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SNF Market Intelligence Report
March 2026 · Proprietary & Confidential
Exclusively SNF Since 2012
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Below is 3G Healthcare Real Estate’s March 2026 intelligence report on Florida’s skilled nursing facility market — Medicaid rate environment, legislative landscape, and ownership-level performance benchmarks. As a firm focused exclusively on SNF real estate since 2012, we compile this data because no two state markets are alike, and generic industry updates rarely capture what actually drives value in your specific market.
This is proprietary market intelligence, not a solicitation. We share it because informed owners make better decisions — and because the right conversation, at the right time, makes all the difference.
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$307.39
Avg Per Diem — Oct 2025
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+8.0%
Year-Over-Year Change
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Rate Range: $237.20 – $375.37 / day · Rate Year: Oct 1 – Sep 30
| Period |
Avg Per Diem |
Facilities |
YoY Change |
| Oct 2025 (Current) |
$307.39 |
650 |
+$22.45 / +8.0% |
| Oct 2024 |
$284.94 |
671 |
+$20.83 / +7.9% |
| Oct 2023 |
$264.11 |
675 |
+$7.29 / +2.8% |
| 2-Year Total (2023–2025) |
+$43.28 / day | +16.4% |
Florida reimburses SNFs under Prospective Payment System Version LII (Rule 59G-6.010, F.A.C.), administered by AHCA. Per diem = (Direct Care + Indirect Care + Operating + FRVS) × Budget Neutrality Factor + Quality Incentive + NFQA + supplements. Rates are updated annually each October 1. Effective February 2025, nursing facilities are carved into SMMC 3.0 managed care — MCOs contract directly with facilities but AHCA FFS rates serve as the payment floor (s. 409.908(2)(b) F.S.).
The Quality Incentive was tripled from 10% to 17.862% of non-property NF expenditures effective October 2025 — the largest single rate enhancement in recent Florida NF history. Facilities must score at least 33% of 49 quality points (process, structure, and credentialing measures) to receive it. The FRVS component ties a portion of the rate to physical plant age and value, benefiting newer or renovated facilities.
| Percentile |
Est. Per Diem |
| 10th Percentile |
~$275/day |
| 25th Percentile |
~$297/day |
| Median (50th) |
~$310/day |
| 75th Percentile |
~$322/day |
| 90th Percentile |
~$334/day |
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Operator Implication
The Quality Incentive sunsets June 30, 2026 unless the legislature extends it during the 2026 session. Facilities relying on the tripled incentive for margin stability face meaningful rate exposure if renewal does not pass. Combined with SMMC 3.0 MCO dynamics, operators should model both the floor (AHCA FFS rates) and MCO-negotiated rates when projecting 2026-27 revenue. The FRVS component increasingly differentiates reimbursement by plant age and value — a factor that should be central to any acquisition underwriting in this market.
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| Legislative & Regulatory Watch |
▮ Tier 1 — In Effect
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FY 2024-25 Appropriations Act — 8% NF Rate Increase ($247.8M)
Florida enacted its largest SNF Medicaid rate investment in recent years — $247.8M total — effective July 1, 2024 and carried forward into FY 2025-26. The 8% increase translates to approximately $470,000 per facility annually, driven by post-pandemic staffing cost pressures.
Operator implication: Meaningful margin relief across the board for facilities with high FL Medicaid census. Among the most favorable recent legislative actions for FL SNF operators.
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Quality Incentive Tripled to 17.862% (Oct 1, 2025)
The FL Quality Incentive Program was expanded from 10% to 17.862% of non-property NF expenditures (2025 session, s. 409.908 F.S.), effective October 1, 2025. Facilities must score at least 33% of 49 available quality points covering process, structure, and credentialing measures. This is the largest single rate enhancement in recent FL NF history.
Operator implication: Facilities meeting quality thresholds see meaningful rate uplift vs. peers. However, this incentive SUNSETS June 30, 2026 — see Tier 2 below.
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SMMC 3.0 — NFs Carved Into Managed Care (Feb 1, 2025)
Effective February 1, 2025, nursing facilities entered Statewide Medicaid Managed Care under SMMC 3.0. AHCA FFS rates serve as the payment floor (s. 409.908(2)(b) F.S.) — MCOs may pay above but not below. By July 2026, all FFS rates must be published online in searchable format.
Operator implication: Operators now managing MCO relationships in addition to AHCA compliance. Actual contracted rates may deviate from AHCA benchmarks depending on MCO-negotiated terms.
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NFQA Provider Assessment — Exempt from H.R.1 Phase-Down
The per-resident-day provider tax on non-Medicare bed days remains active. Florida NFs are explicitly exempted from H.R.1’s safe harbor phase-down and remain at the 6% of net patient revenue threshold. Provider tax rates are frozen and cannot be increased.
