SNF cost report margin vs EBITDAR, and why they differ
Why a skilled nursing facility's Medicare cost report shows a margin near zero while its EBITDAR is positive, and how to get from one to the other.
Skilled nursing, by the patient day
Skilled nursing benchmarks by state, from Medicare cost reports
Occupancy, revenue and cost per patient day, payer mix and margins for every state, built from CMS cost reports, plus the math that turns your own numbers into EBITDAR, value and coverage.
Per Patient Day is independent. It is not affiliated with, endorsed by or acting for HUD, FHA, CMS or any government agency.
- Occupancy
- 82.6%
- Revenue / patient day
- $351
- Expense / patient day
- $355
- Medicaid days
- 62.1%
- Medicare PPS / Medicare day
- $627
US medians, 13,092 cost reports, fiscal years ending August 2024 to August 2025
Benchmarks that start from the patient day
Operators run a building on census, revenue per day and cost per day. Lenders read the same figures and compare them with what other buildings report, and every Medicare-certified facility’s cost report is public.
Per Patient Day turns those reports into quartiles for every state, so you can see whether 86% occupancy or $380 a day is strong or ordinary where your building is, and what the building is worth at the cap rate you think a buyer would pay.
Pick a state
Alabama · Arizona · Arkansas · California · Colorado · Connecticut · Delaware · District of Columbia · Florida · Georgia · Hawaii · Idaho · Illinois · Indiana · Iowa · Kansas · Kentucky · Louisiana · Maine · Maryland · Massachusetts · Michigan · Minnesota · Mississippi · Missouri · Montana · Nebraska · Nevada · New Hampshire · New Jersey · New Mexico · New York · North Carolina · North Dakota · Ohio · Oklahoma · Oregon · Pennsylvania · Rhode Island · South Carolina · South Dakota · Tennessee · Texas · Utah · Vermont · Virginia · Washington · West Virginia · Wisconsin · Wyoming
Highest median occupancy
- North Dakota: 94.6%
- West Virginia: 93.8%
- New York: 92.5%
- Florida: 90.9%
- Maine: 90.7%
Highest revenue per patient day
- Oregon: $597
- Hawaii: $555
- California: $480
- Washington: $465
- Nevada: $453
The US skilled nursing facility in one table
| Metric | 25th pct | Median | 75th pct | US median | Range |
|---|---|---|---|---|---|
| Occupancypatient days / bed days available | 69.3% | 82.6% | 90.8% | 82.6% | |
| Net patient revenue per patient day | $301 | $351 | $418 | $351 | |
| Total operating expense per patient day | $304 | $355 | $432 | $355 | |
| Operating margin as reportednet patient revenue less total operating expense | -8.8% | -0.3% | 6.1% | -0.3% | |
| Medicare share of days | 4.3% | 7.5% | 12.6% | 7.5% | |
| Medicaid share of days | 39.4% | 62.1% | 74.5% | 62.1% | |
| Other payers share of daysprivate pay, managed care, VA and others | 17.4% | 27.7% | 47.3% | 27.7% | |
| Medicare PPS payment per Medicare day | $579 | $627 | $694 | $627 | |
| Contract labor share of labor cost | 5.8% | 11.5% | 18.5% | 11.5% | |
| Beds | 76 | 106 | 135 | 106 |
middle half of US facilities US median US median
Source: CMS Skilled Nursing Facility Cost Report data, posted October 2026. How it is calculated.
Guides
Skilled nursing payer mix and occupancy by state
How much of a nursing home's census Medicaid and Medicare pay for in each state, how occupancy compares, and why payer mix moves revenue per patient day.
SNF PPS FY2026 and FY2027 Medicare rate updates explained
Medicare skilled nursing payment updates for FY2026 (3.2%) and FY2027 (2.4%), the PDPM per diem rates, and what they do to revenue per day.
Questions people ask
Where do the benchmarks come from?
From the Medicare cost reports skilled nursing facilities file with CMS each year, as published in the CMS Skilled Nursing Facility Cost Report dataset. Per Patient Day uses full-year reports with usable days and revenue and shows quartiles rather than averages, which limits the pull of outliers.
Why is the median operating margin close to zero?
Because the cost report's total operating expense includes building costs such as depreciation, rent and capital interest. A lender or buyer values a building on EBITDAR or NOI, which leave those out. The guide on cost report margin and EBITDAR explains the gap.
Is Per Patient Day part of CMS?
No. It is an independent site operated by Janover Capital LLC, a commercial mortgage firm, and is not affiliated with or endorsed by CMS, HUD or FHA.