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Every Kentucky building in this report has its own page.
This report is the state. The full read is one building: its occupancy month by month, its cost reports, its Medicaid rate files and its surveys. Free with an account.
October 27, 2026 · Exclusively SNF Sell-Side Advisors · Since 2014
3G Healthcare Real Estate is a sell-side advisory firm working only in skilled nursing facility real estate. This report is the Kentucky ownership and operating picture as we track it, drawn from CMS Provider Information, federal ownership filings, county property records, published Medicaid rate files, and our own resolution work.
Every figure below describes the market in aggregate; nothing here is specific to any single owner or property.
267
facilities
25,400
licensed beds
86%
avg occupancy
50%
showing distress
What the Cost Reports Say · FY2024 to FY2026
Seven days in ten are Medicaid.
Every full-year Medicare cost report Kentucky's skilled nursing facilities filed in FY2024 to FY2026, read as one set of bands: 252 reports across 118 counties. This is the table an owner puts their own filing against.
252
cost reports read across 118 counties
89.8%
median occupancy
71.8%
of the days reported by payer were Medicaid
10.1%
median net margin, 16.3% filed a loss
Seven of every ten patient days Kentucky's skilled nursing facilities billed in FY2024 to FY2026 were Medicaid days: 71.8% of the 7,595,273 patient days on the 251 reports that break days out by payer. The median building ran 89.8% occupancy, with the middle half between 83.5% and 93.5%, on 249 reports that carry it. Patient revenue ran $403 a patient day at the median against $367 of reported operating expense, the cost report's own operating line rather than every cost a building carries. Net margin on the filings themselves was 10.1% at the median. 41 of the 251 reports that carry a bottom line filed a loss, which is 16.3% of them.
Statistic
25th
Median
75th
Reports
National median
Census and payer mix
Occupancy
Patient days as a share of available bed days, both off Worksheet S-3 Part I.
83.5%
89.8%
93.5%
249
84.2%
Medicare share of days
Traditional Medicare days as a share of all patient days, off Worksheet S-3 Part I.
4.3%
6.3%
9.6%
252
7.7%
Medicaid share of days
Medicaid days as a share of all patient days, off Worksheet S-3 Part I.
66.4%
76.3%
82.0%
251
66.3%
Everyone else as a share of days
Patient days that are neither traditional Medicare nor Medicaid, as a share of all patient days on the same filing. Managed care sits in here.
11.7%
17.1%
25.7%
251
23.4%
Per-resident-day economics
Patient revenue per patient day
Net patient revenue off Worksheet G-3, divided by patient days off Worksheet S-3 Part I. Blended across every payer.
$370
$403
$436
252
$373
Operating expense per patient day
Total operating expense off Worksheet G-3, divided by patient days. Net income also counts income and expense outside patient care, such as investment income, rentals and donations, which is why it is not patient revenue minus this line.
$337
$367
$406
252
$372
Net income per patient day
Net income off Worksheet G-3, divided by patient days.
$13
$42
$72
252
$14
Margin and liquidity
Net margin
Net income off Worksheet G-3 over net patient revenue off the same worksheet.
3.2%
10.1%
17.2%
251
3.7%
Current ratio
Current assets over current liabilities on the same filing. Under 1.00 means the building owes more inside a year than it holds to pay it with.
Statewide pool, of the 7,595,273 days on the 251 reports that break days out by payer
Median facility
Medicaid
71.8%
76.3%
Traditional Medicare
7.4%
6.3%
Everyone else, including managed care
20.8%
17.1%
The statewide pool adds to 100 because it divides one set of days three ways. The median facility column does not, and is not meant to: every building’s own mix sums to 100, but the median Medicaid building is not the median Medicare building. Managed care is broken out separately on 20 of the state’s reports; on those 742,456 days Medicare Advantage is 7.9% and managed Medicaid 5.4%, and both sit inside the row above.
