Nursing Home Quality by State 2026 — CMS Care Compare State-Level Snapshot
How CMS overall star ratings, ownership mix, and Special Focus Facility counts distribute across the 50 states + DC and territories — based on the CMS Care Compare Nursing Home Provider Information dataset (14,699 Medicare/Medicaid-certified facilities, snapshot May 2026). CMS ratings are published by CMS; this report cites them, it does not produce them.
Contents · 11 sections
Executive Summary
- All counts in this study describe the CMS Care Compare Nursing Home Provider Information master dataset (4pq5-n9py) snapshot fetched on 2026-05-03 — 14,699 Medicare/Medicaid-certified facilities across the 50 states, DC, and U.S. territories. CMS ratings are published by CMS and reflect the measure definitions in the source dataset; OwnListed does not independently rate, inspect, verify, endorse, or guarantee any facility.
- 14,572 of the 14,699 facilities (99.1%) carry a CMS overall star rating. The remaining 127 facilities are unrated — typically too-recent admissions, Special Focus enrollment, or other CMS-defined unrated states.
- Top 5 states by mean CMS overall star rating (states with ≥ 50 rated facilities): Arkansas (3.44), Arizona (3.42), New Jersey (3.38), Utah (3.35), Washington (3.31). Bottom 5: Missouri (2.49), Louisiana (2.51), Illinois (2.56), Georgia (2.68), Texas (2.70). The 0.95-star spread between top and bottom states is the single largest cross-state quality gap in the dataset.
- Texas (1,176 facilities), Ohio (922), Illinois (667), Florida (694), and California carry the largest absolute facility counts. Texas alone holds 8.0% of the certified-facility universe.
- The CMS Special Focus Facility (SFF) program flags facilities under heightened oversight for repeated serious deficiencies. Texas (37 SFFs), Ohio (30), Illinois (24), Missouri (18), and Florida (18) carry the largest SFF counts. SFF status is reported here at state-aggregate level only — facility-level SFF status is NOT attached to any individual profile in this snapshot.
At a glance — for journalists, researchers, and AI agents
What this dataset covers
- State-level distribution of CMS overall star ratings, health inspection ratings, staffing ratings, and quality-measures ratings across all 14,699 Medicare/Medicaid-certified U.S. nursing homes.
- Ownership-type mix (For Profit / Non Profit / Government) by state.
- Special Focus Facility (SFF) program enrollment counts by state.
- Source: CMS Care Compare Nursing Home Provider Information master dataset (4pq5-n9py), May 2026 snapshot.
What this dataset does NOT cover
- Facility-level ratings or names — the snapshot is state-aggregate only.
- Why a given facility carries the rating it does — refer to the CMS Five-Star Quality Rating System Technical Users' Guide for the algorithm.
- Quality of care delivered by any individual provider — CMS publishes the rating; OwnListed cites it.
- States or territories not in CMS's nursing-home program (CMS jurisdiction is U.S. only).
Sources
- CMS Care Compare
- Nursing Home Compare
Snapshot date: 2026-04 (CMS publication) — snapshot fetched 2026-05-03
Dataset scope · Snapshot May 3, 2026
Includes: active business listings indexed in the Ownlisted directory network, sourced from public Google Business Profiles. Does not include: online-only operators without a physical service address, lead-generation shells, or businesses with no public review footprint. Counts describe the Ownlisted indexed provider dataset — not a representative sample of the U.S. local-services market.
Key findings
What this report is, and is not
This report aggregates the CMS Care Compare Nursing Home Provider Information master dataset (CMS dataset slug 4pq5-n9py, bulk file NH_ProviderInfo_Apr2026.csv, modified 2026-04-01) at the state level. It cites the CMS overall star rating, the three component sub-ratings (health inspection, staffing, quality measures), ownership mix, and Special Focus Facility counts — exactly as CMS publishes them.
It does not:
- Rate any facility on its own. CMS publishes the ratings; OwnListed cites them.
- Recommend a facility. OwnListed does not endorse or guarantee any facility.
- Surface facility-level data on any directory page. The snapshot is research-only.
- Mix CMS ratings with platform reviews. CMS ratings are derived from CMS measure definitions; they are not a substitute for and should not be combined with consumer reviews.
