In SNFRadar’s system: occupancy, staffing and rating, plus its Medicare cost report and a calculator to run its numbers.
Every Pennsylvania 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.
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 Pennsylvania 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.
656
facilities
83,064
licensed beds
82%
avg occupancy
59%
showing distress
What the Cost Reports Say · FY2024 to FY2026
Seven days in ten are Medicaid.
Every full-year Medicare cost report Pennsylvania's skilled nursing facilities filed in FY2024 to FY2026, read as one set of bands: 629 reports across 66 counties. This is the table an owner puts their own filing against.
629
cost reports read across 66 counties
86.9%
median occupancy
69.3%
of the days reported by payer were Medicaid
0.7%
median net margin, 47.8% filed a loss
Seven of every ten patient days Pennsylvania's skilled nursing facilities billed in FY2024 to FY2026 were Medicaid days: 69.3% of the 23,991,985 patient days on the 627 reports that break days out by payer. The median building ran 86.9% occupancy, with the middle half between 76.5% and 92.0%, on 606 reports that carry it. Patient revenue ran $359 a patient day at the median against $377 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 0.7% at the median. 297 of the 621 reports that carry a bottom line filed a loss, which is 47.8% 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.
76.5%
86.9%
92.0%
606
84.2%
Medicare share of days
Traditional Medicare days as a share of all patient days, off Worksheet S-3 Part I.
3.6%
6.1%
10.3%
629
7.7%
Medicaid share of days
Medicaid days as a share of all patient days, off Worksheet S-3 Part I.
53.6%
71.4%
80.9%
627
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.
13.2%
20.2%
35.5%
627
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.
$326
$359
$443
624
$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.
$332
$377
$515
622
$372
Net income per patient day
Net income off Worksheet G-3, divided by patient days.
-$27
$2
$34
629
$14
Margin and liquidity
Net margin
Net income off Worksheet G-3 over net patient revenue off the same worksheet.
-7.4%
0.7%
8.1%
621
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 23,991,985 days on the 627 reports that break days out by payer
Median facility
Medicaid
69.3%
71.4%
Traditional Medicare
7.7%
6.1%
Everyone else, including managed care
23.0%
20.2%
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. Managed care is broken out separately on 227 of the state’s reports; on those 8,817,044 days Medicare Advantage is 7.5% and managed Medicaid 61.6%, and both sit inside the row above.
Urban against rural, at the median
Urban (520)
Rural (109)
Occupancy
87.4%
84.0%
Medicaid share of days
73.0%
73.5%
Patient revenue per patient day
$367
$332
Operating expense per patient day
$385
$342
Net margin
0.7%
1.1%
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
70% of Pennsylvania buildings closed the year at 80% occupancy or better, on the 606 reports that carry occupancy, and 48% of the 621 that carry a bottom line still filed a loss.
A $183 gap per patient day
Operating cost runs $332 a patient day at the 25th percentile against $515 at the 75th, on 622 Pennsylvania reports. At the median building's own year of 35,579 patient days, that gap is $6.5 million a year between a lean cost structure and a heavy one.
Margin without liquidity
The median Pennsylvania filing closed on a current ratio of 0.77, on the 592 reports that carry both sides of the balance sheet, and 60% of them closed under 1.00, which means owing more inside a year than they hold to pay it with. Only 48% 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 2026-03-31, one full-year report per facility: 629 reports covering 24,021,297 patient days, of which 23,991,985 sit on the 627 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
$261
Pennsylvania average daily rate
$254
statewide median
Pennsylvania carries a median Medicaid daily rate of $254 across 530 rated facilities, 81 percent of the buildings we track in the state, with the middle half of the market between $238 and $276 a day. The distribution is tight, which usually means a cost-capped methodology holding most buildings in a band. Non-profit buildings run $19 a day above for-profit ones ($268 against $249 at the median), a gap that reflects the class each sits in rather than the quality of the building. Rates are effective October 2026.
Percentile
Medicaid daily rate
10th
$224
25th
$238
Median (50th)
$254
75th
$276
90th
$294
Range $197 to $519 across 530 rated facilities; rates effective October 2026.
CMS Ownership Analytics · 656 PA SNFs
Ownership
Facilities
Avg ★
Staffing ★
Nurse turnover
1★ / 5★
CMS fines
For-Profit
414
2.42
2.36
49%
129 / 36
$13.8M
Non-Profit
221
3.98
4.22
37%
12 / 114
$2.4M
Government
21
3.29
4.19
39%
4 / 7
$738K
Pennsylvania skilled nursing is 63 percent for-profit by facility count: 414 of 656 buildings, averaging 2.42 stars overall and 2.36 on staffing. The balance is 221 non-profit, 21 government. Non-Profit buildings rate highest at 3.98 stars and for-profit lowest at 2.42. 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
43%
rated one or two stars
24
special focus / candidate
Pennsylvania averages 2.98 stars overall across 656 facilities and 83,064 licensed beds. Average occupancy runs 82 percent, which is the number that decides whether a building services its debt. Quality splits at the bottom: 280 facilities (43 percent) rate one or two stars overall, 145 of them one star. Special Focus status or candidacy covers 24 of them. CMS fines on the current record total $16.9M across 287 facilities. Total nurse turnover averages 44.5 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, 384 of 656 buildings show a distress signal, 59 percent of the total.
