impairment of goodwill	0		$ 0	$ (183,100,000)	(105,302,000)	(183,100,000)	(183,100,000)
Goodwill - ending balance	680,252,000		785,554,000		680,252,000	785,554,000	785,554,000
NEMT
Goodwill [Roll Forward]
Goodwill								231,186,000
Accumulated loss on impairment								(96,000,000)
Goodwill - beginning balance					135,186,000	135,186,000	135,186,000
Impairment of goodwill					0	0	0
Goodwill - ending balance	135,186,000		135,186,000		135,186,000	135,186,000	135,186,000
PCS
Goodwill [Roll Forward]
Goodwill								552,775,000
Accumulated loss on impairment								0
Goodwill - beginning balance					415,444,000	552,775,000	552,775,000
Impairment of goodwill				(137,300,000)	0	(137,331,000)	(137,331,000)
Goodwill - ending balance	415,444,000		415,444,000		415,444,000	415,444,000	415,444,000
RPM
Goodwill [Roll Forward]
Goodwill								280,663,000
Accumulated loss on impairment								0
Goodwill - beginning balance					234,894,000	280,663,000	280,663,000
Impairment of goodwill		$ (105,300,000)		$ (45,800,000)	(105,302,000)	(45,769,000)	(45,769,000)
Goodwill - ending balance	129,592,000		234,894,000		129,592,000	234,894,000	234,894,000
Corporate and Other
Goodwill [Roll Forward]
Goodwill								30,000
Accumulated loss on impairment								$ 0
Goodwill - beginning balance					30,000	30,000	30,000
Impairment of goodwill					0	0	0
Goodwill - ending balance	$ 30,000		$ 30,000		$ 30,000	$ 30,000	$ 30,000

Accrued Expenses and Other Cu_3

Accrued Expenses and Other Current Liabilities (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Payables and Accruals [Abstract]
Accrued compensation and related liabilities	$ 39,834	$ 48,033
Insurance reserves	30,336	22,014
Accrued interest	28,073	10,498
Accrued legal fees	16,158	10,148
Accrued operating expenses	9,188	15,884
Accrued government grants	7,920	9,156
Deferred revenue	3,155	2,629
Union pension obligation	428	1,573
Other	10,197	7,966
Total accrued expenses and other current liabilities	$ 145,289	$ 127,901

Debt - Schedule of Long Term De

Debt - Schedule of Long Term Debt Instruments (Details) - USD ($) $ in Thousands		3 Months Ended
	Jul. 01, 2024	Sep. 30, 2024	Dec. 31, 2023
Debt Instrument [Line Items]
Total long-term debt		$ 986,125	$ 983,757
Short-term debt		233,250	113,800
Revolving Credit Facility
Debt Instrument [Line Items]
Short-term debt		228,000	113,800
Current Term Loan Facility
Debt Instrument [Line Items]
Short-term debt		5,250	0
Term Loan Facility
Debt Instrument [Line Items]
Line of credit facility, periodic principal payment		1,300
Line of credit facility, periodic payment		5,300
Senior Notes | 2025 Senior Notes
Debt Instrument [Line Items]
Face amount		$ 500,000
Stated interest rate (as percent)		5.875%
Total long-term debt		$ 0	494,011
Senior Notes | 2029 Senior Notes
Debt Instrument [Line Items]
Face amount		$ 500,000
Stated interest rate (as percent)		5%
Effective interest rate (as percent)		5.386%
Total long-term debt		$ 490,910	489,746
Secured Debt | Term Loan Facility
Debt Instrument [Line Items]
Face amount	$ 525,000
Total long-term debt		$ 495,215	$ 0
Basis spread on variable rate (in percent)	4.75%
Secured Debt | Term Loan Facility | Secured Overnight Financing Rate (SOFR)
Debt Instrument [Line Items]
Basis spread on variable rate (in percent)	4.75%
Secured Debt | Term Loan Facility | Base Rate
Debt Instrument [Line Items]
Basis spread on variable rate (in percent)	3.75%

Debt - Narrative (Details)

