Choosing a nursing home (the legal name for all nursing facilities, which are also called skilled nursing facilities or SNFs, nursing facilities, rehabilitation facilities, long-term care facilities, health care facilities, and health and rehab centers) for a parent, spouse, or other family member can be one of the most consequential decisions a family makes. Yet families are often trying to make that decision quickly, under tremendous pressure, and while sorting through conflicting information from nursing homes, hospital discharge planners, internet reviews, and senior-placement companies.
For nationwide nursing home ratings and objective quality information, there is only one source you can rely on: the federal government’s Nursing Home Care Compare website.
U.S. Centers for Medicare & Medicaid Services created the Five-Star Quality Rating System specifically to help residents, families, and caregivers compare nursing homes. Care Compare provides an overall rating of 1 to 5 stars, along with separate ratings for health inspections, staffing, and quality measures. CMS states that 5-star nursing homes are considered to have “much above average quality,” while 1-star facilities are considered to have quality that is “much below average.”
Care Compare is also the only place you can reliably verify whether a nursing home participates in Medicare (which only pays for short-term skilled nursing or rehabilitation care after a qualifying three-midnight hospital stay) and/or Medicaid (which pays for long-term care).
CMS Changed Nursing Home Quality Ratings in July 2026
Beginning with the July 2026 Care Compare refresh, CMS made an important change to the Quality Measure portion of its Five-Star system.
The July 2026 CMS Technical Users’ Guide states that CMS is increasing each Quality Measure rating threshold by “one-half of the average improvement in QM scores.” CMS measured that improvement using national Quality Measure performance from January 2025 through April 2026. (Centers for Medicare & Medicaid Services.)
The practical effect is important: a nursing home can improve its actual quality performance and still lose a Quality Measure star.
Imagine that a facility’s quality scores improve over 6 months. Under the old thresholds, that improvement might have been enough for the facility to retain a 4-star Quality Measure rating. But if CMS raises the threshold faster than the facility’s score improves, that same facility could fall to 3 stars despite having better clinical results than it had before.
That does not make the star rating useless. It means families need to understand what the rating represents.
Do Not Judge a Nursing Home by the Overall Star Rating Alone
CMS does not calculate the Five-Star rating from a single measure. The rating system evaluates three separate domains:
• Health inspections — based on state inspection findings, including the number, scope, and severity of deficiencies
• Staffing — based on staffing levels and staff turnover
• Quality measures — based on resident assessment and Medicare claims data measuring specific aspects of resident care and outcomes.
CMS then combines those factors into the overall Five-Star rating. CMS describes the health inspection rating as the starting point for calculating the overall rating, with staffing and Quality Measure performance capable of adjusting that rating.
That is why two nursing homes with the same overall rating can seem very different.
One may have excellent staffing but troubling inspection results. Another may have a strong inspection record but weaker clinical quality measures. A third may have recently improved considerably but lost a Quality Measure star because CMS increased the national threshold.
Always click through the overall rating and examine the individual components.
What Nursing Home Quality Measures Should Families Examine?
CMS’s nursing home quality measures examine specific outcomes and care issues rather than simply assigning a subjective score.
Depending upon the resident population and measure involved, CMS reports data addressing matters such as:
• Hospital readmissions
• Emergency department visits
• Pressure ulcers and pressure injuries
• Antipsychotic medication use
• Falls and injuries
• Decline in activities of daily living
• Vaccination measures
• Other short-stay and long-stay resident outcomes
CMS currently uses 15 quality measures in calculating the Five-Star Quality Measure rating, although Care Compare publishes additional measures that are not included in the star calculation.
Those individual measures often tell you more than the overall number of stars.
How Do I Find Out Whether a Nursing Home Accepts Medicaid?
This is one of the most common questions families ask us.
Start and end with Medicare Nursing Home Care Compare. This is the only reliable source of finding out whether a nursing home takes Medicaid. Do not bother asking the nursing home if they take Medicaid, because many times people working at nursing homes will give you inaccurate information.
In our experience and according to the CMS Care Compare website, approximately 98 percent of all nursing homes accept Medicaid. CMS nursing home data identifies facilities participating in Medicare and/or Medicaid. You simply apply the appropriate filter and search the geographic area in which you are looking. Almost all nursing homes accept Medicare, and most nursing homes actively seek to admit patients who need rehabilitation, because Medicare reimbursement rates are very high, typically higher than the private room of the facility.