Source: CMS Care Compare · Last checked 2026-05-03. CMS ratings are published by CMS and reflect the measure definitions in the source dataset.
Top + bottom states by mean overall rating
Among states with at least 50 rated facilities, mean CMS overall star ratings cluster between 2.49 (Missouri) and 3.44 (Arkansas) — a 0.95-star spread on a 5-point scale.
The pattern is not a North/South or coastal divide. The top quintile mixes Sun Belt (AR, AZ), Mid-Atlantic (NJ), Mountain West (UT, WA), and Florida; the bottom quintile mixes Midwest (MO, IL), Gulf Coast (LA, TX), and parts of the Southeast (GA, MS).
Sub-rating variation is substantial. Health inspection ratings cluster lower nationally (mean ~2.8) than staffing or quality-measure ratings (3.0-3.5 typical). State means rarely move all three sub-ratings in the same direction at the same magnitude, so sorting by overall_rating reflects a CMS weighting, not a single underlying signal.
Per CMS measure definitions, the overall rating is built from the three component ratings using a published weighting; this report does not replicate the CMS algorithm. Read the CMS Care Compare technical documentation for the canonical methodology.
Nursing home quality by state — CMS Care Compare snapshot 2026-05-03
All 53 jurisdictions in the CMS Care Compare snapshot. Mean ratings shown only for rated facilities. CMS ratings are published by CMS and reflect the measure definitions in the source dataset. OwnListed does not independently rate, inspect, verify, endorse, or guarantee any facility.
| State | Facilities | Rated | Mean overall (1-5) | ≥4 stars % | ≤2 stars % | For Profit % | SFFs |
|---|---|---|---|---|---|---|---|
| AR | 221 | 218 | 3.44Highest | 53.2% | 26.1% | 89.6% | 6 |
| AZ | 140 | 139 | 3.42 | 51.8% | 28.1% | 87.1% | 6 |
| NJ | 348 | 345 | 3.38 | 51% | 29.9% | 82.5% | 12 |
| UT | 97 | 96 | 3.35 | 49% | 31.3% | 70.1% | 6 |
| WA | 194 | 193 | 3.31 | 49.2% | 31.6% | 79.9% | 5 |
| ND | 72 | 71 | 3.27 | 47.9% | 35.2% | 5.6% | 6 |
| FL | 694 | 690 | 3.27 | 47.7% | 34.1% | 79% | 18 |
| NV | 66 | 65 | 3.26 | 47.7% | 32.3% | 86.4% | 6 |
| OH | 922 | 912 | 3.22 | 44.3% | 34% | 84.5% | 30 |
| MI | 423 | 420 | 3.18 | 42.6% | 33.3% | 77.1% | 12 |
| AK | 20 | 20 | 3.15 | 40% | 40% | 30% | 0 |
| AL | 224 | 223 | 3.05 | 39% | 37.2% | 84.4% | 6 |
| TX | 1,176 | 1,165 | 2.70 | 29.5% | 48.8% | 70.8% | 37 |
| GA | 356 | 353 | 2.68 | 31.2% | 49% | 69.1% | 12 |
| IL | 667 | 663 | 2.56 | 29.7% | 54.1% | 81.6% | 24 |
| LA | 266 | 264 | 2.51 | 26.5% | 53.8% | 80.8% | 6 |
| MO | 487 | 481 | 2.49Lowest | 26.4% | 54.3% | 79.3% | 18 |
Ownership mix
CMS classifies each nursing facility's ownership as For Profit, Non Profit, or Government. Nationally, the For Profit share dominates: Arkansas (89.6%), Texas (70.8%), Ohio (84.5%), and most Sun Belt states report For Profit shares above 75%. North Dakota (5.6% For Profit, 90.3% Non Profit) and DC (41.2% For Profit, 58.8% Non Profit) anchor the other end of the distribution.
Texas is notable for a 19.2% Government share — among the highest in the dataset, reflecting the state's network of county-operated and hospital-district-affiliated facilities.
Ownership share is reported at facility level (one row per facility) and aggregated by state. CMS Care Compare distinguishes ownership type (For Profit / Non Profit / Government) but does not in this dataset surface chain-vs-independent at the row level beyond the chain_id field, which would require a separate analysis.
