U.S. Skilled Nursing · National Market Intelligence

3G Healthcare Real Estate is a sell-side advisory firm working only in skilled nursing facility real estate. This report is the national ownership and operating picture as we track it, drawn from CMS Provider Information, federal ownership filings, state Medicaid rate files, and county property records, current as of the date shown above.

Every figure below describes the United States skilled nursing market in aggregate, 14,690 facilities across all fifty states, the District of Columbia, and the territories; nothing here is specific to any single owner or property.

Medicaid rate cycles turn over on July 1 in much of the country, and the July 2026 files are posting now. As of this report, 28 states' July files have posted and are loaded in our warehouse: Colorado, Florida, Georgia, Hawaii, Iowa, Idaho, Illinois, Indiana, Kansas, Kentucky, Massachusetts, Mississippi, Montana, North Carolina, Nebraska, New Hampshire, New Jersey, Nevada, Ohio, Oklahoma, Pennsylvania, South Dakota, Utah, Vermont, Washington, Wisconsin, West Virginia, and Wyoming. Ohio repriced 912 facilities. The median rate fell 1.0 percent; 360 facilities took raises and 526 took cuts, with the largest single move a raise of just over 32 percent. Illinois repriced 667 facilities. The median rate fell 0.8 percent; 222 facilities took raises and 395 took cuts, with the largest single move a cut of just over 19 percent. Florida repriced 663 facilities. The median rate fell 0.8 percent; 237 facilities took raises and 321 took cuts, with the largest single move a raise of just over 47 percent. Pennsylvania repriced 597 facilities. The median rate fell 1.5 percent; 185 facilities took raises and 395 took cuts, with the largest single move a raise of just over 26 percent. Indiana repriced 479 facilities. The median rate rose 2.5 percent; 353 facilities took raises and 125 took cuts, with the largest single move a raise of just over 20 percent. North Carolina repriced 425 facilities. The median rate rose 1.9 percent; 357 facilities took raises and 11 took cuts, with the largest single move a raise of just over 49 percent. Iowa repriced 390 facilities. The median rate fell 0.4 percent; 141 facilities took raises and 209 took cuts, with the largest single move a raise of just over 173 percent. Wisconsin repriced 365 facilities. The median rate rose 4.6 percent; 267 facilities took raises and 32 took cuts, with the largest single move a raise of just over 47 percent. Georgia repriced 348 facilities. The median rate rose 0.1 percent; 174 facilities took raises and 172 took cuts, with the largest single move a raise of just over 30 percent. Massachusetts repriced 330 facilities. The median rate rose 0.8 percent; 190 facilities took raises and 108 took cuts, with the largest single move a cut of just over 49 percent. New Jersey repriced 318 facilities. The median rate rose 0.1 percent; 197 facilities took raises and 117 took cuts, with the largest single move a raise of just over 6 percent. Kansas repriced 287 facilities. The median rate rose 2.3 percent; 191 facilities took raises and 90 took cuts, with the largest single move a raise of just over 25 percent. Oklahoma's July file posted for 283 facilities. It enters our file as the baseline cycle, so no prior-period comparison is published yet. Kentucky repriced 253 facilities. The median rate rose 1.7 percent; 176 facilities took raises and 69 took cuts, with the largest single move a raise of just over 31 percent. Colorado repriced 189 facilities. The median rate fell 2.2 percent; 60 facilities took raises and 111 took cuts, with the largest single move a cut of just over 25 percent. Washington repriced 185 facilities. The median rate held flat; 2 facilities took raises and none took cuts, with the largest single move a raise of just over 3 percent. Nebraska repriced 172 facilities. The median rate rose 1.3 percent; one facility took a raise and none took cuts, with the largest single move a raise of just over 1 percent. Mississippi repriced 167 facilities. The median rate held flat; 40 facilities took raises and 61 took cuts, with the largest single move a raise of just over 4 percent. West Virginia repriced 118 facilities. The median rate rose 3.3 percent; 101 facilities took raises and 17 took cuts, with the largest single move a raise of just over 19 percent. South Dakota repriced 89 facilities. The median rate rose 1.4 percent; 88 facilities took raises and none took cuts, with the largest single move a raise of just over 2 percent. Utah repriced 84 facilities. The median rate rose 0.1 percent; 52 facilities took raises and 32 took cuts, with the largest single move a cut of just over 12 percent. Idaho repriced 75 facilities. The median rate fell 0.5 percent; 27 facilities took raises and 39 took cuts, with the largest single move a cut of just over 14 percent. New Hampshire repriced 70 facilities. The median rate rose 2.2 percent; 53 facilities took raises and 15 took cuts, with the largest single move a raise of just over 11 percent. Montana repriced 59 facilities. The median rate rose 3.0 percent; 48 facilities took raises and none took cuts, with the largest single move a raise of just over 5 percent. Nevada repriced 50 facilities. The median rate rose 0.0 percent; 25 facilities took raises and 24 took cuts, with the largest single move a cut of just over 15 percent. Hawaii repriced 36 facilities. The median rate rose 0.7 percent; 23 facilities took raises and 13 took cuts, with the largest single move a cut of just over 6 percent. Vermont repriced 32 facilities. The median rate rose 3.7 percent; 22 facilities took raises and 2 took cuts, with the largest single move a raise of just over 10 percent. Wyoming repriced 32 facilities. The median rate fell 0.1 percent; 15 facilities took raises and 17 took cuts, with the largest single move a cut of just over 5 percent.

