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, 14,693 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, eleven states' July files have posted and are loaded in our warehouse: Georgia, Illinois, Indiana, Kansas, Mississippi, Nebraska, Oklahoma, South Dakota, Utah, Washington, and West Virginia. Illinois repriced 636 facilities. The median rate rose 0.7 percent; 368 facilities took raises and 206 took cuts, with the largest single move a raise of just over 20 percent. Indiana repriced 479 facilities. The median rate rose 2.5 percent; 354 facilities took raises and 124 took cuts, with the largest single move a raise of just over 20 percent. Georgia repriced 343 facilities. The median rate rose 2.1 percent; 211 facilities took raises and 129 took cuts, with the largest single move a cut of just over 34 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. Kansas repriced 280 facilities. The median rate rose 2.3 percent; 186 facilities took raises and 88 took cuts, with the largest single move a raise of just over 25 percent. Washington repriced 174 facilities. The median rate held flat; 72 facilities took raises and one took a cut, with the largest single move a raise of just over 28 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 60 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 81 facilities. The median rate rose 2.4 percent; 62 facilities took raises and 6 took cuts, with the largest single move a raise of just over 6 percent.

The national market is 73 percent for-profit: 10,860 of 14,693 facilities, averaging 2.81 stars overall with a 2.63 staffing rating, and carrying $388.3M of the $464.2M in CMS fines outstanding nationally. The 2,886 non-profits rate materially higher at 3.58 stars with a 3.84 staffing rating. Government ownership, 947 facilities, is dominated by county homes and hospital-district structures in which the license sits public while the real estate is often privately held.

41 percent of facilities nationally, 5,965 of 14,693, rate one or two stars overall against a 2.99-star national average. Average occupancy runs 80 percent, and 528 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, 8,446 of 14,693 buildings show a distress signal, 57 percent of the total.

The ten largest operating groups run 1,744 of the country's 14,693 skilled nursing facilities, 12 percent of the national market and 12 percent of its licensed beds. The remaining 12,949 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 14,693-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: Georgia, Illinois, Indiana, Kansas, Mississippi, Nebraska, Oklahoma, South Dakota, Utah, Washington, and West Virginia.
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.