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Every Minnesota 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 Minnesota 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.
338
facilities
24,057
licensed beds
85%
avg occupancy
57%
showing distress
What the Cost Reports Say · FY2024 to FY2026
The beds are full. The margin is the question.
Every full-year Medicare cost report Minnesota's skilled nursing facilities filed in FY2024 to FY2026, read as one set of bands: 283 reports across 78 counties. This is the table an owner puts their own filing against.
283
cost reports read across 78 counties
85.2%
median occupancy
52.3%
of the days reported by payer were Medicaid
3.8%
median net margin, 36.0% filed a loss
Five of every ten patient days Minnesota's skilled nursing facilities billed in FY2024 to FY2026 were Medicaid days: 52.3% of the 6,218,834 patient days on the 281 reports that break days out by payer. The median building ran 85.2% occupancy, with the middle half between 74.2% and 91.2%, on 281 reports that carry it. Patient revenue ran $440 a patient day at the median against $482 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 3.8% at the median. 100 of the 278 reports that carry a bottom line filed a loss, which is 36.0% 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.
74.2%
85.2%
91.2%
281
84.2%
Medicare share of days
Traditional Medicare days as a share of all patient days, off Worksheet S-3 Part I.
4.7%
6.9%
9.6%
283
7.7%
Medicaid share of days
Medicaid days as a share of all patient days, off Worksheet S-3 Part I.
38.9%
53.0%
63.1%
281
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.
30.7%
39.9%
50.8%
281
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.
$400
$440
$501
283
$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.
$409
$482
$565
282
$372
Net income per patient day
Net income off Worksheet G-3, divided by patient days.
-$11
$17
$45
282
$14
Margin and liquidity
Net margin
Net income off Worksheet G-3 over net patient revenue off the same worksheet.
-2.6%
3.8%
9.3%
278
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 6,218,834 days on the 281 reports that break days out by payer
Median facility
Medicaid
52.3%
53.0%
Traditional Medicare
7.8%
6.9%
Everyone else, including managed care
39.9%
39.9%
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 102 of the state’s reports; on those 2,298,971 days Medicare Advantage is 9.9% and managed Medicaid 3.3%, and both sit inside the row above.
Urban against rural, at the median
Urban (171)
Rural (112)
Occupancy
86.0%
82.6%
Medicaid share of days
53.0%
53.4%
Patient revenue per patient day
$442
$433
Operating expense per patient day
$480
$485
Net margin
3.5%
4.7%
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 Minnesota buildings closed the year at 80% occupancy or better, on the 281 reports that carry occupancy, and 36% of the 278 that carry a bottom line still filed a loss.
A $156 gap per patient day
Operating cost runs $409 a patient day at the 25th percentile against $565 at the 75th, on 282 Minnesota reports. At the median building's own year of 18,888 patient days, that gap is $2.9 million a year between a lean cost structure and a heavy one.
The balance sheet holds
The median Minnesota filing closed on a current ratio of 2.01, on the 267 reports that carry both sides of the balance sheet, and 28% of them closed under 1.00, which means owing more inside a year than they hold to pay it with. Only 36% 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 2026-06-30, one full-year report per facility: 283 reports covering 6,332,200 patient days, of which 6,218,834 sit on the 281 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
Minnesota 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 · 338 MN SNFs
Ownership
Facilities
Avg ★
Staffing ★
Nurse turnover
1★ / 5★
CMS fines
Non-Profit
210
3.49
4.39
41%
29 / 69
$4.7M
For-Profit
103
2.38
3.65
46%
32 / 12
$3.4M
Government
25
3.52
4.12
37%
3 / 8
$144K
Minnesota skilled nursing is 62 percent non-profit by facility count: 210 of 338 buildings, averaging 3.49 stars overall and 4.39 on staffing. The balance is 103 for-profit, 25 government. Government buildings rate highest at 3.52 stars and for-profit lowest at 2.38. 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
Minnesota averages 3.16 stars overall across 338 facilities and 24,057 licensed beds. Average occupancy runs 85 percent, which is the number that decides whether a building services its debt. Quality splits at the bottom: 125 facilities (37 percent) rate one or two stars overall, 64 of them one star. Special Focus status or candidacy covers 12 of them. CMS fines on the current record total $8.3M across 143 facilities. Total nurse turnover averages 42.2 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, 191 of 338 buildings show a distress signal, 57 percent of the total.
