Nursing Homes by State
CMS quality ratings and fine data for 14,695 Medicare and Medicaid certified nursing facilities, broken down by state.
The number of nursing homes and their average quality ratings vary significantly by state, shaped by state Medicaid reimbursement rates, regulatory oversight intensity, workforce availability, and the age distribution of the population. States with large elderly populations, Florida, California, Texas, and New York, have the most facilities. Average star ratings by state reflect the aggregate quality of care in that state's nursing home industry, though individual facilities within any state can range from one to five stars.
Nursing Homes by State
All states with CMS-rated nursing facilities, sorted by total facility count.
| # | State | Facilities | Avg Rating | Total Fines | Browse |
|---|---|---|---|---|---|
| 1 | Texas (TX) | 1,165 | 2.7 / 5 | $56,825,573 | Browse |
| 2 | California (CA) | 1,153 | 3.2 / 5 | $28,829,224 | Browse |
| 3 | Ohio (OH) | 911 | 3.2 / 5 | $20,281,395 | Browse |
| 4 | Florida (FL) | 691 | 3.3 / 5 | $17,779,673 | Browse |
| 5 | Illinois (IL) | 663 | 2.6 / 5 | $69,427,810 | Browse |
| 6 | Pennsylvania (PA) | 653 | 3.0 / 5 | $15,796,300 | Browse |
| 7 | New York (NY) | 593 | 3.0 / 5 | $12,094,723 | Browse |
| 8 | Indiana (IN) | 505 | 3.1 / 5 | $2,554,275 | Browse |
| 9 | Missouri (MO) | 480 | 2.5 / 5 | $15,684,361 | Browse |
| 10 | Michigan (MI) | 421 | 3.2 / 5 | $13,969,103 | Browse |
| 11 | North Carolina (NC) | 416 | 2.9 / 5 | $15,753,619 | Browse |
| 12 | Iowa (IA) | 387 | 3.1 / 5 | $6,770,591 | Browse |
| 13 | Georgia (GA) | 353 | 2.7 / 5 | $4,673,217 | Browse |
| 14 | New Jersey (NJ) | 346 | 3.4 / 5 | $11,804,408 | Browse |
| 15 | Massachusetts (MA) | 338 | 3.0 / 5 | $11,641,648 | Browse |
| 16 | Minnesota (MN) | 336 | 3.2 / 5 | $6,751,120 | Browse |
| 17 | Wisconsin (WI) | 321 | 3.0 / 5 | $12,443,056 | Browse |
| 18 | Tennessee (TN) | 298 | 3.0 / 5 | $7,275,520 | Browse |
| 19 | Kansas (KS) | 293 | 3.0 / 5 | $6,439,660 | Browse |
| 20 | Virginia (VA) | 285 | 3.0 / 5 | $5,774,530 | Browse |
| 21 | Oklahoma (OK) | 281 | 2.7 / 5 | $5,389,230 | Browse |
| 22 | Kentucky (KY) | 266 | 3.0 / 5 | $4,713,573 | Browse |
| 23 | Louisiana (LA) | 265 | 2.5 / 5 | $12,708,465 | Browse |
| 24 | Alabama (AL) | 223 | 3.0 / 5 | $2,937,009 | Browse |
| 25 | Maryland (MD) | 219 | 3.1 / 5 | $4,770,350 | Browse |
| 26 | Arkansas (AR) | 218 | 3.5 / 5 | $1,964,186 | Browse |
| 27 | Colorado (CO) | 208 | 3.1 / 5 | $5,079,962 | Browse |
| 28 | Mississippi (MS) | 200 | 2.7 / 5 | $3,765,318 | Browse |
| 29 | Washington (WA) | 191 | 3.3 / 5 | $10,391,679 | Browse |
| 30 | Connecticut (CT) | 190 | 3.0 / 5 | $3,082,876 | Browse |
| 31 | South Carolina (SC) | 186 | 3.1 / 5 | $2,673,804 | Browse |
| 32 | Nebraska (NE) | 178 | 2.9 / 5 | $1,558,508 | Browse |
| 33 | Arizona (AZ) | 139 | 3.4 / 5 | $1,050,519 | Browse |
| 34 | Oregon (OR) | 127 | 3.1 / 5 | $3,187,636 | Browse |
| 35 | West Virginia (WV) | 122 | 3.0 / 5 | $3,323,393 | Browse |
| 36 | Utah (UT) | 96 | 3.3 / 5 | $2,334,331 | Browse |
| 37 | South Dakota (SD) | 94 | 2.8 / 5 | $3,100,065 | Browse |
| 38 | Idaho (ID) | 79 | 3.2 / 5 | $1,059,402 | Browse |
| 39 | Maine (ME) | 77 | 3.0 / 5 | $563,585 | Browse |
| 40 | New Hampshire (NH) | 72 | 3.0 / 5 | $526,197 | Browse |
| 41 | Rhode Island (RI) | 71 | 2.9 / 5 | $4,505,653 | Browse |
| 42 | North Dakota (ND) | 71 | 3.2 / 5 | $1,875,531 | Browse |
| 43 | New Mexico (NM) | 67 | 2.9 / 5 | $2,753,637 | Browse |
| 44 | Nevada (NV) | 65 | 3.2 / 5 | $802,555 | Browse |
| 45 | Montana (MT) | 60 | 2.9 / 5 | $3,046,575 | Browse |
| 46 | Delaware (DE) | 43 | 3.3 / 5 | $2,356,786 | Browse |
| 47 | Hawaii (HI) | 41 | 3.6 / 5 | $708,439 | Browse |
| 48 | Wyoming (WY) | 35 | 3.0 / 5 | $697,520 | Browse |
| 49 | Vermont (VT) | 32 | 2.8 / 5 | $2,705,170 | Browse |
| 50 | Alaska (AK) | 20 | 3.3 / 5 | $765,525 | Browse |
| 51 | Washington D.C. (DC) | 17 | 3.5 / 5 | $1,195,669 | Browse |
| 52 | Puerto Rico (PR) | 8 | 3.0 / 5 | $40,836 | Browse |
| 53 | Guam (GU) | 1 | 2.0 / 5 | $13,247 | Browse |
Average rating is based on the CMS overall star rating (1-5 stars) for facilities with available ratings. Total fines reflect cumulative CMS civil monetary penalties.
What Drives State-Level Nursing Home Quality
Staffing and Reimbursement
Nursing home quality is heavily influenced by staffing levels, and staffing levels are largely determined by Medicaid reimbursement rates set by each state. States that reimburse facilities at higher rates can attract and retain more qualified staff, which correlates with better resident outcomes and higher CMS star ratings. States with chronically low Medicaid rates tend to show lower average ratings, more deficiency citations, and higher staff turnover. The CMS Five-Star Quality Rating System measures staffing levels as one of its three main components, alongside health inspections and quality measures.
State Regulatory Oversight
Each state operates its own nursing home inspection program under a federal contract with CMS, which means the intensity of regulatory enforcement varies. Some states conduct more frequent unannounced inspections, issue more deficiency citations per visit, and impose larger civil monetary penalties for violations. A state with many citations and fines is not necessarily performing worse, it may simply have more aggressive oversight. When evaluating a state's nursing home industry, reviewing both the average star rating and the regulatory intensity together gives the most balanced picture.
Explore Nursing Home Data
Browse facilities by star rating, search by name, or view quality statistics.