Urban against rural, at the median
Urban (127)
Rural (125)
Occupancy
90.3%
88.4%
Medicaid share of days
72.8%
78.4%
Patient revenue per patient day
$427
$371
Operating expense per patient day
$390
$344
Net margin
12.3%
8.1%
Each side is ranked over its own filings, so the two columns are two medians and not a split of one. A filing CMS left unclassified is in neither column, which is why the two counts need not add to the state total.
Full buildings, thin years
82% of Kentucky buildings closed the year at 80% occupancy or better, on the 249 reports that carry occupancy, and 16% of the 251 that carry a bottom line still filed a loss.
A $69 gap per patient day
Operating cost runs $337 a patient day at the 25th percentile against $406 at the 75th, on 252 Kentucky reports. At the median building's own year of 30,022 patient days, that gap is $2.1 million a year between a lean cost structure and a heavy one.
Margin without liquidity
The median Kentucky filing closed on a current ratio of 1.09, on the 208 reports that carry both sides of the balance sheet, and 46% of them closed under 1.00, which means owing more inside a year than they hold to pay it with. Only 16% of the state's filings lost money on patient care, so this is a working-capital reading rather than an earnings one.
Medicare cost reports as filed, fiscal years ending 2024-12-31 to 2026-03-31, one full-year report per facility: 252 reports covering 7,612,230 patient days, of which 7,595,273 sit on the 251 reports that break days out by payer, which is what the payer table below divides by. Every line carries the number of reports behind it, and a line standing on fewer than 20 reports is not ranked. Operating expense is the cost report’s own operating line. Net income also counts income and expense outside patient care, such as investment income, rentals and donations, which is why it is not patient revenue minus that line.
Medicaid Rate Snapshot
$385
Kentucky average daily rate
$380
statewide median
Kentucky carries a median Medicaid daily rate of $380 across 236 rated facilities, 88 percent of the buildings we track in the state, with the middle half of the market between $355 and $412 a day. The distribution is tight, which usually means a cost-capped methodology holding most buildings in a band. For-profit buildings run $13 a day above non-profit ones ($382 against $369 at the median), a gap that reflects the class each sits in rather than the quality of the building. Rates are effective July 2026.
Percentile
Medicaid daily rate
10th
$338
25th
$355
Median (50th)
$380
75th
$412
90th
$440
Range $288 to $515 across 236 rated facilities; rates effective July 2026.
CMS Ownership Analytics · 267 KY SNFs
Ownership
Facilities
Avg ★
Staffing ★
Nurse turnover
1★ / 5★
CMS fines
For-Profit
221
2.87
2.46
47%
51 / 36
$3.0M
Non-Profit
40
3.45
4.00
44%
8 / 13
$1.0M
Government
6
4.17
5.00
29%
0 / 3
$72K
Kentucky skilled nursing is 83 percent for-profit by facility count: 221 of 267 buildings, averaging 2.87 stars overall and 2.46 on staffing. The balance is 40 non-profit, 6 government. Government buildings rate highest at 4.17 stars and for-profit lowest at 2.87. Ownership type as CMS records it describes the license holder. The real estate behind it is frequently a different party, and that is the layer we resolve.
Quality, Staffing & Distress Signals
39%
rated one or two stars
6
special focus / candidate
Kentucky averages 2.98 stars overall across 267 facilities and 25,400 licensed beds. Average occupancy runs 86 percent, which is the number that decides whether a building services its debt. Quality splits at the bottom: 104 facilities (39 percent) rate one or two stars overall, 59 of them one star. Special Focus status or candidacy covers 6 of them. CMS fines on the current record total $4.1M across 90 facilities. Total nurse turnover averages 46.4 percent. Counting any facility that carries at least one of a one- or two-star overall rating, Special Focus status or candidacy, CMS fines on the current record, or a distressed-title flag from county records, 134 of 267 buildings show a distress signal, 50 percent of the total.
Where the Beds Are
County
Facilities
Licensed beds
Jefferson
39
4,024
Fayette
12
1,303
Kenton
8
769
Daviess
7
653
Hardin
7
602
Hopkins
7
590
Warren
7
567
Whitley
5
534
Market Structure
53%
run by the eight largest groups
47%
run by everyone else
The eight largest operating groups run 141 of Kentucky's 267 skilled nursing facilities, 53 percent of the state and 51 percent of its licensed beds. The remaining 126 buildings are spread across a long tail of smaller operators and independents.