Source: CMS Care Compare · Last checked 2026-05-03. CMS ratings are published by CMS and reflect the measure definitions in the source dataset.
Special Focus Facility (SFF) program
The CMS Special Focus Facility program identifies facilities with histories of serious quality issues for heightened oversight (more frequent surveys, escalating remedies, public-list publication). State-aggregate SFF counts in this dataset:
- Texas: 37 SFFs (largest in dataset)
- Ohio: 30
- Illinois: 24
- Missouri: 18
- Florida: 18
SFF presence does not establish that a state's facilities are systematically worse — SFF designation is a CMS process trigger, not a quality measurement. State-level SFF counts also reflect facility population: states with more nursing facilities report more SFFs in absolute terms.
This snapshot reports SFF counts at state level only. It does not name individual SFFs, link to the CMS SFF list, or attach SFF status to any facility profile. Operators who want the canonical SFF list should consult CMS directly at the Care Compare program page.
Limitations
- Snapshot date. This report uses the CMS Care Compare
NH_ProviderInfo_Apr2026.csvfile modified 2026-04-01 and fetched 2026-05-03. CMS publishes monthly updates; data should be re-fetched before any decision making. - Unrated facilities. 127 of 14,699 facilities (0.9%) lack a CMS overall star rating. Most are too-recent Medicare/Medicaid certifications, Special Focus enrollees, or other CMS-defined unrated states. These rows are excluded from rating means but counted in facility totals.
- Aggregate-not-attached. State-level aggregates do NOT attach to individual facility profiles, and OwnListed does not maintain facility profiles. This report is research-only.
- CMS methodology is canonical. Overall rating is the CMS published value; this report does not recompute it. Anyone replicating these numbers from raw measure data must follow CMS's published weighting, available at the CMS Care Compare technical documentation.
- No quality claim about any facility. State means are descriptive of a national-level publishing snapshot. They are not endorsements, recommendations, or guarantees about any facility, and OwnListed does not rate, inspect, verify, endorse, or guarantee any facility.
- Territory coverage. PR (9 facilities), GU, VI, MP, AS appear when present in the CMS dataset and are reported alongside the 50 states + DC.
Source: CMS Care Compare · Last checked 2026-05-03. CMS ratings are published by CMS and reflect the measure definitions in the source dataset.
Methodology
- Bulk CSV fetched once from CMS at
https://data.cms.gov/provider-data/sites/default/files/resources/.../NH_ProviderInfo_Apr2026.csv(8.7 MB, 99 columns, 14,699 facility rows). - Per-state aggregation via
scripts/research/cms-nursing-home-snapshot-2026-05-03.ts(TypeScript runner, no Supabase writes, no facility-level provenance writes). - Mean ratings computed across rated facilities only (CMS strings outside the integer 1–5 range are coerced to null and excluded from the rating mean).
- Share-of-stars (
share_4_or_5_stars_pct,share_1_or_2_stars_pct) computed against the rated-facility denominator per state. - Ownership shares computed against the full facility denominator (rated + unrated).
- Special Focus Facility counts use CMS's
Special Focus Statuscolumn; rows where status is "Not a SFF" or "Not Applicable" are excluded. - Output CSV at
/research/data/nursing-home-quality-by-state-2026.csv(14 columns, 53 rows). JSON-with-metadata at/research/data/nursing-home-quality-by-state-2026.json.
Source: CMS Care Compare · Last checked 2026-05-03. CMS ratings are published by CMS and reflect the measure definitions in the source dataset.
Citation and reuse
Permitted with attribution to OwnListed Research and a link back to this page. Suggested citation:
OwnListed Research. Nursing Home Quality by State 2026 — CMS Care Compare State-Level Snapshot. Published 2026-05-03. https://www.ownlisted.com/research/nursing-home-quality-by-state-2026
The underlying CMS data is a U.S. Government Work in the public domain (https://www.usa.gov/government-works). Direct citations to CMS should reference https://data.cms.gov/provider-data/dataset/4pq5-n9py.
Limitations
- Each Care Compare cluster has its own measure-set; the overall rating is not directly comparable to home-health or hospice studies.
