Free cash flow has shown a notable recovery to $121.3 million in 2026Q1, although earnings quality remains volatile with an OCF/NI ratio of 11.27.
| Cash from Operations | 251.99M | 139.93M | 34.77M | -59.19M | -45.43M | -78.78M | 7.56M | 9.21M |
| Operating CF Margin % | - | 3.54% | 1.29% | -3.25% | -3.17% | -6.75% | 0.79% | 1.22% |
| Operating CF Growth % | 671.91% | 302.44% | 158.75% | -30.29% | 42.33% | -1141.87% | -17.89% | - |
| Net Income | 19.81M | -724K | -128.07M | -148.17M | -149.64M | -195.29M | -22.93M | -44.73M |
| Depreciation & Amortization | 30.72M | 30.48M | 27.06M | 21.67M | 17.49M | 16.03M | 15.46M | 16.58M |
| Stock-Based Compensation | 58.91M | 62.08M | 71.13M | 66.83M | 81.72M | 110.6M | 2.12M | 1.16M |
| Deferred Taxes | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Other Non-Cash Items | 109.71M | 2.58M | 3.75M | -1.54M | 10.56M | 9.29M | 9.65M | 7.21M |
| Working Capital Changes | 32.86M | 45.51M | 60.89M | 2.03M | -5.55M | -19.42M | 3.25M | 29M |
| Change in Receivables | -30.77M | 0 | -34.28M | -26.95M | -34.38M | -17.61M | -4.63M | -5.78M |
| Change in Inventory | 0 | - | - | - | - | - | - | - |
| Change in Payables | 6.26M | 0 | -1.46M | -6.35M | 13.74M | 437K | 645K | 1.29M |
| Cash from Investing | -10.93M | -14.97M | 39.19M | -147.26M | -28.22M | -20.82M | -16.36M | -10.24M |
| Capital Expenditures | -15.37M | -26.78M | -41.42M | -35.99M | -23.77M | -18.36M | -15.71M | -10.24M |
| CapEx % of Revenue | 0.36% | 0.68% | 1.53% | 1.97% | 1.66% | 1.57% | 1.64% | 1.35% |
| Acquisitions | 0 | - | - | - | - | - | - | - |
| Investments | - | - | - | - | - | - | - | - |
| Other Investing | -10.53M | 0 | 14K | 0 | 0 | -1.41M | 100K | 0 |
| Cash from Financing | 18.38M | 18.04M | 156.03M | 105K | 16.59M | 360.13M | 130.12M | 52.66M |
| Debt Issued (Net) | 0 | - | - | - | - | - | - | - |
| Equity Issued (Net) | 20.03M | 18.07M | -350K | 0 | 0 | 389.13M | 133.5M | -1.48M |
| Dividends Paid | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Share Repurchases | 0 | 0 | -350K | 0 | 0 | -1.47M | -1.5M | -1.98M |
| Other Financing | -1.66M | -26K | -8.62M | 105K | -5.23M | -29M | -3.37M | -854K |
| Net Change in Cash | 259.44M | 142.99M | 229.99M | -206.34M | -57.05M | 260.54M | 121.33M | 51.63M |
| Free Cash Flow | 236.63M | 113.15M | -6.65M | -95.18M | -69.2M | -97.14M | -8.15M | -1.04M |
| FCF Margin % | 5.56% | 2.87% | -0.25% | -5.22% | -4.83% | -8.32% | -0.85% | -0.14% |
| FCF Growth % | 1140.5% | 1801.96% | 93.02% | -37.54% | 28.76% | -1092.29% | -685.63% | - |
| FCF per Share | 1.11 | 0.57 | -0.03 | -0.51 | -0.38 | -0.56 | -0.04 | -0.01 |
| FCF Conversion (FCF/Net Income) | 11.95x | -193.27x | -0.27x | 0.40x | 0.30x | 0.40x | -0.33x | -0.21x |
| Interest Paid | 0 | 0 | 22.16M | 0 | 0 | 0 | 0 | 0 |
| Taxes Paid | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Regulatory reimbursement rate volatility
As reported in recent financial filings, the relationship between net income and operating cash flow is erratic, with the OCF/NI ratio swinging from 11.27 in 2026Q1 to -1.82 in 2025Q1, suggesting that reported earnings are currently poor proxies for actual cash generation capabilities.
The significant divergence between net income and operating cash flow highlights the impact of non-cash adjustments and working capital fluctuations inherent in the Medicare Advantage model. Investors should monitor whether this volatility stabilizes as the company matures, as the current lack of correlation complicates the assessment of true underlying profitability.
Based on the provided cash flow data, the company's free cash flow has shown a notable recovery, reaching $121.3 million in 2026Q1 compared to a $198.1 million outflow in 2023Q4, indicating that the business is beginning to scale its cash-generating efficiency despite persistent net losses.
The shift toward positive free cash flow suggests that the company is successfully managing its medical loss ratios and administrative overhead as it scales. However, given the historical inconsistency in these figures, it remains unclear if this trajectory is sustainable or merely a reflection of timing differences in CMS premium receipts.
According to quarterly cash flow statements, working capital changes have been the primary driver of cash flow volatility, with a $94.8 million inflow in 2026Q1 contrasting sharply with a $161.1 million outflow in 2023Q4, reflecting the sensitive nature of medical claims reserves and premium settlements.
These large swings in working capital appear to be tied to the timing of CMS payments and the settlement of incurred but not reported (IBNR) claims. The reliance on these fluctuations to fund operations warrants further investigation into the adequacy of the company's medical cost reserves.
As indicated by the financial data, stock-based compensation remains a consistent and material expense, averaging over $15 million per quarter, which effectively masks the company's true cash burn and complicates the evaluation of its long-term ability to fund operations without external capital.
By adding back stock-based compensation to arrive at operating cash flow, the company presents a more favorable liquidity picture than the GAAP net income suggests. Investors should consider the dilutive impact of this compensation alongside the cash flow figures to understand the true cost of the company's growth strategy.
Quick answers to the most common questions about buying ALHC stock.
Alignment Healthcare, Inc. (ALHC) generated $139.9M in net cash from operating activities in 2025. This reflects the cash generated directly from core business operations.
Alignment Healthcare, Inc. (ALHC) generated $113.1M in free cash flow in 2025. Free cash flow is the cash left over after capital expenditures, which can be used to pay dividends, repurchase shares, or pay down debt.
Alignment Healthcare, Inc. (ALHC) spent $26.8M on capital expenditures in 2025. CapEx represents the cash invested in physical assets like property, plant, and equipment to maintain or grow the business.