Operating scale is not the same as real-estate ownership, and in most markets the two are separate. The property behind these portfolios is held across a far larger and more fragmented set of owners, many of them holding a single building outright. That is the layer we resolve, and it is why a market that looks consolidated from the operating side is usually anything but from the ownership side.
Hospital Discharge Demand
32,655
SNF-relevant discharges (minimum)
57
reporting hospitals
Kentucky's 57 reporting hospitals discharged at least 32,655 traditional-Medicare inpatients in the diagnosis groups that most often need skilled care afterward, in federal fiscal 2024. Sepsis leads at 10,469 discharges. Every one of these patients needed a next setting, and the facilities positioned closest to the highest-volume hospitals see that demand first.
Condition
Discharges (at least)
Sepsis
10,469
Heart failure
5,023
Pneumonia
3,843
Urinary tract infection
2,836
Respiratory infection
2,655
Kidney failure
2,613
Stroke
2,055
COPD
1,475
Hip & femur surgery
1,238
Hip & knee replacement
448
Hospital
SNF-relevant discharges
30-day HF readmissions
NORTON HOSPITALS, INC · LOUISVILLE
4,046
21.7%
BAPTIST HEALTH LOUISVILLE · LOUISVILLE
2,736
20.8%
BAPTIST HEALTH LEXINGTON · LEXINGTON
1,569
22.3%
BAPTIST HEALTH HARDIN · ELIZABETHTOWN
1,478
18.9%
ST ELIZABETH EDGEWOOD · EDGEWOOD
1,440
19.7%
KING'S DAUGHTERS' MEDICAL CENTER · ASHLAND
1,400
21.8%
UNIVERSITY OF KENTUCKY HOSPITAL · LEXINGTON
1,208
21.6%
OWENSBORO HEALTH REGIONAL HOSPITAL · OWENSBORO
1,198
21.4%
UOFL HEALTH - JEWISH HOSPITAL and Mary & Elizabeth Hospital · LOUISVILLE
1,159
21.2%
THE MEDICAL CENTER (BOWLING GREEN) · BOWLING GREEN
1,140
19.2%
Traditional Medicare discharges, federal fiscal 2024, in the diagnosis groups that most often discharge to skilled care. CMS withholds any line under 11 discharges, so every figure is a minimum. Readmission rates: CMS Care Compare, three-year window; n/a means CMS reports too few cases.
Medicare Readmission Penalty
86%
of graded facilities are cut this year
1.1%
average cut across the graded set
223 of Kentucky's 259 graded skilled nursing facilities (86%) are taking a live Medicare payment cut this federal fiscal year under CMS's SNF Value-Based Purchasing program, which blends readmissions, infections, staffing and turnover into one multiplier and applies it to every Medicare day a building bills. The graded set averages a 1.1% cut across the whole state. A federal number like that says little read alone, which is why we check it against the fuller financial and operational record we hold on every building before it reaches a report: the buildings already under pressure elsewhere are the ones a payment cut actually threatens.
CMS SNF Value-Based Purchasing, FY2026 determination, published February 2026. The multiplier blends readmissions, infections, staffing and turnover and applies to every Medicare day a facility bills; below 1.0 is a live payment cut, not a one-time fine.
Medicare Advantage Penetration
55.5%
of the state's Medicare population is in Medicare Advantage plans
Medicare Advantage now covers 55.5% of Kentucky's Medicare population, as of April 2026. That is up 4.2 points in three years. Breathitt County runs highest in the state at 72.5%. An MA member typically draws fewer skilled-nursing days per admission than traditional Medicare, so the counties at the top of that list are the ones structurally losing SNF days first, whatever the raw discharge count says.
