In SNFRadar’s system: occupancy, staffing and rating, plus its Medicare cost report and a calculator to run its numbers.
Every Maryland 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 Maryland 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.
221
facilities
27,235
licensed beds
86%
avg occupancy
54%
showing distress
What the Cost Reports Say · FY2024 to FY2026
Seven days in ten are Medicaid.
Every full-year Medicare cost report Maryland's skilled nursing facilities filed in FY2024 to FY2026, read as one set of bands: 213 reports across 24 counties. This is the table an owner puts their own filing against.
213
cost reports read across 24 counties
88.5%
median occupancy
67.7%
of the days reported by payer were Medicaid
6.6%
median net margin, 26.6% filed a loss
Seven of every ten patient days Maryland's skilled nursing facilities billed in FY2024 to FY2026 were Medicaid days: 67.7% of the 8,224,241 patient days on the 211 reports that break days out by payer. The median building ran 88.5% occupancy, with the middle half between 78.7% and 92.2%, on 211 reports that carry it. Patient revenue ran $450 a patient day at the median against $430 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 6.6% at the median. 55 of the 207 reports that carry a bottom line filed a loss, which is 26.6% 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.
78.7%
88.5%
92.2%
211
84.2%
Medicare share of days
Traditional Medicare days as a share of all patient days, off Worksheet S-3 Part I.
10.1%
15.6%
21.0%
213
7.7%
Medicaid share of days
Medicaid days as a share of all patient days, off Worksheet S-3 Part I.
56.5%
69.7%
77.8%
211
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.
9.3%
13.1%
18.8%
211
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.
$412
$450
$498
210
$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.
$393
$430
$506
209
$372
Net income per patient day
Net income off Worksheet G-3, divided by patient days.
-$1
$32
$67
212
$14
Margin and liquidity
Net margin
Net income off Worksheet G-3 over net patient revenue off the same worksheet.
-0.4%
6.6%
12.8%
207
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 8,224,241 days on the 211 reports that break days out by payer
Median facility
Medicaid
67.7%
69.7%
Traditional Medicare
16.3%
15.6%
Everyone else, including managed care
16.0%
13.1%
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 113 of the state’s reports; on those 4,966,285 days Medicare Advantage is 4.6% and managed Medicaid 1.7%, and both sit inside the row above.
Census is not the constraint
74% of Maryland buildings closed the year at 80% occupancy or better, on the 211 reports that carry occupancy, and 27% of the 207 that carry a bottom line still filed a loss.
A $113 gap per patient day
Operating cost runs $393 a patient day at the 25th percentile against $506 at the 75th, on 209 Maryland reports. At the median building's own year of 38,054 patient days, that gap is $4.3 million a year between a lean cost structure and a heavy one.
Margin without liquidity
The median Maryland filing closed on a current ratio of 1.38, on the 196 reports that carry both sides of the balance sheet, and 35% of them closed under 1.00, which means owing more inside a year than they hold to pay it with. Only 27% 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: 213 reports covering 8,230,635 patient days, of which 8,224,241 sit on the 211 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 Context
Maryland does not publish facility-level Medicaid daily rates in a form we have been able to obtain, so there is no per-building rate picture published for this market. That absence is itself the point: without published rates most owners have no reliable way to benchmark their own building, and we maintain the comparison independently.
CMS Ownership Analytics · 221 MD SNFs
Ownership
Facilities
Avg ★
Staffing ★
Nurse turnover
1★ / 5★
CMS fines
For-Profit
182
2.94
2.88
42%
33 / 32
$4.6M
Non-Profit
35
4.29
4.51
32%
0 / 19
$196K
Government
4
4.75
4.50
26%
0 / 3
$94K
Maryland skilled nursing is 82 percent for-profit by facility count: 182 of 221 buildings, averaging 2.94 stars overall and 2.88 on staffing. The balance is 35 non-profit, 4 government. Government buildings rate highest at 4.75 stars and for-profit lowest at 2.94. 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
34%
rated one or two stars
6
special focus / candidate
Maryland averages 3.19 stars overall across 221 facilities and 27,235 licensed beds. Average occupancy runs 86 percent, which is the number that decides whether a building services its debt. Quality splits at the bottom: 76 facilities (34 percent) rate one or two stars overall, 33 of them one star. Special Focus status or candidacy covers 6 of them. CMS fines on the current record total $4.8M across 89 facilities. Total nurse turnover averages 40.2 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, 120 of 221 buildings show a distress signal, 54 percent of the total.