This distinction matters enormously because Medicare and Medicaid serve very different purposes. Medicare may pay for a limited period of skilled nursing or rehabilitation care when its coverage requirements are satisfied, but Medicare does not pay indefinitely for custodial long-term nursing home care. Medicaid is the government program that pays for ongoing nursing home care for eligible residents (Medicare).
Are There Really Separate “Medicaid Beds” in a Medicaid-Certified Nursing Home?
Families are frequently given innacurate information, including being told by a nursing home that they don’t take Medicaid when they do. Families are also often told some version of this:
“Yes, we accept Medicaid, but we don’t have any Medicaid beds available.”
That statement is highly misleading.
In a Medicaid-certified nursing home, beds are not a permanent inventory divided into one group of “private-pay beds” and another group of “Medicaid beds.”
Most nursing homes typically prefer to admit someone who can pay its higher private-pay rate. That is an admissions preference.
But once a resident has been admitted, federal law severely restricts when the nursing home can involuntarily transfer or discharge that resident.
The federal regulation at 42 C.F.R. § 483.15 requires the facility to use identical transfer and discharge practices “regardless of source of payment.” It also provides that a facility “must permit each resident to remain in the facility” unless one of the specifically authorized grounds for transfer or discharge applies.
Most importantly for Medicaid Planning, when a resident becomes Medicaid-eligible after admission, 42 C.F.R. § 483.15(c)(1)(i)(E) provides that the facility may charge that resident only the charges permitted under Medicaid.
So if your loved one enters a Medicaid-certified nursing home as a private-pay resident and later becomes eligible for Medicaid, the nursing home cannot simply say: “This is a private-pay bed, so you have to leave.”
That is not how the federal nursing home rules work.
For practical purposes, every bed in a Medicaid-certified nursing home is potentially a Medicaid bed once the resident occupying that bed qualifies for Medicaid.
Can a Nursing Home Require Private Payment Before Medicaid?
A nursing home may prefer to admit someone who will initially pay privately. But a Medicaid-certified nursing home cannot require a Medicaid-eligible resident or potential resident to waive Medicaid rights or promise not to apply for Medicaid.
The federal admissions regulation expressly prohibits a facility from requiring a resident or potential resident to waive Medicare or Medicaid rights. It also prohibits the facility from requiring an assurance that the person will not apply for Medicare or Medicaid benefits. 42 C.F.R. § 483.15(a)(2).
That distinction matters.
A facility’s preference for a private-pay applicant is one issue.
Telling an existing resident that they must continue private-paying after becoming Medicaid-eligible is another issue entirely, and it is not legal.
What About Nursing Home Medicaid Waiting Lists?
Nursing homes often tell families that they have a waiting list. They may tell you something like “we have a six-month waiting list” or “there are 40 people ahead of your mother.”
Do not assume that means your family member will actually wait 6 months or that 40 people will literally be admitted first.
We deal with nursing home admissions every day. Many nursing home waiting lists are far less concrete than families imagine.
A facility’s list may contain people who:
• Entered another nursing home
• No longer require nursing home care
• Are not ready to move
• Cannot be reached
• No longer satisfy the facility’s admission requirements
• Died while their names remained on the list
Now consider the position of the nursing home admissions director:
- A bed opens today.
- The admissions office could spend hours calling people who put their names on a waiting list months ago, reaching voicemail after voicemail and determining whether each person is still alive, still needs nursing home care, still wants that facility, and is actually prepared to move.
- Or the admissions office may have a qualified applicant available today, medically ready for admission, already approved for Medicaid or with a Medicaid application being handled by an experienced Elder Law firm.
Which applicant do you think is easier to admit?
This is why nursing home placement is not simply a matter of putting a name on a list and waiting.
How the Farr Law Firm Helps Clients Get Into Nursing Homes
Our Nursing Home Coordinator, Jeannie Farr, has long-standing working relationships with nursing home administrators and admissions personnel throughout Virginia, Maryland, and Washington, DC.
We get clients admitted to nursing homes regularly despite “waiting lists.”
