Nursing Home Star Rating Changes by State
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Of the 14,457 nursing homes with a CMS overall star rating in both the Sep 2025 and the Sep 2026 data files, 4,300 (29.7%) had a higher overall rating in Sep 2026, 6,597 (45.6%) had the same rating and 3,560 (24.6%) had a lower rating. The table shows the same split for each state.
- Homes compared14,457
- Rating went up29.7%
- Stayed the same45.6%
- Rating went down24.6%
These figures describe the homes in each state as a group, not any one home. To look at one home, search by name, city or ZIP code.
By state
Select a column heading to sort the table.
| Alabama | 223 | 26.9% (60) | 55.2% (123) | 17.9% (40) |
|---|---|---|---|---|
| Alaska | 20 | 20.0% (4) | 45.0% (9) | 35.0% (7) |
| Arizona | 138 | 26.1% (36) | 46.4% (64) | 27.5% (38) |
| Arkansas | 215 | 42.8% (92) | 38.1% (82) | 19.1% (41) |
| California | 1,148 | 27.4% (314) | 47.5% (545) | 25.2% (289) |
| Colorado | 207 | 31.4% (65) | 44.4% (92) | 24.2% (50) |
| Connecticut | 190 | 27.9% (53) | 46.8% (89) | 25.3% (48) |
| Delaware | 42 | 23.8% (10) | 54.8% (23) | 21.4% (9) |
| District of Columbia | 17 | 29.4% (5) | 47.1% (8) | 23.5% (4) |
| Florida | 687 | 31.1% (214) | 48.2% (331) | 20.7% (142) |
| Georgia | 350 | 30.3% (106) | 44.6% (156) | 25.1% (88) |
| Guam | 1 | 100.0% (1) | 0.0% (0) | 0.0% (0) |
| Hawaii | 40 | 37.5% (15) | 45.0% (18) | 17.5% (7) |
| Idaho | 79 | 30.4% (24) | 40.5% (32) | 29.1% (23) |
| Illinois | 661 | 25.6% (169) | 54.0% (357) | 20.4% (135) |
| Indiana | 501 | 27.9% (140) | 49.3% (247) | 22.8% (114) |
| Iowa | 384 | 29.9% (115) | 42.4% (163) | 27.6% (106) |
| Kansas | 290 | 33.8% (98) | 43.1% (125) | 23.1% (67) |
| Kentucky | 263 | 39.2% (103) | 39.5% (104) | 21.3% (56) |
| Louisiana | 262 | 32.1% (84) | 46.6% (122) | 21.4% (56) |
| Maine | 77 | 35.1% (27) | 39.0% (30) | 26.0% (20) |
| Maryland | 217 | 32.3% (70) | 46.1% (100) | 21.7% (47) |
| Massachusetts | 336 | 31.0% (104) | 50.0% (168) | 19.0% (64) |
| Michigan | 417 | 28.8% (120) | 44.1% (184) | 27.1% (113) |
| Minnesota | 335 | 29.6% (99) | 43.6% (146) | 26.9% (90) |
| Mississippi | 198 | 26.8% (53) | 48.0% (95) | 25.3% (50) |
| Missouri | 474 | 25.1% (119) | 48.5% (230) | 26.4% (125) |
| Montana | 57 | 35.1% (20) | 33.3% (19) | 31.6% (18) |
| Nebraska | 176 | 27.8% (49) | 41.5% (73) | 30.7% (54) |
| Nevada | 64 | 31.2% (20) | 48.4% (31) | 20.3% (13) |
| New Hampshire | 72 | 31.9% (23) | 36.1% (26) | 31.9% (23) |
| New Jersey | 343 | 35.6% (122) | 37.9% (130) | 26.5% (91) |
| New Mexico | 66 | 31.8% (21) | 42.4% (28) | 25.8% (17) |
| New York | 589 | 29.0% (171) | 49.6% (292) | 21.4% (126) |
| North Carolina | 413 | 32.2% (133) | 47.5% (196) | 20.3% (84) |
| North Dakota | 70 | 25.7% (18) | 48.6% (34) | 25.7% (18) |
| Ohio | 907 | 28.6% (259) | 44.4% (403) | 27.0% (245) |
| Oklahoma | 280 | 30.7% (86) | 43.2% (121) | 26.1% (73) |
| Oregon | 126 | 34.1% (43) | 40.5% (51) | 25.4% (32) |
| Pennsylvania | 648 | 29.2% (189) | 46.3% (300) | 24.5% (159) |
| Puerto Rico | 6 | 50.0% (3) | 16.7% (1) | 33.3% (2) |
| Rhode Island | 70 | 30.0% (21) | 37.1% (26) | 32.9% (23) |
| South Carolina | 186 | 34.4% (64) | 40.9% (76) | 24.7% (46) |
| South Dakota | 92 | 34.8% (32) | 41.3% (38) | 23.9% (22) |
| Tennessee | 295 | 38.0% (112) | 41.7% (123) | 20.3% (60) |
| Texas | 1,154 | 25.8% (298) | 41.3% (477) | 32.8% (379) |
| Utah | 95 | 33.7% (32) | 40.0% (38) | 26.3% (25) |
| Vermont | 31 | 35.5% (11) | 32.3% (10) | 32.3% (10) |
