Quality points and the Ohio per diem
Why a rating reset can move an Ohio nursing home's Medicaid rate in the middle of a sale, and what that did to one of ours.
Part of Ohio's Medicaid rate for nursing homes is tied to quality points, so a rating reset can lower a building's per diem while it is under contract.
In our Ohio closing (May 2026), a Medicaid rate reset stripped the facility of quality points and dropped its per-diem reimbursement by roughly $50 a day, mid-process. Softer hospital discharges pulled census from the high 80s into the low 80s at the same time.
The deal still closed all cash at $10.5 million, about $106,000 per operational bed, because more than one qualified buyer stayed engaged and the economics were restructured when financing conditions shifted. Read the deal sheet.
What an Ohio seller should plan for
- Know where the building stands on quality before going to market.
- Expect buyers to underwrite the rate they will receive, not the rate you receive today.
- Keep a second buyer warm.
Ohio's rates, legislation and every building are on SNFRadar's Ohio report.