In SNFRadar’s system: occupancy, staffing and rating, plus its Medicare cost report and a calculator to run its numbers.
Every Michigan 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 Michigan 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.
422
facilities
44,006
licensed beds
82%
avg occupancy
52%
showing distress
What the Cost Reports Say · FY2024 to FY2026
43% of the filings show a loss on patient care.
Every full-year Medicare cost report Michigan's skilled nursing facilities filed in FY2024 to FY2026, read as one set of bands: 402 reports across 77 counties. This is the table an owner puts their own filing against.
402
cost reports read across 77 counties
86.2%
median occupancy
63.6%
of the days reported by payer were Medicaid
1.2%
median net margin, 43.3% filed a loss
Six of every ten patient days Michigan's skilled nursing facilities billed in FY2024 to FY2026 were Medicaid days: 63.6% of the 12,676,263 patient days on the 399 reports that break days out by payer. The median building ran 86.2% occupancy, with the middle half between 75.2% and 91.9%, on 396 reports that carry it. Patient revenue ran $388 a patient day at the median against $406 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 1.2% at the median. 174 of the 402 reports that carry a bottom line filed a loss, which is 43.3% 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.
75.2%
86.2%
91.9%
396
84.2%
Medicare share of days
Traditional Medicare days as a share of all patient days, off Worksheet S-3 Part I.
3.7%
5.9%
9.9%
400
7.7%
Medicaid share of days
Medicaid days as a share of all patient days, off Worksheet S-3 Part I.
51.3%
64.2%
74.5%
401
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.
20.5%
28.9%
38.9%
399
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.
$353
$388
$450
401
$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.
$359
$406
$485
400
$372
Net income per patient day
Net income off Worksheet G-3, divided by patient days.
-$17
$4
$30
401
$14
Margin and liquidity
Net margin
Net income off Worksheet G-3 over net patient revenue off the same worksheet.
-4.5%
1.2%
6.9%
402
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 12,676,263 days on the 399 reports that break days out by payer
Median facility
Medicaid
63.6%
64.2%
Traditional Medicare
7.3%
5.9%
Everyone else, including managed care
29.1%
28.9%
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 157 of the state’s reports; on those 5,689,854 days Medicare Advantage is 10.9% and managed Medicaid 8.2%, and both sit inside the row above.
Urban against rural, at the median
Urban (300)
Rural (102)
Occupancy
87.3%
84.1%
Medicaid share of days
63.4%
65.9%
Patient revenue per patient day
$397
$376
Operating expense per patient day
$414
$389
Net margin
1.2%
1.1%
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.
Census is not the constraint
64% of Michigan buildings closed the year at 80% occupancy or better, on the 396 reports that carry occupancy, and 43% of the 402 that carry a bottom line still filed a loss.
A $126 gap per patient day
Operating cost runs $359 a patient day at the 25th percentile against $485 at the 75th, on 400 Michigan reports. At the median building's own year of 29,859 patient days, that gap is $3.8 million a year between a lean cost structure and a heavy one.
Margin without liquidity
The median Michigan filing closed on a current ratio of 1.13, on the 362 reports that carry both sides of the balance sheet, and 43% of them closed under 1.00, which means owing more inside a year than they hold to pay it with. Only 43% 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 2024-06-30 to 2026-03-31, one full-year report per facility: 402 reports covering 12,697,290 patient days, of which 12,676,263 sit on the 399 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
Michigan 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 · 422 MI SNFs
Ownership
Facilities
Avg ★
Staffing ★
Nurse turnover
1★ / 5★
CMS fines
For-Profit
323
2.91
3.34
46%
62 / 56
$10.8M
Non-Profit
61
3.85
4.23
37%
8 / 32
$474K
Government
38
3.84
4.42
40%
2 / 16
$1.1M
Michigan skilled nursing is 77 percent for-profit by facility count: 323 of 422 buildings, averaging 2.91 stars overall and 3.34 on staffing. The balance is 61 non-profit, 38 government. Non-Profit buildings rate highest at 3.85 stars and for-profit lowest at 2.91. The 38 government-owned buildings are a structural feature worth reading carefully: in most states these are county or hospital-district arrangements in which a public body holds the license while the real estate sits with a private party. 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
37%
rated one or two stars
12
special focus / candidate
Michigan averages 3.13 stars overall across 422 facilities and 44,006 licensed beds. Average occupancy runs 82 percent, which is the number that decides whether a building services its debt. Quality splits at the bottom: 156 facilities (37 percent) rate one or two stars overall, 72 of them one star. Special Focus status or candidacy covers 12 of them. CMS fines on the current record total $12.4M across 157 facilities. Total nurse turnover averages 44.1 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, 221 of 422 buildings show a distress signal, 52 percent of the total.