Michigan has already posted its next statewide ceiling update: Class I and Class III variable-cost limits rise 2.1 and 1.8 percent, effective September 30, 2026.

The national market is 74 percent for-profit: 10,875 of 14,690 facilities, averaging 2.81 stars overall with a 2.64 staffing rating, and carrying $379.8M of the $455.0M in CMS fines outstanding nationally. The 2,859 non-profits rate materially higher at 3.58 stars with a 3.86 staffing rating. Government ownership, 956 facilities, is dominated by county homes and hospital-district structures in which the license sits public while the real estate is often privately held.

40 percent of facilities nationally, 5,912 of 14,690, rate one or two stars overall against a 2.99-star national average. Average occupancy runs 80 percent, and 527 facilities sit on the Special Focus list or its candidate pool. 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, 8,360 of 14,690 buildings show a distress signal, 57 percent of the total.

The ten largest operating groups run 1,723 of the country's 14,690 skilled nursing facilities, 12 percent of the national market and 12 percent of its licensed beds. The remaining 12,967 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.

That concentration is increasing rather than holding steady. The largest operators have each added double-digit numbers of operations so far this year, one multi-state portfolio of roughly 3,600 beds changed operators in a single announced transaction this summer, and a top-five operator is exiting the business through a billion-dollar bankruptcy sale whose facility-by-facility license transfers are in motion now. CMS chain data lags all of it until each transfer is recorded, so the concentration above reads slightly low.

This is a 14,690-facility, 1.57-million-bed market with no dominant landlord.

Quality and financial stress track together. Where staffing ratings sit lowest and turnover highest, distress flags and CMS fines concentrate, and that is where ownership turns over fastest. The July Medicaid cycle is the single most important repricing event of the year for most of these buildings, which is why we publish the watch above and track every file as it lands.

Public comparables remain thin across much of the country; many states disclose neither facility-level rates nor sale prices. We maintain ownership, transaction history, and capital structure on every skilled nursing facility in the country, and we work only in this asset class.

1. CMS Provider Information / Care Compare (facility counts, Five-Star ratings, occupancy, staffing, fines, Special Focus status), 2026 refresh.
2. CMS Payroll-Based Journal (nurse staffing hours and turnover).
3. Federal ownership filings (PECOS Form 855A indirect-owner tree; HCRIS cost-report related parties).
4. State Medicaid nursing-facility rate files, loaded per state as each cycle posts. July 2026 cycle loaded as of this report: Colorado, Florida, Georgia, Hawaii, Iowa, Idaho, Illinois, Indiana, Kansas, Kentucky, Massachusetts, Mississippi, Montana, North Carolina, Nebraska, New Hampshire, New Jersey, Nevada, Ohio, Oklahoma, Pennsylvania, South Dakota, Utah, Vermont, Washington, Wisconsin, West Virginia, and Wyoming.
5. County property and mortgage records via the 3G real-estate-ownership resolution layer.
6. 3G Healthcare Real Estate proprietary warehouse, resolved as of July 2026.