|
SNF Market Intelligence Report
April 2026 · Proprietary & Confidential
Exclusively SNF Since 2012
|
|
Indiana’s skilled nursing facility market is at an inflection point. The state completed its transition to managed care Medicaid through the PathWays for Aging program in 2024–25, ending decades of fee-for-service predictability. SNF reimbursement is now MCO-determined, creating a growing divide between operators with strong managed care contracts and those with weak positions — and a meaningful pipeline of motivated sellers as a result.
This report covers Indiana’s Medicaid floor rate trajectory, the State-Directed Payment (SDP) supplement that raises effective rates $20–$22/day above the floor, ownership-segment performance, and the top operator chains shaping the market. Indiana is 3GHCRE’s home state and a priority market.
This is proprietary market intelligence prepared exclusively for 3G Healthcare Real Estate’s internal use and select client distribution. Not a solicitation.
|
|
Market Snapshot — January 2026
|
495
Licensed Facilities
|
$302.42
Avg Floor Rate / Day
|
~$322–$325
Effective Rate w/ SDP
|
5.15
Distress Score 🟠
|
|
|
Table A — Medicaid Floor Rate Trend (2024–2026)
FSSA-set per diem floor rate — FFS-equivalent basis. Does not include MCO-negotiated amounts above floor or SDP supplement.
| Period |
Facilities |
Avg Rate |
P25 |
P75 |
Range |
| Jan 2024 |
500 |
$293.31 |
$278.24 |
$308.22 |
$205–$444 |
| Jul 2024 |
500 |
$305.58 |
$289.05 |
$322.51 |
$205–$459 |
| Jan 2025 |
499 |
$303.96 |
$287.74 |
$319.55 |
$217–$458 |
| Jul 2025 |
499 |
$306.21 |
$290.80 |
$321.08 |
$213–$467 |
| Jan 2026 ✦ |
495 |
$302.42 |
$286.95 |
$318.21 |
$207–$464 |
✦ Most recent period. Source: Indiana FSSA / Supabase medicaid.rates. Daily rate range filtered $100–$600.
|
|
Rate Trend Read: The floor rate peaked at $306.21 in Jul 2025 and dipped to $302.42 by Jan 2026 — a –$3.79/day ($1.2%) correction. This is the FSSA-set floor only. Under PathWays, MCOs can and do pay above-floor rates, so the floor trend understates actual revenue for well-positioned operators. The 2-year trend from Jan 2024 baseline is +$9.11/day (+3.1%) — modest but positive in real terms.
|
|
|
Table B — Effective Medicaid Rate Including State-Directed Payment (SDP)
Under PathWays for Aging, Indiana supplements the floor rate through a CMS-approved SDP pool paid via MCOs. The floor alone understates actual Medicaid revenue.
|
SDP Pool — CMS Approved (SFY Jul 2024 – Jun 2025)
|
$180.7M
Total Pool
|
$162.6M
Pool 1: Utilization (90%)
|
$18.1M
Pool 2: Quality (10%)
|
|
| Facility Type / Quality Tier |
Floor Rate |
Est. SDP Add-On |
Effective Rate |
100-Bed Annual Impact |
| Private NF — 1–2 star |
$302.42 |
+$9–$12 |
~$311–$314 |
+$328K–$438K |
| Private NF — 3–4 star |
$302.42 |
+$18–$22 |
~$320–$324 |
+$657K–$803K |
| NSGO (County/Gov) — any star |
$307.55 |
+$25–$30 |
~$332–$337 |
+$912K–$1.1M |
| Private NF — 5 star / strong MCO |
$302.42 |
+$35–$58 |
~$340–$360 |
+$1.3M–$2.1M |
SDP estimates are aggregate approximations derived from CMS-approved pool totals (~$180.7M ÷ ~8.7M Medicaid resident days). Actual facility amounts depend on MCO contract terms, quality tier, and Medicaid utilization. Annual impact assumes 65% Medicaid census on 100 certified beds.
|
|
H.R. 1 Watch: The One Big Beautiful Bill Act (enacted July 4, 2025) caps state-directed payments to MCOs at 100% of the Medicare rate for Medicaid expansion states — Indiana qualifies. This ceiling is not currently binding at today’s SDP levels, but it constrains future growth and increases policy risk for operators dependent on SDP to fund operations.