Where the Beds Are
County
Facilities
Licensed beds
Wayne
63
8,194
Oakland
43
4,842
Macomb
30
4,246
Kent
27
2,350
Genesee
15
1,773
Saginaw
11
1,027
Ottawa
11
802
Ingham
9
1,069
Market Structure
52%
run by the eight largest groups
48%
run by everyone else
The eight largest operating groups run 218 of Michigan's 422 skilled nursing facilities, 52 percent of the state and 56 percent of its licensed beds. The remaining 204 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
52,307
SNF-relevant discharges (minimum)
86
reporting hospitals
Michigan's 86 reporting hospitals discharged at least 52,307 traditional-Medicare inpatients in the diagnosis groups that most often need skilled care afterward, in federal fiscal 2024. Sepsis leads at 16,631 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
16,631
Heart failure
9,583
Pneumonia
4,869
Kidney failure
4,094
Respiratory infection
4,093
Urinary tract infection
4,062
Stroke
3,561
COPD
2,214
Hip & femur surgery
2,040
Hip & knee replacement
1,160
Hospital
SNF-relevant discharges
30-day HF readmissions
BEAUMONT HOSPITAL, TROY · TROY
2,836
21.5%
BEAUMONT HOSPITAL ROYAL OAK · ROYAL OAK
2,556
21.2%
TRINITY HEALTH ANN ARBOR HOSPITAL · ANN ARBOR
2,172
20.5%
SPECTRUM HEALTH · GRAND RAPIDS
1,869
17.9%
ASCENSION PROVIDENCE HOSPITAL, SOUTHFIELD AND NOVI · SOUTHFIELD
1,704
21.1%
HENRY FORD MACOMB HOSPITAL · CLINTON TOWNSHIP
1,534
19.8%
UNIVERSITY OF MICHIGAN HEALTH SYSTEM · ANN ARBOR
1,449
19.2%
ST JOE MERCY HOSPITAL SYSTEM LIVONIA · LIVONIA
1,382
21.7%
COVENANT MEDICAL CENTER · SAGINAW
1,369
21.7%
TRINITY HEALTH OAKLAND HOSPITAL · PONTIAC
1,244
19.5%
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
76%
of graded facilities are cut this year
0.7%
average cut across the graded set
304 of Michigan's 401 graded skilled nursing facilities (76%) 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 0.7% 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
63.7%
of the state's Medicare population is in Medicare Advantage plans
Medicare Advantage now covers 63.7% of Michigan's Medicare population, as of April 2026. That is up 5.0 points in three years. Newaygo County runs highest in the state at 77.5%. 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
Newaygo County
77.5%
Ottawa County
77.3%
Muskegon County
75.4%
Ionia County
74.2%
Allegan County
73.5%
Kent County
73.5%
Clinton County
71.2%
Lake County
71.0%
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: Wayne County with 63 facilities and 8,194 beds, Oakland County with 43 facilities and 4,842 beds, Macomb County with 30 facilities and 4,246 beds.
Legislative & Regulatory Watch
In effect
Michigan: Medicaid Rates (effective October 1, 2026)
Michigan's published Medicaid schedule raises 4 statewide ancillary rates by 1.2% to 4.2%, effective October 1, 2026. The largest move takes the Hospital Leave Day Rate to $163.86 a day from $157.22. On the state's own site by September 25, 2026.
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. This one moves in the operator's favour.
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.
If a county-level Michigan 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.
Michigan 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: 402 filings from 402 Michigan 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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