3G Healthcare Real Estate
Indiana

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.

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. The 2-year trend from Jan 2024 baseline is +$9.11/day (+3.1%).

Table B — Effective Medicaid Rate Including State-Directed Payment (SDP)

SDP Pool — CMS Approved (SFY Jul 2024 – Jun 2025)

$180.7M

Total Pool

$162.6M

Pool 1 (90%)

$18.1M

Pool 2 (10%)

Facility Type / Quality Tier Floor Rate Est. SDP Effective 100-Bed 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) $307.55 +$25–$30 ~$332–$337 +$912K–$1.1M
Private NF — 5 star $302.42 +$35–$58 ~$340–$360 +$1.3M–$2.1M

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.

Table C — Performance by Ownership Type (Jan 2026)

Ownership Count Avg Rate Stars Beds Occ.
For Profit — Corp 203 $300.60 3.07 ⭐ 95 72%
Government — County 102 $307.55 3.32 ⭐ 103 76%
Non Profit — Corp 75 $300.35 3.20 ⭐ 97 77%
For Profit — LLC 47 $299.53 2.55 ⭐ 93 68%
All Other 68 $303.87 3.18 ⭐ 101 73%

Table D — CMS Star Rating Distribution (Jan 2026)

Rating Facilities Avg Floor Rate Share 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.

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. 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.

Stan Klos III · stan@3ghcre.com
Christian Patrick · cp@3ghcre.com

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