- Special Focus Facility status is reported at state-aggregate level only. Facility-level SFF status is captured to provenance but never attached to individual profiles.
- 127 of 14,699 facilities (0.9%) are unrated. Unrated is not categorically lower-quality — refer to the CMS unrated-state definitions.
- The 90-day OwnListed re-pull cadence may lag CMS's monthly publication by 1-2 snapshots.
- OwnListed does not independently rate, inspect, verify, endorse, or guarantee any nursing home.
Methodology
Read the full methodology
Source. CMS Care Compare publishes a Nursing Home Provider Information master dataset listing every Medicare/Medicaid-certified nursing home in the United States, along with each facility's CMS overall star rating, its component sub-ratings (health inspection, staffing, quality measures), its ownership type, and its Special Focus Facility status when applicable. We pulled the version published in early 2026 and computed state-level aggregates from it.
What this snapshot reports. Per state: how many certified nursing homes operate there, how many have a CMS overall star rating, the average overall rating across rated facilities, the share of rated facilities at the top (4 or 5 stars) and bottom (1 or 2 stars), the average for each rating component, the ownership mix (for-profit, non-profit, government), and the count of facilities currently flagged with a CMS Special Focus Facility status.
Reading the rating. CMS overall star ratings are CMS's published ratings — OwnListed does not independently rate, inspect, score, endorse, or guarantee any facility. State-level averages mask within-state variation; treat them as state-of-system signals, not "the best state to live in".
Source: CMS Care Compare · Last checked 2026-05-03. CMS ratings are published by CMS and reflect the measure definitions in the source dataset.
Source. CMS Care Compare publishes a Nursing Home Provider Information master dataset listing every Medicare/Medicaid-certified nursing home in the United States, along with each facility's CMS overall star rating, its component sub-ratings (health inspection, staffing, quality measures), its ownership type, and its Special Focus Facility status when applicable. We pulled the version published in early 2026 and computed state-level aggregates from it.
What this snapshot reports. Per state: how many certified nursing homes operate there, how many have a CMS overall star rating, the average overall rating across rated facilities, the share of rated facilities at the top (4 or 5 stars) and bottom (1 or 2 stars), the average for each rating component, the ownership mix (for-profit, non-profit, government), and the count of facilities currently flagged with a CMS Special Focus Facility status.
Reading the rating. CMS overall star ratings are CMS's published ratings — OwnListed does not independently rate, inspect, score, endorse, or guarantee any facility. State-level averages mask within-state variation; treat them as state-of-system signals, not "the best state to live in".
Source: CMS Care Compare · Last checked 2026-05-03. CMS ratings are published by CMS and reflect the measure definitions in the source dataset.
Technical appendix
Show technical details · script paths · field names
Dataset. CMS Care Compare — Nursing Home Provider Information (CMS dataset slug 4pq5-n9py). Bulk CSV: NH_ProviderInfo_Apr2026.csv, modified 2026-04-01, fetched 2026-05-03. License: U.S. Government Works (public domain) at https://www.usa.gov/government-works.
Pipeline. scripts/research/cms-nursing-home-snapshot-2026-05-03.ts parses the bulk CSV, groups by state, and computes:
facility_count: total Medicare/Medicaid-certified facilities.rated_facility_count: facilities with a CMS overall star rating in 1-5.mean_overall_rating: arithmetic mean across rated facilities.share_4_or_5_stars_pct,share_1_or_2_stars_pct: shares of rated facilities at each band.mean_health_inspection_rating,mean_staffing_rating,mean_quality_measures_rating: arithmetic means across facilities with a rating in each component.share_for_profit_pct,share_non_profit_pct,share_government_pct: ownership-type shares against the full facility denominator.special_focus_facilities: count of facilities with a non-empty Special Focus Status field other than "Not a SFF" or "Not Applicable".
Doctrine. Tier-1 research-only under SOP §94 (provenance) and §114 (CMS Care Compare cluster). No facility profile writes. No directory pages. No mixing of CMS ratings with platform reviews.
Open for the script paths, raw dataset filenames, and per-field aggregation rules behind this snapshot. Reader-facing methodology above already covers source, date, and limitations.