When a nursing home knows that our client is already on Medicaid or that Farr Law Firm is filing and handling the Medicaid application, the facility knows it is dealing with an applicant who is ready to move and whose Medicaid eligibility process is being professionally managed.
No attorney or nursing home coordinator can force a facility to admit a particular applicant. A nursing home still must determine that it can meet the applicant’s medical and care needs and that an appropriate bed is available.
But please don’t hear “waiting list” and assume the discussion is over.
How Should I Compare Nursing Homes Near Me?
Medicare Nursing Home Care Compare is the only way to search for nursing homes.
Search then examine:
• The overall Five-Star rating
• The health inspection rating
• The staffing rating
• The Quality Measure rating
• The actual inspection deficiencies
• The severity of those deficiencies
• Individual quality measures
• Staffing levels and turnover
• Whether the nursing home participates in Medicaid
• Whether the facility can meet your family member’s particular medical and behavioral needs
• The nursing home’s location relative to family members who will visit and advocate for the resident
Care Compare is the only official way you can make meaningful comparisons among nursing homes and identify areas about which you should ask questions.
Frequently Asked Questions About Nursing Home Ratings and Medicaid
What is the most reliable website for nursing home ratings?
For nationwide nursing home comparisons, use the federal government’s Medicare Nursing Home Care Compare website. It contains CMS Five-Star ratings, inspection information, staffing information, quality measures, and federal certification data.
How can I tell whether a nursing home accepts Medicaid?
Look up the facility through Medicare Nursing Home Care Compare website and verify its participation. This is the only method for making this determination. Do not rely on what the nursing home tells you.
Can a nursing home improve and still lose a star rating?
Yes. Beginning with the July 2026 refresh, CMS raised the Quality Measure rating thresholds based on national improvement. A nursing home’s Quality Measure performance can improve while still failing to reach the new, higher threshold for its prior star level.
Does a 5-star nursing home automatically mean it is the best nursing home for my parent?
No. Five stars are useful information, not a substitute for investigation. Examine the health inspection, staffing, and Quality Measure ratings separately and then determine whether the particular facility can meet your family member’s needs. CMS designed the rating system to help consumers make comparisons and identify questions to investigate.
Does a Medicaid-certified nursing home have only a limited number of “Medicaid beds”?
Do not think of a Medicaid-certified nursing home as having a permanent inventory of private-pay beds and Medicaid beds. Once a resident is admitted and later becomes Medicaid-eligible, federal law protects the resident from being discharged merely because the payment source changes from private payment to Medicaid.
Can a nursing home make a resident promise not to apply for Medicaid?
No. 42 C.F.R. § 483.15(a)(2) prohibits a nursing facility from requiring a resident or potential resident to waive Medicaid rights or provide an assurance that the person will not apply for Medicaid.
Are nursing home waiting lists absolute?
No. A waiting list does not necessarily establish the actual order in which future admissions will occur. An applicant who is medically appropriate, financially ready, available for immediate admission, and already Medicaid-eligible or Medicaid-pending may present a far more practical admission opportunity than names that have been sitting on a facility list for months.
The Bottom Line: Use CMS Care Compare, But Look Behind the Stars
If you are trying to choose the best nursing home for a family member, you must start with Medicare Nursing Home Care Compare.
Do not stop at the overall star rating. The second most important rating is usually the staffing ratio. And there’s no substitute for a personal visit and personal tour of the facility.
The July 2026 CMS changes make that especially important because a nursing home can improve its quality performance and still lose a Quality Measure star when CMS raises the national threshold.
Look separately at health inspections, staffing, quality measures, and individual deficiencies.
Use Care Compare to verify Medicaid participation.
And do not let phrases such as “we don’t have any Medicaid beds” or “the waiting list is 6 months” end your investigation.
The questions that matter are whether the facility is Medicaid-certified, whether it can meet your loved one’s care needs, whether an appropriate bed is available, whether the resident qualifies for Medicaid, and whether the Medicaid application and nursing home admission process are being handled correctly.
If a loved one needs nursing home care in Virginia, Maryland, or Washington, DC, Farr Law Firm assists families with both Medicaid eligibility and nursing home placement. Contact Farr Law Firm for assistance.