Debt - Narrative (Details)						3 Months Ended		9 Months Ended
	Sep. 30, 2024 USD ($)	Sep. 29, 2024	Jul. 01, 2024 USD ($)	Feb. 22, 2024 USD ($)	Jun. 26, 2023	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Dec. 31, 2023 USD ($)	Feb. 03, 2022 USD ($)
Line of Credit Facility [Line Items]
Deferred financing fees	$ 32,313,000					$ 32,313,000		$ 32,313,000		$ 16,243,000
Loss on debt extinguishment						11,797,000	$ 0	11,797,000	$ 0
Payment of debt issuance costs								25,512,000	$ 376,000
Maximum
Line of Credit Facility [Line Items]
Net leverage ratio		5.25
Senior Notes
Line of Credit Facility [Line Items]
Debt instrument, covenant, maximum indebtedness principal amount	50,000,000					50,000,000		50,000,000
Credit Agreement
Line of Credit Facility [Line Items]
Debt instrument, covenant, maximum indebtedness principal amount	40,000,000					$ 40,000,000		40,000,000
Net leverage ratio						5.59
Remaining borrowing capacity				$ 100,000,000
Face amount			$ 255,000,000
Debt instrument covenant minimum liquidity	$ 100,000,000		$ 75,000,000			$ 100,000,000		$ 100,000,000
Debt instrument, fee			0.3 million
Debt instrument covenant interest coverage minimum	2					2		2
Basis spread on variable rate (in percent)	0.25%
Letters of credit outstanding	$ 228,000,000					$ 228,000,000		$ 228,000,000		113,800,000
Weighted average interest rate for borrowings outstanding (as percent)	9.30%					9.30%		9.30%
Credit Agreement | Maximum
Line of Credit Facility [Line Items]
Net leverage ratio	6.50	5.25
Unused capacity, commitment fee percentage								0.50%
Credit Agreement | Maximum | Term Benchmark loans
Line of Credit Facility [Line Items]
Basis spread on variable rate (in percent)								4.25%
Credit Agreement | Maximum | Alternate Base Rate
Line of Credit Facility [Line Items]
Basis spread on variable rate (in percent)								3.25%
Credit Agreement | Minimum
Line of Credit Facility [Line Items]
Unused capacity, commitment fee percentage								0.30%
Credit Agreement | Minimum | Term Benchmark loans
Line of Credit Facility [Line Items]
Basis spread on variable rate (in percent)								2.50%
Credit Agreement | Minimum | Alternate Base Rate
Line of Credit Facility [Line Items]
Basis spread on variable rate (in percent)								1.50%
Credit Agreement | Debt Instrument, Covenant Period, One
Line of Credit Facility [Line Items]
Net leverage ratio				5.50	5.25
Credit Agreement | Debt Instrument, Covenant Period, Two
Line of Credit Facility [Line Items]
Net leverage ratio				5.25	5
Credit Agreement | Debt Instrument, Covenant Period, Three
Line of Credit Facility [Line Items]
Net leverage ratio				5	4.75
Credit Agreement | Debt Instrument, Covenant Period, Four
Line of Credit Facility [Line Items]
Net leverage ratio				4.75	4.50
Credit Agreement | Thereafter
Line of Credit Facility [Line Items]
Net leverage ratio					4.50
Credit Agreement | Revolving Credit Facility
Line of Credit Facility [Line Items]
Maximum borrowing capacity											$ 325,000,000
Credit Agreement | Revolving Credit Facility | Maximum
Line of Credit Facility [Line Items]
Unused capacity, commitment fee percentage								4.25%
Credit Agreement | Revolving Credit Facility | Minimum
Line of Credit Facility [Line Items]
Unused capacity, commitment fee percentage								2.50%
Credit Agreement | Bridge Loan
Line of Credit Facility [Line Items]
Maximum borrowing capacity											25,000,000
Credit Agreement | Letter of Credit
Line of Credit Facility [Line Items]
Maximum borrowing capacity											60,000,000
Letters of credit outstanding	$ 55,600,000					$ 55,600,000		$ 55,600,000		40,400,000
Credit Agreement | Letter of Credit | Maximum
Line of Credit Facility [Line Items]
Debt instrument, pro forma net leverage ratio								2.70
Credit Agreement | Alternative Currency Loan
Line of Credit Facility [Line Items]
Maximum borrowing capacity											$ 75,000,000
2025 Senior Notes | Senior Notes
Line of Credit Facility [Line Items]
Deferred financing fees	14,500,000					14,500,000		$ 14,500,000
Unamortized debt issuance expense			$ 4,500,000
Redemption price, percentage			1.469%
Repayments of senior debt			$ 507,300,000
Interest expense, debt			3,800,000
Loss on debt extinguishment			11,800,000
Face amount			7,300,000
2029 Senior Notes | Senior Notes
Line of Credit Facility [Line Items]
Deferred financing fees	13,500,000					13,500,000		13,500,000
Term Loan Facility | Secured Debt
Line of Credit Facility [Line Items]
Unamortized debt issuance expense	23,200,000					23,200,000		23,200,000
Fair value	$ 523,700,000					$ 523,700,000		$ 523,700,000
Face amount			$ 525,000,000
Basis spread on variable rate (in percent)			4.75%
Weighted average interest rate for borrowings outstanding (as percent)	10.08%					10.08%		10.08%
Payment of debt issuance costs			$ 24,400,000
Debt instrument, percentage of principal amount			0.0025
Term Loan Facility | Secured Debt | Base Rate
Line of Credit Facility [Line Items]
Basis spread on variable rate (in percent)			3.75%
Term Loan Facility | Secured Debt | Secured Overnight Financing Rate (SOFR)
Line of Credit Facility [Line Items]
Basis spread on variable rate (in percent)			4.75%
Term Loan Facility | Secured Debt | Debt Instrument, Covenant Period, One
Line of Credit Facility [Line Items]
Net leverage ratio			0.750
Debt instrument covenant leverage ratio			4.40
Term Loan Facility | Secured Debt | Debt Instrument, Covenant Period, Two
Line of Credit Facility [Line Items]
Net leverage ratio			0.500
Term Loan Facility | Secured Debt | Debt Instrument, Covenant Period, Two | Maximum
Line of Credit Facility [Line Items]
Debt instrument covenant leverage ratio			4.40
Term Loan Facility | Secured Debt | Debt Instrument, Covenant Period, Two | Minimum
Line of Credit Facility [Line Items]
Debt instrument covenant leverage ratio			3.90
Term Loan Facility | Secured Debt | Debt Instrument, Covenant Period, Three
Line of Credit Facility [Line Items]
Net leverage ratio			0.250
Term Loan Facility | Secured Debt | Debt Instrument, Covenant Period, Three | Maximum
Line of Credit Facility [Line Items]
Debt instrument covenant leverage ratio			3.90
Term Loan Facility | Secured Debt | Debt Instrument, Covenant Period, Three | Minimum
Line of Credit Facility [Line Items]
Debt instrument covenant leverage ratio			3.40
Term Loan Facility | Secured Debt | Debt Instrument, Covenant Period, Four
Line of Credit Facility [Line Items]
Net leverage ratio			0
Debt instrument covenant leverage ratio			3.40
2025 Senior Notes
Line of Credit Facility [Line Items]
Fair value	$ 0					$ 0		$ 0		499,200,000
2025 Senior Notes | Senior Notes
Line of Credit Facility [Line Items]
Face amount	500,000,000					500,000,000		500,000,000
2029 Senior Notes
Line of Credit Facility [Line Items]
Fair value	315,000,000					315,000,000		315,000,000		$ 410,000,000
2029 Senior Notes | Senior Notes
Line of Credit Facility [Line Items]
Unamortized debt issuance expense	9,100,000					9,100,000		9,100,000
Face amount	$ 500,000,000					$ 500,000,000		$ 500,000,000