County
Medicare Advantage share
Breathitt County
72.5%
Elliott County
72.3%
Leslie County
71.9%
Clay County
71.9%
Wolfe County
70.9%
Morgan County
70.2%
Magoffin County
70.0%
Lee County
69.9%
CMS Medicare Monthly Enrollment, county grain, April 2026. An MA member typically draws fewer skilled-nursing days per admission than traditional Medicare, so a rising share is a structural headwind on SNF demand, not a one-quarter blip.
Market Observations
Beds concentrate where the population does: Jefferson County with 39 facilities and 4,024 beds, Fayette County with 12 facilities and 1,303 beds, Kenton County with 8 facilities and 769 beds.
Legislative & Regulatory Watch
In effect
Federal: Staffing Mandate (Oct 2026)
Operator implication: Staffing floors bind hardest on buildings already below the state average on hours per resident, which is where distressed sales start.
Under Kentucky's reimbursement methodology, the temporary nursing-facility per-diem add-on is being ratcheted down: from $39.84 (Jul-Dec 2025) to $38.25 (Jan-Jun 2026) to $36.66 (Jul-Dec 2026), shaving roughly $3+ per Medicaid day off NF revenue over the year. The cut sits on top of the new price-based methodology rather than the rebased standard price itself.
Operator implication: Reimbursement is the single largest line in a nursing facility's revenue, so a rate move of any size resets valuation across the whole state.
OBBBA (signed Jul 4, 2025) freezes/phases down Medicaid provider taxes (with an NF/ICF carve-out below 6%), caps and cuts state directed payments starting 2028, and imposes work-reporting requirements from Dec 31, 2026 projected to drop ~149,000 Kentuckians from Medicaid. Fewer covered patients and squeezed state Medicaid financing are net negatives for SNF payer mix and rates, despite the nursing-facility provider-t
Operator implication: Federal rules reach every building in the country, so the effect shows up in the same quarter across the entire portfolio.
Kentucky surveyors issued 41 Immediate Jeopardy citations across 30 facilities in 2025, led by F689 (accidents) with an uptick in F600/F607 abuse-and-neglect tags. Heightened survey enforcement raises compliance costs, civil money penalty exposure, and liability risk for Kentucky SNF operators.
Operator implication: Survey and enforcement changes move the risk of citation and fines, which lenders and buyers price directly.
If a county-level Kentucky breakdown, or the ownership and capital-structure detail behind any facility in it, would be useful, a short confidential conversation is the fastest way to get it. There is no cost and no obligation, and the buyer you select covers our fee.
CMS Provider Information / Care Compare: facility counts, licensed beds, occupancy, Five-Star ratings, staffing, nurse turnover, fines and Special Focus status, processed 2026-09-01.
CMS Payroll-Based Journal: nurse staffing hours and turnover.
Federal ownership filings: PECOS Form 855A indirect-owner tree and HCRIS cost-report related parties.
County property and mortgage records via the 3G real-estate-ownership resolution layer.
3G Healthcare Real Estate proprietary warehouse, resolved as of the date shown above.
Kentucky published Medicaid nursing-facility rate files: 236 rated facilities, effective July 2026.
State and federal legislative and regulatory tracking via the 3G intelligence scan, with the source for each item linked in that section.
CMS Medicare inpatient claims (fiscal 2024): hospital discharge volumes by diagnosis group, traditional Medicare only; CMS withholds lines under 11 discharges, so volumes are minimums. Readmission rates from CMS Care Compare's three-year measure window.
CMS SNF Value-Based Purchasing facility-level file, FY2026 determination (published February 2026): readmission, infection, staffing and turnover measures rolled into one Medicare payment multiplier per facility.
CMS Medicare Monthly Enrollment: Medicare Advantage penetration by county, April 2026.
Medicare cost reports (CMS HCRIS), FY2024 to FY2026: 252 filings from 252 Kentucky skilled nursing facilities, one full-year report each, loaded 2026-10-06. Occupancy, patient days by payer, patient revenue, operating expense and net income as each facility filed them.
3G Healthcare Real Estate is a brokerage firm specializing exclusively in skilled
nursing facility real estate. We do not provide legal, financial, or tax advice.
3G Healthcare Real Estate, 456 N. Meridian St #441332, Indianapolis, IN 46204.
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