In SNFRadar’s system: occupancy, staffing and rating, plus its Medicare cost report and a calculator to run its numbers.
Every New Hampshire 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.
The full read, filmed on our example building.The full read, filmed on our example building.
NH
New Hampshire Skilled Nursing: Market Intelligence Report
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 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.
73
facilities
7,326
licensed beds
81%
avg occupancy
55%
showing distress
What the Cost Reports Say · FY2024 to FY2026
Seven days in ten are Medicaid.
Every full-year Medicare cost report New Hampshire's skilled nursing facilities filed in FY2024 to FY2026, read as one set of bands: 69 reports across 10 counties. This is the table an owner puts their own filing against.
69
cost reports read across 10 counties
85.5%
median occupancy
66.3%
of the days reported by payer were Medicaid
2.4%
median net margin, 37.7% filed a loss
Seven of every ten patient days New Hampshire's skilled nursing facilities billed in FY2024 to FY2026 were Medicaid days: 66.3% of the 2,026,005 patient days on the 68 reports that break days out by payer. The median building ran 85.5% occupancy, with the middle half between 77.2% and 91.2%, on 68 reports that carry it. Patient revenue ran $424 a patient day at the median against $425 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 2.4% at the median. 26 of the 69 reports that carry a bottom line filed a loss, which is 37.7% 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.
77.2%
85.5%
91.2%
68
84.2%
Medicare share of days
Traditional Medicare days as a share of all patient days, off Worksheet S-3 Part I.
7.4%
10.2%
15.1%
69
7.7%
Medicaid share of days
Medicaid days as a share of all patient days, off Worksheet S-3 Part I.
54.3%
66.2%
75.0%
68
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.
16.3%
22.0%
28.8%
68
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.
$385
$424
$454
68
$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.
$376
$425
$505
68
$372
Net income per patient day
Net income off Worksheet G-3, divided by patient days.
-$28
$9
$36
69
$14
Margin and liquidity
Net margin
Net income off Worksheet G-3 over net patient revenue off the same worksheet.
-7.7%
2.4%
9.0%
69
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 2,026,005 days on the 68 reports that break days out by payer
Median facility
Medicaid
66.3%
66.2%
Traditional Medicare
10.7%
10.2%
Everyone else, including managed care
23.0%
22.0%
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.
Urban against rural, at the median
Urban (38)
Rural (31)
Occupancy
86.6%
84.0%
Medicaid share of days
61.4%
69.7%
Patient revenue per patient day
$432
$405
Operating expense per patient day
$427
$419
Net margin
1.6%
7.0%
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
65% of New Hampshire buildings closed the year at 80% occupancy or better, on the 68 reports that carry occupancy, and 38% of the 69 that carry a bottom line still filed a loss.
A $129 gap per patient day
Operating cost runs $376 a patient day at the 25th percentile against $505 at the 75th, on 68 New Hampshire reports. At the median building's own year of 26,011 patient days, that gap is $3.4 million a year between a lean cost structure and a heavy one.
Margin without liquidity
The median New Hampshire filing closed on a current ratio of 1.24, on the 67 reports that carry both sides of the balance sheet, and 40% of them closed under 1.00, which means owing more inside a year than they hold to pay it with. Only 38% 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 2026-04-30, one full-year report per facility: 69 reports covering 2,050,588 patient days, of which 2,026,005 sit on the 68 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 Snapshot
$272
New Hampshire average daily rate
$271
statewide median
New Hampshire carries a median Medicaid daily rate of $271 across 58 rated facilities, 79 percent of the buildings we track in the state, with the middle half of the market between $256 and $279 a day. The distribution is tight, which usually means a cost-capped methodology holding most buildings in a band. For-profit buildings run $23 a day above government ones ($275 against $252 at the median), a gap that reflects the class each sits in rather than the quality of the building. Rates are effective July 2026.
Percentile
Medicaid daily rate
10th
$247
25th
$256
Median (50th)
$271
75th
$279
90th
$300
Range $218 to $343 across 58 rated facilities; rates effective July 2026.
CMS Ownership Analytics · 73 NH SNFs
Ownership
Facilities
Avg ★
Staffing ★
Nurse turnover
1★ / 5★
CMS fines
For-Profit
45
2.67
2.64
45%
12 / 6
$502K
Non-Profit
16
3.63
4.20
46%
0 / 4
$45K
Government
12
3.67
4.42
37%
0 / 3
$32K
New Hampshire skilled nursing is 62 percent for-profit by facility count: 45 of 73 buildings, averaging 2.67 stars overall and 2.64 on staffing. The balance is 16 non-profit, 12 government. Government buildings rate highest at 3.67 stars and for-profit lowest at 2.67. 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.
