SNF occupancy by state: where the beds are full, and where they aren't

Texas has more skilled-nursing facilities than any other state, and one of the lowest occupancy rates in the country. Both facts describe the same market. The gap between them is where the diligence starts.

Median skilled-nursing occupancy is 83.8% across 12,232 Medicare cost-report filings. That single number hides a spread that runs from about 62% in Oklahoma to nearly 95% in North Dakota. For a buyer, the national figure is a starting point and nothing more. Where a facility sits inside that range, and which way its state is trending, is the read that matters.

• National median — 83.8% · Recovered above pre-COVID levels
• Fullest state — 94.8% · North Dakota, 48 facilities
• Softest state — 62.0% · Oklahoma, 248 facilities
• Largest market — 67.1% · Texas, roughly 1,000 facilities

Why occupancy is the first number a SNF buyer checks

A skilled-nursing facility carries a largely fixed cost base. Staffing ratios, the building, and its overhead do not fall much when a wing empties out, so every unoccupied bed comes straight off the margin. That makes occupancy the operating figure that tracks the P&L most tightly.

Sort facilities into occupancy quartiles and the gradient is clean. The bottom quarter, below about 71% occupied, runs a 5.8% EBITDAR margin and a negative operating margin near 3.5%. The top quarter, above roughly 91%, runs 12.0% EBITDAR and a positive 3.3% operating line. Only the fullest facilities clear a clearly positive operating margin. Everything below is fighting fixed costs. A buyer prices census risk first because census is what feeds the rest of the model.

The national picture

Median occupancy at 83.8% is a recovery number. The sector bottomed near 78% during the pandemic and has climbed back above its pre-COVID level since. The trade data tells the same story from a different source: NIC put nursing-care occupancy at 84.5% in the third quarter of 2024, its fourteenth consecutive quarter of gains, as bed absorption outran new supply and closures pulled capacity out of the market.

Both figures are directional, not audited, and they agree on the shape. Supply is tightening, demand is firming, and the national rate has settled into the low-to-mid 80s. The story is underneath it.

The states where beds are full, and the ones with slack

Occupancy clusters by geography, and the ends of the distribution are far apart. At the full end sit North Dakota (94.8%), West Virginia (94.5%), New York (93.0%), Florida (91.8%), and California (91.1%). At the slack end are Oklahoma (62.0%), Oregon (63.3%), Texas (67.1%), Idaho (72.0%), and Missouri (72.0%). Forty-four states carry enough facilities to rank.

Supply constraint explains part of the gap. States that limit new beds through certificate-of-need rules tend to run fuller than open-entry states, where operators can keep building into a market that is already soft. New York, with strong supply controls, sits near the top. Texas, which does not gate nursing-facility supply the same way, sits near the bottom despite being the largest market in the country.

That is the headline. The two biggest SNF states land at opposite ends of the range. California, with 953 rankable facilities, runs 91.1% occupied. Texas, with roughly 1,000, runs 67.1%. The largest single market in the sector is also one of the softest, which is why market selection is a first-order decision, not a detail.

What high and low occupancy signal for a deal

A full-occupancy state points to pricing power and lower census risk, and those buildings usually price accordingly. A soft-occupancy state is where distressed supply and turnaround plays live: the cheapest entry point for an operator that believes it can fill beds an incumbent could not.

Read the occupancy map as a census-risk map, not a profit map.

One caution keeps buyers honest. A full state is not a high-margin state. Across the ranked states, the correlation between median occupancy and median operating margin is weak, near 0.14. Occupancy sets a facility's operating leverage, but the state Medicaid rate and payer mix set the ceiling on what an occupied day earns. A building in a high-rate state can run at 80% and clear money that a facility in a low-rate state cannot match at 90%.

That distinction matters most in the soft states. Low occupancy plus a low state reimbursement rate is structural pressure, not a fixable census problem. Low occupancy in a state with room to raise rates or absorb demand is a different setup, and a more workable one. The number tells you where to look. It does not tell you which is which.

Reading a single facility against its state

The state median is a benchmark, not a verdict on any one building. Two adjustments make it usable.

• Reconcile the reported rate — Occupancy divides patient-days by certified beds, so an operator that has taken a wing offline can post a low figure while running its open beds nearly full. The reported number is the right benchmark for the market. On a specific target, check it against available, staffed beds before trusting it.
• Weigh the trend over the level — A facility at 82% and climbing is a different asset from one at 82% and sliding, and the same holds for a state.

A building three points under its state median can lead its local market or trail it, depending on the county and the competition next door. Read a target against a local, same-state comp, not the national line. For how the figure is built, see how SNF occupancy is calculated; for the full financial picture, see what skilled-nursing facilities actually earn and what a SNF is worth.

To place a specific facility or state against the full distribution, the Post-Acute tool returns median occupancy, revenue, and margin for any market on the free tier.

Sources and method

• Source — CMS HCRIS provider cost reports, FY2024 and FY2025 filings
• Analysis set — 12,232 facility-level filings with reported occupancy, after dropping consolidated chain filings and margin-plausibility outliers
• State ranking — Per-state medians computed only for states with at least 40 rankable facilities; 44 states qualify
• Occupancy definition — Patient-days divided by certified beds, as reported on the filing
• Statistics — Medians throughout; no means, since facility-level occupancy and margin are too dispersed for a mean to carry meaning
• Cross-check — The computed national median aligns with NIC's Q3 2024 nursing-care occupancy of 84.5%
• Known limits — Self-reported, unaudited, and lagging current operations; treat as directional market position, not a live census read

Full methodology and limitations

Disclaimer

This article is a market-data benchmarking resource derived from publicly available Medicare cost reports. It does not provide, and must not be relied upon as, a fair market value determination, valuation opinion, appraisal, or legal, tax, or compliance advice. Cost-report figures are self-reported, unaudited, and subject to revision. The opinion of value for any specific arrangement remains the professional judgment of a qualified appraiser.