New Hampshire 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 New Hampshire 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.

New Hampshire carries a median Medicaid daily rate of $265 across 56 rated facilities, 77 percent of the buildings we track in the state, with the middle half of the market between $250 and $271 a day. The distribution is tight, which usually means a cost-capped methodology holding most buildings in a band. For-profit buildings run $15 a day above government ones ($265 against $250 at the median), a gap that reflects the class each sits in rather than the quality of the building. Rates are effective January 2026.

New Hampshire skilled nursing is 62 percent for-profit by facility count: 45 of 73 buildings, averaging 2.61 stars overall and 2.65 on staffing. The balance is 16 non-profit, 12 government. Government buildings rate highest at 3.67 stars and for-profit lowest at 2.61. The 12 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.

New Hampshire averages 2.99 stars overall across 73 facilities and 7,326 licensed beds. Average occupancy runs 80 percent, which is the number that decides whether a building services its debt. Quality splits at the bottom: 32 facilities (44 percent) rate one or two stars overall, 12 of them one star. Special Focus status or candidacy covers 6 of them. CMS fines on the current record total $563K across 22 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, 41 of 73 buildings show a distress signal, 56 percent of the total.

The four largest operating groups run 29 of New Hampshire's 73 skilled nursing facilities, 40 percent of the state and 33 percent of its licensed beds. The remaining 44 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.

New Hampshire's 13 reporting hospitals discharged at least 10,613 traditional-Medicare inpatients in the diagnosis groups that most often need skilled care afterward, in federal fiscal 2024. Sepsis leads at 3,166 discharges. Every one of these patients needed a next setting, and the facilities positioned closest to the highest-volume hospitals see that demand first.

51 of New Hampshire's 68 graded skilled nursing facilities (75%) 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 0.8% 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 31.4% of New Hampshire's Medicare population, as of April 2026. That is down 1.3 points in three years. Merrimack County runs highest in the state at 37.3%. 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: Hillsborough County with 21 facilities and 2,236 beds, Rockingham County with 12 facilities and 1,117 beds, Merrimack County with 7 facilities and 900 beds.

1. CMS Provider Information / Care Compare: facility counts, licensed beds, occupancy, Five-Star ratings, staffing, nurse turnover, fines and Special Focus status, processed 2026-07-01.
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. New Hampshire published Medicaid nursing-facility rate files: 56 rated facilities, effective January 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.