Quality, Staffing & Distress Signals
44%
rated one or two stars
5
special focus / candidate
New Hampshire averages 3.04 stars overall across 73 facilities and 7,326 licensed beds. Average occupancy runs 81 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 5 of them. CMS fines on the current record total $579K across 23 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, 40 of 73 buildings show a distress signal, 55 percent of the total.
Where the Beds Are
County
Facilities
Licensed beds
Hillsborough
21
2,236
Rockingham
12
1,117
Merrimack
7
900
Cheshire
7
541
Strafford
6
598
Grafton
5
547
Coos
5
420
Belknap
4
396
Market Structure
40%
run by the four largest groups
60%
run by everyone else
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.
Hospital Discharge Demand
10,613
SNF-relevant discharges (minimum)
13
reporting hospitals
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.
Condition
Discharges (at least)
Sepsis
3,166
Heart failure
1,746
Pneumonia
1,142
Respiratory infection
1,136
Stroke
852
Urinary tract infection
809
Kidney failure
719
Hip & femur surgery
537
Hip & knee replacement
279
COPD
227
Hospital
SNF-relevant discharges
30-day HF readmissions
CONCORD HOSPITAL · CONCORD
1,266
23.9%
ELLIOT HOSPITAL · MANCHESTER
1,184
21.0%
WENTWORTH-DOUGLASS HOSPITAL · DOVER
1,156
21.5%
MARY HITCHCOCK MEMORIAL HOSPITAL · LEBANON
1,128
21.1%
PORTSMOUTH REGIONAL HOSPITAL · PORTSMOUTH
932
22.7%
CATHOLIC MEDICAL CENTER · MANCHESTER
908
24.1%
SOUTHERN NH MEDICAL CENTER · NASHUA
806
23.7%
EXETER HOSPITAL INC · EXETER
756
22.1%
ST JOSEPH HOSPITAL · NASHUA
707
21.2%
CONCORD HOSPITAL- LACONIA · LACONIA
600
21.6%
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
75%
of graded facilities are cut this year
0.8%
average cut across the graded set
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.
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
31.4%
of the state's Medicare population is in Medicare Advantage plans
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.
County
Medicare Advantage share
Merrimack County
37.3%
Strafford County
36.2%
Hillsborough County
35.3%
Belknap County
34.2%
Coos County
32.9%
Rockingham County
31.5%
Cheshire County
26.0%
Grafton County
22.5%
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: 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.
Legislative & Regulatory Watch
In effect
Federal: Staffing Mandate (Oct 2026)
Operator implication: Staffing floors bind hardest on buildings already below the state average on hours per resident, which is where distressed sales start.
Facing post-H.R. 1 budget strain, states moved on SNF Medicaid rates entering FY2026: Idaho enacted a 4% across-the-board provider rate cut and Colorado reversed a 1.6% increase, while some New Hampshire homes report >9% losses in per-resident funding. AHCA survey data warns that 58% of providers would cut staff if federal Medicaid funding falls.
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.
Relative to minimum nursing home staffing standards. Last action: Minority Committee Report: Refer for Interim Study (2026-02-25)
Operator implication: Staffing floors bind hardest on buildings already below the state average on hours per resident, which is where distressed sales start.
Relative to the penalty for false reports of suspected abuse and neglect made to the division for children, youth, and families, relative to owner's project manager services for school building aid projects, and relative to long-term care eligibility and making an appropriation therefor. Last action: Veto Sustained 08/19/2026: Regular Calendar 168-140 Lacking Necessary Two-Thirds Vote House Journal 16 (2026-08-19)
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.
Relative to long-term care eligibility and making an appropriation therefor. Last action: Inexpedient to Legislate: Motion Adopted Regular Calendar 182-154 04/23/2026 House Journal 11 P. 56 (2026-04-23)
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 New Hampshire 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.
New Hampshire published Medicaid nursing-facility rate files: 58 rated facilities, effective July 2026.
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: 69 filings from 69 New Hampshire 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.
You have read the New Hampshire report.
See a building against these numbers, in SNFRadar’s system:
SNFRadar
