3G Healthcare Real Estate

Mississippi

SNF Market Intelligence Report

March 2026 · Proprietary & Confidential

Exclusively SNF Since 2012

Below is 3G Healthcare Real Estate’s March 2026 intelligence report on Mississippi’s skilled nursing facility market — Medicaid rate environment, legislative landscape, and ownership-level performance benchmarks. Mississippi is one of the most operationally complex SNF markets in the country. What happens in Jackson affects every facility in the state, and the federal dynamics unfolding through H.R.1 add an additional layer of urgency for owners watching the reimbursement trajectory.

This is proprietary market intelligence, not a solicitation. We share it because informed operators make better decisions — and because specific knowledge of your state’s environment is more valuable than generic industry commentary.

Medicaid Rate Snapshot

$284.07

Avg Per Diem — Jan 2026

+0.8%

Year-Over-Year Change

Rate Range: $208.78 – $336.95 / day · Median: $287.45/day · Updated Quarterly

Period Avg Per Diem Median Facilities Range
Jan 2026 (Current) $284.07 $287.45 167 $208–$337
Oct 2025 $282.66 $285.93 171 $207–$349
Jan 2025 (Post-Rebase) $281.89 $284.87 171 $210–$353
Oct 2024 (Pre-Rebase) $298.49 $301.29 189 $215–$377
Apr 2024 $298.32 $300.53 189 $215–$379
⚠ Jan 2025 rebase: avg dropped ~$16.60/day and ~18 facilities exited the rate file. Rates have stabilized but have not recovered to pre-rebase levels as of Jan 2026. Source: 3GHCRE SNF Precision Tool | MS DOM rate data.

Mississippi reimburses SNFs under a cost-based prospective per diem system administered by the Mississippi Division of Medicaid (DOM). Rates are updated quarterly (January, April, July, October), providing more frequent adjustments than most states in the region. Effective January 1, 2026, the state transitioned to PDPM case-mix alignment under SPA 25-0015, moving from the prior RUG-IV methodology. The state fiscal year runs July 1 through June 30.

Mississippi nursing facilities are carved out of managed care — the state Medicaid agency sets rates directly in a fee-for-service system, providing rate transparency uncommon in other states. This means operators deal directly with DOM rather than navigating MCO contract dynamics. The permanent CON moratorium (in place since 1990) means no new NF beds can be licensed: acquisitions are the only market entry path.

Percentile Est. Per Diem
10th Percentile ~$230/day
25th Percentile ~$254/day
Median (50th) $287.45/day
75th Percentile ~$310/day
90th Percentile ~$325/day

Operator Implication

Rates stabilized at $281.89–$284.07/day following the January 2025 rebase but have not recovered to pre-rebase levels ($298.49). With quarterly updates and PDPM now in effect, rate movement will be driven primarily by case-mix acuity levels and cost report submissions. Operators with higher-acuity residents command higher per diems under the new methodology. The CON moratorium means that market entry is acquisition-only — a structural barrier that supports asset valuations despite the challenging rate environment.

Legislative & Regulatory Watch

▮ Tier 1 — In Effect

In Effect

SPA 25-0015 — PDPM Transition (Jan 1, 2026)

Mississippi’s State Plan Amendment 25-0015 transitioned SNF Medicaid reimbursement from the prior RUG-IV case-mix classification to the federal Patient Driven Payment Model (PDPM) effective January 1, 2026. Cost-based quarterly rate updates continue under the new methodology. This represents the most significant reimbursement structure change for Mississippi SNF operators in years.

Operator implication: Facilities with higher-acuity resident populations are positioned to benefit under PDPM’s patient-driven model. Operators should review case-mix coding practices and ensure cost reports reflect actual patient complexity.

In Effect

CON Moratorium — Permanent Since 1990

Mississippi has maintained a permanent moratorium on new nursing facility bed licensure since 1990. No new NF beds can be licensed in the state. This is the structural foundation of the Mississippi SNF market: acquisitions are the only viable market entry path for any buyer or new operator.

Operator implication: The moratorium creates a supply-constrained market that supports asset values despite challenging reimbursement dynamics. There is no competitive new supply entering the market. Any player who wants licensed capacity must acquire it.

▮ Tier 2 — Active — Watch Closely

Active — Watch Closely

⚠ P.L. 119-21 (H.R.1) — ~$3.2B FMAP Reduction Over 10 Years

Federal legislation P.L. 119-21 projects an approximately $3.2 billion reduction in Federal Medical Assistance Percentages (FMAP) for Mississippi over 10 years. The provider tax is frozen at the federal maximum, which constrains DOM’s primary lever for increasing the Medicaid match without legislative appropriations. As a non-expansion state, Mississippi does not benefit from the expansion-state FMAP floor protections included in the legislation.

Operator implication: This is the most consequential external pressure on Mississippi Medicaid reimbursement in the near term. A reduction in FMAP match funds constrains DOM’s capacity to increase base rates, even if appropriations support is available at the state level. Monitor federal implementation closely.

Active — Watch Closely

Post-PDPM Rate Recalibration — Pre-Rebase Levels Not Yet Recovered

The January 2025 rebase that accompanied the methodology transition dropped average per diems approximately $16.60/day from the October 2024 levels ($298.49 to $281.89). As of January 2026, the state average of $284.07/day has not returned to pre-rebase levels despite 12 months of quarterly updates. The pace of recovery will depend on future cost report cycles and DOM’s rate-setting decisions under the new PDPM framework.