Stock-Based Compensation and _2

Stock-Based Compensation and Similar Arrangements (Details) - USD ($)	3 Months Ended			9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2022	Sep. 30, 2024	Sep. 30, 2023
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation	$ 0	$ 0		$ 0	$ 0
Period for recognition (in years)				3 years
Employee Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares available for purchase (in shares)			1,000,000
Annual maximum payroll deduction amount			$ 25,000
Purchase price of common stock, percent			85%
Total shares of common stock reserved for future issuance (in shares)	966,172			966,172
Common stock options
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock options outstanding (in shares)	50,096			50,096
Weighted-average exercise price (in dollars per share)	$ 116.62			$ 116.62
Restricted Stock Awards ("RSAs") and Restricted Stock Units ("RSUs")
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation	$ 1,300,000	1,100,000		$ 4,400,000	2,900,000
Restricted Stock Awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares of unvested RSAs outstanding (in shares)	15,948			15,948
Weighted-average grant date fair value (in dollars per share)	$ 48.90			$ 48.90
Restricted Stock Units (RSUs)
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Shares of unvested RSAs outstanding (in shares)	287,947			287,947
Weighted-average grant date fair value (in dollars per share)	$ 42.28			$ 42.28
Performance Shares
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock-based compensation	$ (800,000)	$ 400,000		$ 0	$ 500,000
Shares of unvested RSAs outstanding (in shares)	267,345			267,345
Weighted-average grant date fair value (in dollars per share)	$ 46.53			$ 46.53
Award vesting period (in years)				3 years

Loss Per Share - Schedule of Ba

Loss Per Share - Schedule of Basic and Diluted Loss Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended						9 Months Ended
	Sep. 30, 2024	Jun. 30, 2024	Mar. 31, 2024	Sep. 30, 2023	Jun. 30, 2023	Mar. 31, 2023	Sep. 30, 2024	Sep. 30, 2023
Numerator:
Net loss	$ (26,604)	$ (128,884)	$ (22,300)	$ (4,302)	$ (190,944)	$ (3,962)	$ (177,788)	$ (199,208)
Denominator:
Denominator for basic earnings per share -- weighted-average shares (in shares)	14,253,192			14,182,839			14,224,155	14,169,537
Denominator for diluted earnings per share -- weighted-average shares (in shares)	14,253,192			14,182,839			14,224,155	14,169,537
Loss per share:
Basic loss per share (in dollars per share)	$ (1.87)			$ (0.30)			$ (12.50)	$ (14.06)
Diluted loss per share (in dollars per share)	$ (1.87)			$ (0.30)			$ (12.50)	$ (14.06)

Loss Per Share - Schedule of An

Loss Per Share - Schedule of Antidilutive Securities (Details) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Stock options to purchase common stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities (in shares)	58,948	90,579	70,183	96,725
Restricted stock awards and restricted stock units
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Antidilutive securities (in shares)	300,752	141,712	290,693	97,719

Income Taxes (Details)

Income Taxes (Details)	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Income Tax Disclosure [Abstract]
Effective income tax rate (as percent)	(31.60%)	(28.60%)	(1.20%)	(2.10%)