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VA
Virginia 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 Virginia 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.
289
facilities
32,648
licensed beds
88%
avg occupancy
53%
showing distress
What the Cost Reports Say · FY2024 to FY2026
The beds are full. The margin is the question.
Every full-year Medicare cost report Virginia's skilled nursing facilities filed in FY2024 to FY2026, read as one set of bands: 272 reports across 110 counties. This is the table an owner puts their own filing against.
272
cost reports read across 110 counties
91.2%
median occupancy
63.8%
of the days reported by payer were Medicaid
11.0%
median net margin, 12.1% filed a loss
Six of every ten patient days Virginia's skilled nursing facilities billed in FY2024 to FY2026 were Medicaid days: 63.8% of the 9,957,934 patient days on the 265 reports that break days out by payer. The median building ran 91.2% occupancy, with the middle half between 85.9% and 93.9%, on 271 reports that carry it. Patient revenue ran $394 a patient day at the median against $360 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 11.0% at the median. 32 of the 264 reports that carry a bottom line filed a loss, which is 12.1% 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.
85.9%
91.2%
93.9%
271
84.2%
Medicare share of days
Traditional Medicare days as a share of all patient days, off Worksheet S-3 Part I.
5.4%
9.1%
17.5%
272
7.7%
Medicaid share of days
Medicaid days as a share of all patient days, off Worksheet S-3 Part I.
53.5%
65.8%
77.0%
265
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.
15.7%
22.0%
29.6%
265
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.
$345
$394
$453
270
$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.
$313
$360
$443
269
$372
Net income per patient day
Net income off Worksheet G-3, divided by patient days.
$20
$45
$74
272
$14
Margin and liquidity
Net margin
Net income off Worksheet G-3 over net patient revenue off the same worksheet.
5.0%
11.0%
17.1%
264
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 9,957,934 days on the 265 reports that break days out by payer
Median facility
Medicaid
63.8%
65.8%
Traditional Medicare
11.1%
9.1%
Everyone else, including managed care
25.1%
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. Managed care is broken out separately on 155 of the state’s reports; on those 5,856,856 days Medicare Advantage is 6.2% and managed Medicaid 61.9%, and both sit inside the row above.
Urban against rural, at the median
Urban (202)
Rural (70)
Occupancy
91.2%
90.7%
Medicaid share of days
63.9%
74.4%
Patient revenue per patient day
$408
$345
Operating expense per patient day
$375
$324
Net margin
11.1%
10.3%
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.
Full buildings, thin years
87% of Virginia buildings closed the year at 80% occupancy or better, on the 271 reports that carry occupancy, and 12% of the 264 that carry a bottom line still filed a loss.
A $130 gap per patient day
Operating cost runs $313 a patient day at the 25th percentile against $443 at the 75th, on 269 Virginia reports. At the median building's own year of 37,078 patient days, that gap is $4.8 million a year between a lean cost structure and a heavy one.
The balance sheet holds
The median Virginia filing closed on a current ratio of 1.94, on the 248 reports that carry both sides of the balance sheet, and 23% of them closed under 1.00, which means owing more inside a year than they hold to pay it with. Only 12% 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 2024-12-31 to 2026-03-31, one full-year report per facility: 272 reports covering 10,047,162 patient days, of which 9,957,934 sit on the 265 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
$259
Virginia average daily rate
$255
statewide median
Virginia carries a median Medicaid daily rate of $255 across 215 rated facilities, 74 percent of the buildings we track in the state, with the middle half of the market between $242 and $272 a day. The distribution is tight, which usually means a cost-capped methodology holding most buildings in a band. Non-profit buildings run $21 a day above for-profit ones ($275 against $254 at the median), a gap that reflects the class each sits in rather than the quality of the building. Rates are effective October 2025.
Percentile
Medicaid daily rate
10th
$233
25th
$242
Median (50th)
$255
75th
$272
90th
$289
Range $181 to $578 across 215 rated facilities; rates effective October 2025.
CMS Ownership Analytics · 289 VA SNFs
Ownership
Facilities
Avg ★
Staffing ★
Nurse turnover
1★ / 5★
CMS fines
For-Profit
222
2.62
2.00
50%
58 / 26
$6.4M
Non-Profit
58
4.07
4.05
40%
2 / 28
$359K
Government
9
4.38
3.00
41%
0 / 3
$59K
Virginia skilled nursing is 77 percent for-profit by facility count: 222 of 289 buildings, averaging 2.62 stars overall and 2.00 on staffing. The balance is 58 non-profit, 9 government. Government buildings rate highest at 4.38 stars and for-profit lowest at 2.62. 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
42%
rated one or two stars
6
special focus / candidate
Virginia averages 2.96 stars overall across 289 facilities and 32,648 licensed beds. Average occupancy runs 88 percent, which is the number that decides whether a building services its debt. Quality splits at the bottom: 120 facilities (42 percent) rate one or two stars overall, 60 of them one star. Special Focus status or candidacy covers 6 of them. CMS fines on the current record total $6.8M across 103 facilities. Total nurse turnover averages 48.1 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, 152 of 289 buildings show a distress signal, 53 percent of the total.