Operator implication: Underwriting based on pre-January 2025 rate levels will overstate projected revenues. Use $281.89–$284.07/day as the current calibration range until rates demonstrably recover above the $298 threshold.

▮ Tier 3 — On the Horizon

On the Horizon

Medicaid Expansion — Legislative Movement Unlikely Near-Term

Mississippi remains one of the last non-expansion states. No active Medicaid expansion bills have been identified in the 2025-26 legislative session. If expansion were enacted, it would materially improve reimbursement dynamics for operators with high Medicaid census by broadening the eligible population and improving federal match rates. No current movement on this front as of March 2026.

Timing: No credible session timeline. A long-term structural watch item with the highest potential impact on operator economics if enacted.

On the Horizon

FY 2026-27 State Budget — DOM Rate Appropriations

Mississippi’s annual Medicaid appropriations process will determine DOM’s capacity to adjust NF rates in FY 2026-27. Combined with FMAP constraints from H.R.1, state-level budget dynamics are a key rate trajectory variable. Quarterly SPA amendments and cost report recalibrations under PDPM will also shape the rate environment.

Timing: FY 2026-27 session underway. Rate changes would take effect in subsequent quarterly updates.

On the Horizon

No SNF-Specific Legislation Identified — 2025-26 Session

No major SNF-specific legislative activity has been identified in the current Mississippi legislative session. Standard Medicaid administration continues under DOM. We continue to monitor session developments and any proposed regulatory changes.

No current items identified. Monitoring continues.

State Snapshot — By Ownership Type

Across 210 certified SNFs in Mississippi, the tables below compare star ratings, Medicaid rates, staffing intensity, and compliance outcomes by ownership category. Source: 3GHCRE SNF Precision Tool, powered by CMS Provider Information (most recent processing date) and MS Division of Medicaid rate file (Jan 2026). 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 163 2.54 2.69 3.52 2.10 2.08 2.18 85.5% $278.59
Government 26 2.96 3.20 4.00 2.40 2.13 2.55 84.2% $303.15
Non-Profit 21 3.19 3.00 4.00 2.43 2.43 2.50 88.9% $301.56

★ = CMS Five-Star (1–5). LS QM = Long-Stay Quality Measures. SS QM = Short-Stay Quality Measures. Medicaid rate = avg of matched facilities in MS DOM Jan 2026 rate file. Source: 3GHCRE SNF Precision Tool | Powered by CMS Provider Information & MS DOM 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 2.40 0.56 48.8% 43.1% $4.02 57.1% 14.1%
Government 2.85 0.95 43.0% 34.1% $0.12 30.8% 0.0%
Non-Profit 2.76 0.77 45.4% 41.3% $0.16 38.1% 9.5%

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 — Mississippi 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 Mississippi 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
2.48 1.09 0.63 4.21 3.51 0.37 1.21 0.60 3.41 3.00

CM = Case Mix adjusted. Wknd = Weekend. Case Mix Index reflects average resident acuity. MS has notably high LPN utilization (1.09 HPRD) relative to RN hours (0.63), a common pattern in lower-acuity Southern markets. Source: 3GHCRE SNF Precision Tool | Powered by CMS State & National Averages Data | March 2026.

Market Observations

Mississippi is a supply-constrained SNF market of 210 certified facilities and 17,473 beds — one of the smaller state markets by size but with its own distinctive structural dynamics. The permanent CON moratorium, in place since 1990, means that no new bed capacity can enter the market. For a buyer, every position available is through acquisition; for a seller, there is no competitive new supply to contend with. That structural scarcity supports valuations in a market that would otherwise look challenged on purely operational metrics.

The market is heavily Medicaid-dependent — a natural result of Mississippi’s demographics and non-expansion status. The for-profit sector (78% of facilities) averages 2.54 overall stars with nursing turnover near 48.8%, among the highest in the region. Non-profit facilities outperform on quality and staffing metrics with an average 3.19 overall stars and 45.4% turnover. Occupancy rates are high relative to the national average, reflecting consistent census demand in a constrained-supply market.

Mississippi sits at the lower end of the Southeast corridor on per diem rates ($208–$337/day), alongside Alabama, Louisiana, and Arkansas. The PDPM transition and quarterly rate update cycle offer more operational responsiveness than annual-update states, though the pace of rate recovery post-rebase will be a critical watch item through 2026.

If you own or operate a skilled nursing facility in Mississippi and want a confidential perspective on how these rate dynamics and structural market realities affect your asset’s position — whether you’re thinking about timing, value, or simply what options look like — we’re happy to have that conversation. Sellers pay nothing; our compensation comes entirely from the buyer side.

Start a Confidential Conversation

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

Sources

Mississippi Division of Medicaid — NF Per Diem Rate Files | MS DOM | January 2026 Rate Period
SPA 25-0015 — PDPM Transition | Mississippi Division of Medicaid | Effective January 1, 2026
Mississippi Legislature — CON Moratorium | Mississippi Legislature | Original Enactment 1990, Permanent
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) — FMAP Reduction Provisions | U.S. Congress | 2025
3G Healthcare Real Estate SNF Market Intelligence Database | 3G Healthcare Real Estate | March 2026

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.

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