Where the Beds Are
County
Facilities
Licensed beds
Montgomery
58
6,979
Allegheny
52
6,790
Philadelphia
46
6,888
Lancaster
31
3,984
Bucks
29
3,245
Delaware
28
4,030
Luzerne
22
2,568
Chester
20
2,451
Market Structure
24%
run by the eight largest groups
76%
run by everyone else
The eight largest operating groups run 158 of Pennsylvania's 656 skilled nursing facilities, 24 percent of the state and 25 percent of its licensed beds. The remaining 498 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
88,835
SNF-relevant discharges (minimum)
124
reporting hospitals
Pennsylvania's 124 reporting hospitals discharged at least 88,835 traditional-Medicare inpatients in the diagnosis groups that most often need skilled care afterward, in federal fiscal 2024. Sepsis leads at 28,030 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
28,030
Heart failure
15,639
Pneumonia
7,492
Respiratory infection
7,459
Urinary tract infection
7,377
Kidney failure
7,055
Stroke
6,135
Hip & knee replacement
3,581
Hip & femur surgery
3,312
COPD
2,755
Hospital
SNF-relevant discharges
30-day HF readmissions
LEHIGH VALLEY HOSPITAL · ALLENTOWN
4,311
22.9%
JEFFERSON ABINGTON HOSPITAL · ABINGTON
2,859
22.6%
READING HOSPITAL · WEST READING
2,663
24.1%
WELLSPAN YORK HOSPITAL · YORK
2,050
21.3%
LANCASTER GENERAL HOSPITAL · LANCASTER
2,043
19.2%
PAOLI HOSPITAL · PAOLI
2,016
21.7%
UPMC PINNACLE HOSPITALS · HARRISBURG
2,001
22.1%
JEFFERSON HEALTH- NORTHEAST · PHILADELPHIA
1,946
23.2%
CHESTER COUNTY HOSPITAL · WEST CHESTER
1,850
18.3%
ST LUKES HOSPITAL · BETHLEHEM
1,845
24.4%
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
73%
of graded facilities are cut this year
0.6%
average cut across the graded set
468 of Pennsylvania's 641 graded skilled nursing facilities (73%) 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.
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
54.6%
of the state's Medicare population is in Medicare Advantage plans
Medicare Advantage now covers 54.6% of Pennsylvania's Medicare population, as of April 2026. That is up 3.6 points in three years. Cambria County runs highest in the state at 76.6%. 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
Cambria County
76.6%
Indiana County
76.3%
Armstrong County
75.8%
Lawrence County
71.9%
Westmoreland County
71.8%
Beaver County
71.6%
Somerset County
70.8%
Greene County
70.1%
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: Montgomery County with 58 facilities and 6,979 beds, Allegheny County with 52 facilities and 6,790 beds, Philadelphia County with 46 facilities and 6,888 beds.
Legislative & Regulatory Watch
In effect
Pennsylvania: Reimbursement (Jul 2026)
Operator implication: Payment policy changes reach every building in the state, and the effect on a thin-margin operator arrives within a quarter. This one moves in the operator's favour.
The 2026 State of Pennsylvania Nursing Homes Report documents that PA has lost 37 facilities and 4,318 certified beds since 2020, with 49% of providers declining hospital admissions in the prior 90 days and inadequate Medicaid funding cited as the leading cause of reduced capacity. LeadingAge PA is requesting a 0.84 BAF floor and roughly $274 million in annualized state investment for FY 2026-27.
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.
The BAF, a cost-control formula that pays PA nursing facilities only ~77-80 cents per dollar of audited care costs, expires June 30, 2026 without legislative action, and providers are pressing lawmakers for a stable funding floor (e.g., 90% of cost) instead of a quiet three-year reauthorization. A Lehigh County facility reported losing an estimated $125 per resident per day in Q1 2026 under the current formula.
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.
Pennsylvania is transitioning its Medicaid nursing-facility case-mix methodology to a modified, nursing-component-only PDPM model, with May 1 and August 1, 2025 picture dates expected to feed calendar-year 2026 rates. The shift changes how acuity drives reimbursement and creates winners and losers among facilities depending on their resident mix.
Operator implication: Payment policy changes reach every building in the state, and the effect on a thin-margin operator arrives within a quarter. This one moves in the operator's favour.
Nursing homes got a slight boost under the latest state budget, but say more support is needed for the critical industry.
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. This one moves in the operator's favour.
The PA Department of Health is rolling out proposed SNF regulations in four packages; the third package (published March 19, 2026) expands the ownership, financial, staffing, operating-budget, and regulatory-history information applicants must disclose to open a facility or take ownership of an existing one (a CHOW burden), and a forthcoming final package will address resident rights and staffing ratios. PA's ~685 SN
Operator implication: Federal rules reach every building in the country, so the effect shows up in the same quarter across the entire portfolio.
If a county-level Pennsylvania 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.
Pennsylvania published Medicaid nursing-facility rate files: 530 rated facilities, effective October 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: 629 filings from 629 Pennsylvania 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 Pennsylvania report.
See a building against these numbers, in SNFRadar’s system:
SNFRadar