Where the Beds Are
County
Facilities
Licensed beds
Hennepin
54
5,544
Ramsey
28
2,476
St. Louis
17
1,155
Dakota
9
867
Stearns
9
620
Washington
8
656
Olmsted
8
542
Otter Tail
7
492
Market Structure
40%
run by the eight largest groups
60%
run by everyone else
The eight largest operating groups run 136 of Minnesota's 338 skilled nursing facilities, 40 percent of the state and 41 percent of its licensed beds. The remaining 202 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
25,786
SNF-relevant discharges (minimum)
44
reporting hospitals
Minnesota's 44 reporting hospitals discharged at least 25,786 traditional-Medicare inpatients in the diagnosis groups that most often need skilled care afterward, in federal fiscal 2024. Sepsis leads at 8,927 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
8,927
Heart failure
4,342
Respiratory infection
2,237
Pneumonia
2,178
Stroke
2,105
Urinary tract infection
1,566
Kidney failure
1,525
Hip & femur surgery
1,395
Hip & knee replacement
891
COPD
620
Hospital
SNF-relevant discharges
30-day HF readmissions
MAYO CLINIC HOSPITAL ROCHESTER · ROCHESTER
2,498
19.8%
MERCY HOSPITAL · COON RAPIDS
1,744
20.1%
PARK NICOLLET METHODIST HOSPITAL · SAINT LOUIS PARK
1,614
22.9%
CENTRACARE - ST. CLOUD HOSPITAL · SAINT CLOUD
1,469
20.0%
ABBOTT NORTHWESTERN HOSPITAL · MINNEAPOLIS
1,392
18.7%
ALLINA UNITED HOSPITAL · SAINT PAUL
1,377
20.2%
REGIONS HOSPITAL · SAINT PAUL
1,317
19.4%
ESSENTIA HEALTH ST MARY'S MEDICAL CENTER · DULUTH
1,316
20.2%
M HEALTH FAIRVIEW SOUTHDALE HOSPITAL · EDINA
1,132
18.9%
ST LUKES HOSPITAL · DULUTH
1,072
23.8%
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
49%
of graded facilities are cut this year
0.2%
average raise across the graded set
148 of Minnesota's 303 graded skilled nursing facilities (49%) 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 0.2% raise 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
56.7%
of the state's Medicare population is in Medicare Advantage plans
Medicare Advantage now covers 56.7% of Minnesota's Medicare population, as of April 2026. That is down 0.8 points in three years. Mcleod County runs highest in the state at 71.6%. 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
Mcleod County
71.6%
Meeker County
70.6%
Sibley County
68.6%
Le Sueur County
68.3%
Aitkin County
66.8%
Goodhue County
65.7%
Lake County
65.5%
Rice County
64.8%
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: Hennepin County with 54 facilities and 5,544 beds, Ramsey County with 28 facilities and 2,476 beds, St. Louis County with 17 facilities and 1,155 beds.
Legislative & Regulatory Watch
Active / watch
Minnesota: Medicaid Rate (May 2026)
Calculation of border city nursing facility rate adjustments clarified. Last action: Introduction and first reading, referred to Human Services Finance and Policy (2026-05-11)
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.
Calculation clarification of border city nursing facility rate adjustments Last action: Referred to Human Services (2026-04-09)
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.
Red Lake Nation nursing home improvements appropriation Last action: Referred to Capital Investment (2026-03-25)
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.
City of Ely nursing facility onetime rate add-on provision and appropriation Last action: Referred to Human Services (2026-03-18)
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 Minnesota 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.
Minnesota 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: 283 filings from 283 Minnesota 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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