| Virginia | 285 | 24.6% (70) | 56.8% (162) | 18.6% (53) |
| Washington | 188 | 30.9% (58) | 43.6% (82) | 25.5% (48) |
| West Virginia | 120 | 39.2% (47) | 40.8% (49) | 20.0% (24) |
| Wisconsin | 319 | 27.6% (88) | 48.6% (155) | 23.8% (76) |
| Wyoming | 33 | 30.3% (10) | 39.4% (13) | 30.3% (10) |
| United States | 14,457 | 29.7% (4,300) | 45.6% (6,597) | 24.6% (3,560) |
Each percentage is the share of the homes compared in that state; the number of homes is in brackets. The "United States" row covers the homes in all the rows above.
Download this table (CSV). Each column comes twice: as shown on this page and as a plain value. Please credit Nursing Home Checker and CMS.
How we calculated this
- Field: "Overall Rating" (1 to 5) in CMS's monthly Provider Information files, as published in each file.
- Months compared: the Sep 2026 file (the latest one this site uses) and the Sep 2025 file.
- Homes included: the 14,457 homes with an overall rating in both files. Left out: 233 of the 14,690 homes in the Sep 2026 file, because one or both files have no overall rating for them (the home is not in the earlier file, or CMS published no overall rating for it in one of the two months).
- "Went up" means the rating in the later file is higher than in the earlier file. Only these two files are compared, so a rating that changed and then changed back in between counts as "stayed the same".
- CMS changed parts of its rating method during this period. For example, its Technical Users' Guide says that effective with the July 2026 refresh CMS raised the quality measure rating thresholds. A change in a rating can therefore come from a change in CMS's method as well as from a change at the home.
- CMS's overall rating starts from the health inspection rating, and CMS sets health inspection ratings by comparing homes within each state. Compare state figures with care.
- Each home is counted in the state listed for it in the Sep 2026 Provider Information file. The table has a row for each place where that file lists homes: 50 states, the District of Columbia, Guam and Puerto Rico.
More data reports
- Nurse staffing hoursAverage reported nurse staffing: 3.77 hours per resident per day in CMS's Oct 2023 file (April–June 2023) and 3.85 in its Sep 2026 file (January–March 2026).
- Weekend staffingAverage reported nurse staffing: 3.86 hours per resident per day overall, 3.42 on weekends (Sep 2026 file: January–March 2026).
- Nursing staff turnoverAverage total nursing staff turnover: 45.8% across the 13,538 homes CMS reports it for (Sep 2026 file: January–December 2025).
- Changes of ownershipCMS's September 29, 2026 file lists a change of ownership effective from September 30, 2023 to September 29, 2026 for 1,452 homes (10.1%). The file lists no change effective after May 8, 2026.
- Changes since last month544 homes had a higher overall rating in the Sep 2026 file than in the Aug 2026 file; 404 had a lower one.
- Fines and payment denialsCMS lists 2,689 fines totaling $105,022,269 at 2,147 homes with a penalty date from September 2, 2025 to September 1, 2026.
- Special Focus FacilitiesThe Sep 2026 CMS file lists 87 Special Focus Facilities and 440 candidates.
Source: CMS Provider Data Catalog, Nursing homes including rehab services: Provider Information files processed Sep 2025 (from CMS's archive) and Sep 2026.
Updated each time CMS publishes new data. Calculated by Nursing Home Checker; these are not CMS's own figures. Report an error