Operator implication: Rate stability on the NFQA assessment; the Medicaid share is passed through as a per diem add-on. The freeze prevents upward adjustment but also prevents unwanted increases.
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▮ Tier 2 — Active — Watch Closely
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⚠ Quality Incentive Sunset — June 30, 2026 [Highest Near-Term Risk]
The tripled Quality Incentive (17.862%) is currently set to expire June 30, 2026 unless the Florida Legislature acts during the 2026 session to extend it. No renewal legislation has been confirmed as of March 2026. If it lapses, the incentive reverts to pre-2025 levels (10%), representing a meaningful per diem reduction for qualifying facilities.
Operator implication: This is the single most consequential near-term policy risk for Florida SNF operators. Facilities with high quality scores should model the impact of a reversion when setting 2026-27 financial projections.
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H.R.1 (P.L. 119-21) — Federal Medicaid Cap for Non-Expansion States
As a non-expansion state, Florida NF Medicaid payments are capped at 110% of Medicare rates under H.R.1 (vs. 100% for expansion states). Approximately 1.5 million Floridians are projected to lose Medicaid coverage from combined ACA and Medicaid changes — with potential census implications for facilities with Medicaid-dependent populations.
Operator implication: Non-expansion status creates a relative disadvantage vs. expansion states on the federal match cap, though FL’s NFQA exemption from the provider tax phase-down partially offsets this exposure.
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FFS Rate Publication Mandate — July 2026
By July 2026, AHCA is required to publish all FFS nursing facility rates in a searchable online format. Implementation deadline is active; no delays have been announced as of March 2026.
Operator implication: Increased rate transparency will allow buyers, analysts, and operators to benchmark facility-level rates more systematically. Facilities with below-median per diems may face valuation pressure as their rate position becomes more visible.
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▮ Tier 3 — On the Horizon
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FY 2026-27 Appropriations — Rate Determination & Quality Incentive Renewal
The annual appropriations process will determine whether the 8% rate increase trajectory continues and how the Quality Incentive is structured. Both outcomes will be negotiated during the 2026 session, with the incentive renewal carrying the highest stakes.
Timing: 2026 Florida legislative session. Monitor session activity beginning Q1 2026.
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CMS Federal Staffing Mandate — Compliance Cost Exposure
The 2024 CMS federal staffing mandate requires minimum RN and nurse aide staffing levels. Florida’s for-profit sector (>80% of facilities) averages 0.67 RN hours/resident/day — well below the national median and the staffing mandate thresholds. No state-level suspension has been enacted. Compliance costs are significant for the majority of Florida operators.
Timing: Federal compliance deadlines phased through 2026-2027. Florida has not acted to modify or delay requirements at the state level.
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SMMC MCO Rate Divergence — Post-Floor Dynamics
Under SMMC 3.0, individual MCO-negotiated rates above the AHCA FFS floor will increasingly differentiate operator revenue. As contracts mature, the spread between the AHCA benchmark and actual contracted rates will become a key driver of per diem variation — potentially widening the gap between top-performing and underperforming operators.
Timing: Ongoing through 2026 as MCO contract cycles renew. Impacts operators differently based on census mix and MCO relationships.
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| State Snapshot — By Ownership Type |
Across 755 certified SNFs in Florida, the tables below compare star ratings, Medicaid rates, staffing intensity, and compliance outcomes by ownership category. Source: CMS Provider Information via 3GHCRE Supabase (most recent processing date) and AHCA Medicaid rate file (Oct 2025). State-level CNA, LPN, and weekend staffing from CMS State & National Averages file.
Table A — CMS Star Ratings & Medicaid Rate by Ownership Type
| Ownership |
# |
Overall★ |
Hlth Insp★ |
Staffing★ |
QM★ |
LS QM★ |
SS QM★ |
Occ% |
Avg Rate/day |
| For-Profit |
606 |
3.12 |
2.71 |
3.02 |
4.20 |
4.70 |
3.07 |
89.0% |
$307.92 |
| Non-Profit |
134 |
3.50 |
3.09 |
3.86 |
4.17 |
4.56 |
3.50 |
84.0% |
$307.75 |
| Government |
15 |
3.80 |
3.60 |
4.40 |
3.07 |
3.21 |
3.75 |
91.8% |
$273.03† |
★ = CMS Five-Star (1–5). LS QM = Long-Stay Quality Measures. SS QM = Short-Stay Quality Measures. † Government rate from 1 matched AHCA facility; most FL government facilities (VA, state-operated) are not in the AHCA FFS rate file. Source: 3GHCRE SNF Precision Tool | Powered by CMS Provider Information & AHCA Rate Data | March 2026.