|
|
|
Table C — Performance by Ownership Type (Jan 2026)
Indiana has a uniquely high share of government-owned (NSGO) facilities — 123 of 495 — the legacy of county-operated nursing homes across rural Indiana.
| Ownership Type |
Count |
Avg Rate |
Avg Stars |
Avg Beds |
Occupancy |
| For Profit — Corporation |
203 |
$300.60 |
3.07 ⭐ |
95 |
72% |
| Government — County NSGO |
102 |
$307.55 |
3.32 ⭐ |
103 |
76% |
| Non Profit — Corporation |
75 |
$300.35 |
3.20 ⭐ |
97 |
77% |
| For Profit — LLC Watch |
47 |
$299.53 |
2.55 ⭐ |
93 |
68% |
| All Other |
68 |
$303.87 |
3.18 ⭐ |
101 |
73% |
Occupancy = average_residents ÷ bed_count. NSGO = Non-State Government Owner (county/municipal). For-profit LLC segment shows lowest stars (2.55) and occupancy (68%) — primary distress cohort.
|
|
Table D — CMS Star Rating Distribution (Jan 2026)
Indiana’s star distribution is relatively even — notable that the 1-star cohort (85 facilities) commands nearly $13/day less in floor rates than 5-star facilities, and this gap widens materially once SDP quality-tier premiums are layered in.
| Rating |
Facilities |
Avg Floor Rate |
Share of Market |
Segment Flag |
| ★ 1 Star |
85 |
$293.00 |
17.2% |
High Distress |
| ★★ 2 Stars |
92 |
$297.20 |
18.6% |
Watch |
| ★★★ 3 Stars |
103 |
$305.55 |
20.8% |
Stable |
| ★★★★ 4 Stars |
103 |
$305.72 |
20.8% |
Strong |
| ★★★★★ 5 Stars |
104 |
$306.45 |
21.0% |
Premium |
|
|
PathWays for Aging — What Operators & Buyers Need to Know
|
The Transition Is Complete — FFS Is Gone
Indiana fully transitioned LTC Medicaid from fee-for-service to PathWays MCO management in 2024–25. The FSSA floor rate still sets a minimum, but the actual amount an SNF receives is determined by its individual MCO contracts — which can be materially above or below the floor depending on the operator’s leverage and quality profile.
|
|
Winners Under PathWays
✓ High-quality operators (4–5 star)
✓ Facilities with diversified payer mix
✓ Regional chains with MCO negotiating scale
✓ Post-acute/skilled-mix focused operators
|
|
Motivated Seller Candidates
→ Single-MCO dependent operators
→ High Medicaid census + weak contract
→ 1–2 star facilities with low occupancy
→ Small independent operators (1–3 facilities)
|
|
|
3GHCRE Indiana Market Read
Indiana is 3G Healthcare Real Estate’s home state and a Tier 1 market. The PathWays transition has created a bifurcated landscape: well-run facilities with strong MCO positioning are thriving, while operators relying on the legacy predictability of FFS are experiencing real margin compression. This is a transaction pipeline, not a market headwind.
|
|
|
3G Healthcare Real Estate works exclusively in skilled nursing — no other asset class. Our buyer-compensated model means sellers pay no fee. If you or a client are evaluating options in Indiana or any other state, we bring proprietary market intelligence and a competitive multi-buyer process.
|
|
3G Healthcare Real Estate — Exclusively SNF Since 2012
Indianapolis, Indiana · www.3ghcre.com
This report is prepared by 3G Healthcare Real Estate for informational purposes only and does not constitute investment, legal, or financial advice. Medicaid floor rates sourced from Indiana FSSA and 3GHCRE Supabase data platform (Jan 2026 period). SDP per-diem estimates are aggregate approximations derived from CMS-approved pool totals and CMS occupancy data. Actual facility-level amounts are determined by MCO contract terms, quality tier assignment, and Medicaid utilization as reported to FSSA. H.R. 1 cap provisions per the One Big Beautiful Bill Act, §438.6(c). 3G Healthcare Real Estate is a li
|