Where the Beds Are
County
Facilities
Licensed beds
Henrico
14
1,866
Virginia Beach City
14
1,462
Fairfax
13
1,576
Roanoke City
9
1,188
Norfolk City
8
1,173
Lynchburg City
8
927
Albemarle
7
616
Richmond City
6
866
Market Structure
56%
run by the eight largest groups
44%
run by everyone else
The eight largest operating groups run 161 of Virginia's 289 skilled nursing facilities, 56 percent of the state and 62 percent of its licensed beds. The remaining 128 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
63,058
SNF-relevant discharges (minimum)
70
reporting hospitals
Virginia's 70 reporting hospitals discharged at least 63,058 traditional-Medicare inpatients in the diagnosis groups that most often need skilled care afterward, in federal fiscal 2024. Sepsis leads at 23,099 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
23,099
Heart failure
10,255
Stroke
5,097
Urinary tract infection
4,801
Pneumonia
4,765
Kidney failure
4,630
Respiratory infection
4,540
Hip & femur surgery
2,976
COPD
1,675
Hip & knee replacement
1,220
Hospital
SNF-relevant discharges
30-day HF readmissions
INOVA FAIRFAX HOSPITAL · FALLS CHURCH
3,312
20.9%
MARY WASHINGTON HOSPITAL · FREDERICKSBURG
2,481
22.2%
CENTRA HEALTH - LYNCHBURG GEN HOSPITAL · LYNCHBURG
2,401
17.3%
CARILION MEDICAL CENTER · ROANOKE
2,322
21.2%
CJW MEDICAL CENTER · RICHMOND
2,318
20.5%
WINCHESTER MEDICAL CENTER · WINCHESTER
2,282
22.2%
SENTARA LEIGH HOSPITAL · NORFOLK
1,973
21.1%
SENTARA VIRGINIA BEACH GENERAL HOSPITAL · VIRGINIA BEACH
1,860
21.2%
INOVA LOUDOUN HOSPITAL · LEESBURG
1,729
18.7%
RIVERSIDE REGIONAL MEDICAL CENTER · NEWPORT NEWS
1,701
19.2%
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
78%
of graded facilities are cut this year
0.8%
average cut across the graded set
216 of Virginia's 276 graded skilled nursing facilities (78%) 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
39.6%
of the state's Medicare population is in Medicare Advantage plans
Medicare Advantage now covers 39.6% of Virginia's Medicare population, as of April 2026. That is up 3.6 points in three years. Dickenson County runs highest in the state at 72.4%. 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
Dickenson County
72.4%
Scott County
71.1%
Lee County
70.6%
Wise County
69.8%
Norton City
67.0%
Buchanan County
65.5%
Russell County
64.7%
Bristol City
63.8%
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: Henrico County with 14 facilities and 1,866 beds, Virginia Beach City County with 14 facilities and 1,462 beds, Fairfax County with 13 facilities and 1,576 beds.
Legislative & Regulatory Watch
In effect
Virginia: Medicaid Rate (Aug 2026)
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. This one moves in the operator's favour.
The FY2026-28 budget (HB30 amendment 291 #12c) directs DMAS to defer the scheduled nursing-facility rate rebasing and re-examine the methodology; the next rebasing is now pushed to rates effective July 1, 2030. VHCA-VCAL backed the deferral to avoid a methodology change that could have cut rates, but it freezes the cost-basis update for years amid rising costs.
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 General Assembly raised the nursing-facility base-rate benchmark from the 50th to the 59th percentile of Day-Weighted Median costs, with DMAS allocating $21.65M/year for base-rate reform and $40.8M for the Value-Based Purchasing program in both SFY2025 and SFY2026, lifting Medicaid base payments. SFY2026 price-based rates are posted effective July 1 and October 1, 2025.
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. This one moves in the operator's favour.
The One Big Beautiful Bill Act (signed July 2025, ~$911B in federal Medicaid cuts over a decade) could cost Virginia healthcare facilities ~$26B in federal payments over 14 years; for SNFs it shortens the non-expansion retroactive-coverage window from 90 to 60 days (raising unpaid-claim risk) and mandates 6-month eligibility redeterminations from Dec. 31, 2026, while nursing-facility provider taxes are exempted from
Operator implication: Payment policy changes reach every building in the state, and the effect on a thin-margin operator arrives within a quarter.
Legislators advanced a two-year ~$205B budget that funds healthcare, hedges against decreased federal dollars, and creates a Medicaid Financial Sustainability Workgroup to identify strategies to moderate spending growth, signaling future cost-containment pressure on Medicaid-funded providers including SNFs.
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.
Publicly accessible nursing home info. portal; reporting of incident involving emerg. med. services. Last action: Left in Committee Appropriations (2026-02-18)
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 Virginia 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.
Virginia published Medicaid nursing-facility rate files: 215 rated facilities, effective October 2025.
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: 272 filings from 272 Virginia 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.
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