Table B — Staffing Hours & Compliance by Ownership Type
| Ownership |
Total HPRD |
RN HPRD |
Nurse Turn% |
RN Turn% |
Fines $M |
% Fined |
% Pmt Denial |
| For-Profit |
2.27 |
0.67 |
44.5% |
48.3% |
$22.05 |
48.3% |
3.0% |
| Non-Profit |
2.53 |
0.94 |
34.5% |
37.1% |
$3.61 |
43.3% |
3.0% |
| Government |
2.95 |
1.23 |
39.8% |
35.7% |
$0.33 |
60.0% |
13.3% |
HPRD = Hours Per Resident Day (unadjusted). Turnover = CMS-reported 12-month nursing staff turnover. Fines = total CMS penalties over prior 36 months. Source: 3GHCRE SNF Precision Tool | March 2026.
Table C — Florida Staffing Detail: CNA / LPN / Weekend / Case Mix (State-Level)
CMS does not publish CNA, LPN, or weekend breakdowns by ownership type at the facility level. The figures below are Florida state-level averages from the CMS State & National Averages file.
| CNA HPRD |
LPN HPRD |
RN HPRD |
Total HPRD |
Wknd Total |
Wknd RN |
Case Mix Idx |
CM RN HPRD |
CM Total |
CM Wknd |
| 2.34 |
0.79 |
0.73 |
3.86 |
3.52 |
0.53 |
1.33 |
0.65 |
3.74 |
3.30 |
CM = Case Mix adjusted. Wknd = Weekend. Case Mix Index reflects average resident acuity. Source: 3GHCRE SNF Precision Tool | Powered by CMS State & National Averages Data | March 2026.
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Florida is the largest SNF market in the country by facility count (694 certified SNFs, 84,457 beds) with dominant for-profit ownership at 79% of facilities. Occupancy statewide is running at 88.0% as of February 2026 — 7.8 percentage points above the national average of 80.2% — driven by strong demographic demand from Florida’s large and growing elderly population. The combined rate improvement of $43.28/day over two years (+16.4%) puts Florida well above the Southeast corridor median and in line with the country’s most favorable non-expansion state rate environments.
Buyer demand for Florida SNF assets remains active, particularly in the Tampa Bay, Central Florida, Space Coast, and Jacksonville metro corridors. Florida maintains an active Certificate of Need (CON) program for skilled nursing facilities, administered by AHCA on a twice-annual batching cycle — one of the few service categories retained under CON after the state’s broad 2019 repeal that eliminated hospital CON requirements. This supply constraint is a structural tailwind for existing operators and a meaningful factor in acquisition underwriting. The FRVS component ties a portion of each facility’s Medicaid rate to physical plant age and value, creating meaningful reimbursement differentiation between newly constructed or renovated facilities and aging stock.
With 3 facilities currently on Special Focus status and 15 on SFF Candidate lists (as of CMS March 2026), distressed asset opportunities are present across the market. CMS Five-Star scores skew lower in the for-profit segment (avg 3.1) compared to non-profit peers (3.5) and government facilities (3.8), reflecting the sector’s staffing intensity challenges relative to the federal mandate baseline.
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If you own or operate a skilled nursing facility in Florida and want a confidential, no-pressure perspective on how these rate dynamics and legislative developments affect your asset’s position — or if you’re simply thinking about what options look like — we’re happy to talk. Sellers pay nothing; our compensation comes entirely from the buyer side.
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Stan Klos III
Principal, 3G Healthcare Real Estate
Cell: 813-562-7780 | Office: 317-982-5106
sklos@3ghcre.com | 3ghcre.com
Exclusively SNF Since 2012
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Sources
| AHCA — Nursing Home Rate Files | Agency for Health Care Administration | FY 2025-26 (Oct 2025 Rate Period) |
| Florida Appropriations Act (FY 2024-25) — 8% NF Rate Increase ($247.8M) | Florida Legislature | 2024 Session |
| Florida Statutes s. 409.908 — Quality Incentive Program (17.862%) | Florida Legislature | 2025 Session |
| Florida Administrative Code Rule 59G-6.010 (PPS Version LII) | AHCA | Effective Oct 1, 2024 |
| CMS Provider Information Dataset | Centers for Medicare & Medicaid Services | March 2026 Release |
| CMS Staffing Data (Payroll-Based Journal) | Centers for Medicare & Medicaid Services | Most Recent Quarter |
| H.R.1 (P.L. 119-21) — NF Medicaid Cap Provisions | U.S. Congress | 2025 |
| 3G Healthcare Real Estate SNF Market Intelligence Database | 3G Healthcare Real Estate | March 2026 |
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3G Healthcare Real Estate
456 N. Meridian St #441332, Indianapolis, IN 46204
This communication is intended for the named recipient only and contains proprietary market intelligence compiled by 3G Healthcare Real Estate.
This is not a solicitation. 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.
You are receiving this because you are a healthcare real estate professional in our network.
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