Where the Beds Are
County
Facilities
Licensed beds
Baltimore
43
5,179
Montgomery
34
4,633
Baltimore City
27
3,479
Prince Georges
19
2,796
Anne Arundel
14
1,596
Washington
10
998
Carroll
10
903
Frederick
8
967
Market Structure
52%
run by the eight largest groups
48%
run by everyone else
The eight largest operating groups run 115 of Maryland's 221 skilled nursing facilities, 52 percent of the state and 57 percent of its licensed beds. The remaining 106 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
51,758
SNF-relevant discharges (minimum)
43
reporting hospitals
Maryland's 43 reporting hospitals discharged at least 51,758 traditional-Medicare inpatients in the diagnosis groups that most often need skilled care afterward, in federal fiscal 2024. Sepsis leads at 18,389 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
18,389
Heart failure
8,444
Urinary tract infection
4,369
Stroke
4,338
Pneumonia
3,930
Respiratory infection
3,544
Kidney failure
3,352
COPD
2,508
Hip & femur surgery
1,973
Hip & knee replacement
911
Hospital
SNF-relevant discharges
30-day HF readmissions
LUMINIS HEALTH ANNE ARUNDEL MEDICAL CENTER, INC · ANNAPOLIS
3,680
21.1%
UMD UPPER CHESAPEAKE MEDICAL CENTER · BEL AIR
2,271
19.9%
MERITUS MEDICAL CENTER · HAGERSTOWN
2,144
20.4%
SUBURBAN HOSPITAL · BETHESDA
2,144
21.0%
MEDSTAR FRANKLIN SQUARE MEDICAL CENTER · ROSEDALE
2,120
19.4%
FREDERICK HEALTH HOSPITAL · FREDERICK
2,077
19.9%
JOHNS HOPKINS HOWARD COUNTY MEDICAL CENTER · COLUMBIA
2,045
21.7%
UNIVERSITY OF MD BALTIMORE WASHINGTON MEDICAL CENTER · GLEN BURNIE
1,991
19.0%
TIDALHEALTH PENINSULA REGIONAL, INC · SALISBURY
1,922
18.6%
CARROLL HOSPITAL CENTER · WESTMINSTER
1,653
21.3%
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
74%
of graded facilities are cut this year
0.6%
average cut across the graded set
157 of Maryland's 212 graded skilled nursing facilities (74%) 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 0.6% 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
25.0%
of the state's Medicare population is in Medicare Advantage plans
Medicare Advantage now covers 25.0% of Maryland's Medicare population, as of April 2026. That is up 3.2 points in three years. Baltimore City runs highest in the state at 36.7%. 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
Baltimore City
36.7%
Prince George'S County
31.5%
Somerset County
30.1%
Wicomico County
27.4%
Dorchester County
26.7%
Baltimore County
26.0%
Worcester County
25.7%
Charles County
25.3%
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: Baltimore County with 43 facilities and 5,179 beds, Montgomery County with 34 facilities and 4,633 beds, Baltimore City County with 27 facilities and 3,479 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.
Operator implication: Staffing floors bind hardest on buildings already below the state average on hours per resident, which is where distressed sales start.
Office of the Long-Term Care Ombudsman - Mandatory Appropriation Last action: Approved by the Governor - Chapter 762 (2026-05-26)
Operator implication: Budget language sets the reimbursement envelope for the following rate year, so it is the earliest reliable signal of where rates are heading.
Office of the Long-Term Care Ombudsman - Mandatory Appropriation Last action: Approved by the Governor - Chapter 761 (2026-05-26)
Operator implication: Budget language sets the reimbursement envelope for the following rate year, so it is the earliest reliable signal of where rates are heading.
If a county-level Maryland 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.
Maryland does not publish facility-level Medicaid rates in an obtainable form; no per-facility rate data is presented for this state.
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: 213 filings from 213 Maryland 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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