Montana Skilled Nursing - Market Intelligence

3G Healthcare Real Estate is a sell-side advisory firm working only in skilled nursing facility real estate. This report is the Montana 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.

Six of every ten patient days Montana's skilled nursing facilities billed in FY2024 to FY2025 were Medicaid days: 61.3% of the 810,379 patient days on the 38 reports that break days out by payer. The median building ran 69.2% occupancy, with the middle half between 56.1% and 77.2%, on 31 reports that carry it. Patient revenue ran $371 a patient day at the median against $394 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 4.9% at the median. 14 of the 41 reports that carry a bottom line filed a loss, which is 34.1% of them.

Montana carries a median Medicaid daily rate of $291 across 43 rated facilities, 70 percent of the buildings we track in the state, with the middle half of the market between $291 and $294 a day. The distribution is tight, which usually means a cost-capped methodology holding most buildings in a band. Non-profit buildings run $3 a day above government ones ($294 against $291 at the median), a gap that reflects the class each sits in rather than the quality of the building. Rates are effective July 2026.

Montana skilled nursing is 57 percent for-profit by facility count: 35 of 61 buildings, averaging 2.64 stars overall and 3.24 on staffing. The balance is 19 non-profit, 7 government. Government buildings rate highest at 3.57 stars and for-profit lowest at 2.64. The 7 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.

Montana averages 2.88 stars overall across 61 facilities and 4,997 licensed beds. Average occupancy runs 68 percent, which is the number that decides whether a building services its debt. Quality splits at the bottom: 28 facilities (46 percent) rate one or two stars overall, 13 of them one star. Special Focus status or candidacy covers 6 of them. CMS fines on the current record total $3.4M across 42 facilities. Total nurse turnover averages 54.8 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, 44 of 61 buildings show a distress signal, 72 percent of the total.

The six largest operating groups run 29 of Montana's 61 skilled nursing facilities, 48 percent of the state and 56 percent of its licensed beds. The remaining 32 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.

Montana's 10 reporting hospitals discharged at least 6,412 traditional-Medicare inpatients in the diagnosis groups that most often need skilled care afterward, in federal fiscal 2024. Sepsis leads at 2,392 discharges. Every one of these patients needed a next setting, and the facilities positioned closest to the highest-volume hospitals see that demand first.

38 of Montana's 49 graded skilled nursing facilities (78%) 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.

Medicare Advantage now covers 29.9% of Montana's Medicare population, as of April 2026. That is up 2.3 points in three years. Lincoln County runs highest in the state at 41.7%. 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.

Beds concentrate where the population does: Yellowstone County with 7 facilities and 894 beds, Flathead County with 6 facilities and 610 beds, Silver Bow County with 4 facilities and 449 beds.

1. 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.
2. CMS Payroll-Based Journal: nurse staffing hours and turnover.
3. Federal ownership filings: PECOS Form 855A indirect-owner tree and HCRIS cost-report related parties.
4. County property and mortgage records via the 3G real-estate-ownership resolution layer.
5. 3G Healthcare Real Estate proprietary warehouse, resolved as of the date shown above.
6. Montana published Medicaid nursing-facility rate files: 43 rated facilities, effective July 2026.
7. State and federal legislative and regulatory tracking via the 3G intelligence scan, with the source for each item linked in that section.
8. 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.
9. 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.
10. CMS Medicare Monthly Enrollment: Medicare Advantage penetration by county, April 2026.
11. Medicare cost reports (CMS HCRIS), FY2024 to FY2025: 43 filings from 43 Montana 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.