ZREPORTS RESEARCH INSTITUTE™ · STATE RANKING STUDY
A ranking of all fifty states and the District of Columbia computed entirely from the federal enforcement record: civil money penalties, inspection deficiencies, fines, abuse citations, and Special Focus status across 14,695 Medicare certified nursing homes. No surveys, no opinions, no facility input.
PUBLISHED 2026-08-24 · SOURCE: CMS PROVIDER DATA CATALOG · BY SHAWN REDD, ZREPORTS RESEARCH INSTITUTE
| RANK | STATE | SAFETY SCORE | FACILITIES | % WITH FEDERAL PENALTIES | % WITH SEVERE DEFICIENCIES | AVG DEFICIENCIES | AVG FINES / FACILITY | CMS AVG STARS |
|---|---|---|---|---|---|---|---|---|
| 1 | Alabama | 95.3 | 224 | 19.2% | 23.2% | 10.1 | $14,532 | 3.03 |
| 2 | New Hampshire | 89.9 | 73 | 27.4% | 27.4% | 13.9 | $7,386 | 3.01 |
| 3 | Indiana | 86.5 | 507 | 18.1% | 41.0% | 23.4 | $5,209 | 3.15 |
| 4 | Nebraska | 84.8 | 179 | 31.8% | 33.0% | 18.6 | $9,499 | 2.87 |
| 5 | Arkansas | 84.6 | 221 | 32.6% | 31.7% | 19.0 | $9,184 | 3.46 |
| 6 | Kentucky | 81.6 | 268 | 34.7% | 38.1% | 12.8 | $17,665 | 3.05 |
| 7 | Alaska | 79.4 | 20 | 35.0% | 25.0% | 26.3 | $38,276 | 3.25 |
| 8 | New York | 78.5 | 596 | 32.0% | 36.2% | 19.9 | $23,784 | 3.03 |
| 9 | Georgia | 77.2 | 356 | 39.0% | 37.9% | 16.8 | $14,035 | 2.68 |
| 10 | Maine | 76.3 | 78 | 35.9% | 38.5% | 30.2 | $7,225 | 2.96 |
| 11 | Tennessee | 75.4 | 303 | 34.3% | 44.9% | 14.6 | $25,657 | 3.01 |
| 12 | Arizona | 73.8 | 140 | 30.0% | 38.6% | 22.1 | $8,928 | 3.41 |
| 13 | Florida | 72.8 | 694 | 40.6% | 39.3% | 19.6 | $26,765 | 3.28 |
| 14 | Nevada | 69.1 | 66 | 39.4% | 36.4% | 34.3 | $13,076 | 3.23 |
| 15 | New Jersey | 68.3 | 348 | 39.7% | 48.9% | 22.6 | $36,527 | 3.38 |
| 16 | Iowa | 68.3 | 389 | 42.2% | 54.8% | 20.6 | $18,747 | 3.13 |
| 17 | Ohio | 67.3 | 921 | 34.4% | 56.7% | 30.8 | $23,139 | 3.22 |
| 18 | Idaho | 67.1 | 80 | 32.5% | 60.0% | 26.5 | $13,767 | 3.15 |
| 19 | Virginia | 65.2 | 289 | 33.9% | 55.4% | 38.3 | $20,882 | 3.01 |
| 20 | South Carolina | 64 | 187 | 52.4% | 56.7% | 12.6 | $14,641 | 3.09 |
| 21 | Minnesota | 60.7 | 338 | 45.3% | 64.8% | 23.4 | $20,689 | 3.17 |
| 22 | Pennsylvania | 60.6 | 656 | 44.8% | 51.1% | 31.6 | $25,102 | 3.01 |
| 23 | Mississippi | 60 | 202 | 52.5% | 57.9% | 17.8 | $18,897 | 2.69 |
| 24 | Oklahoma | 59.3 | 283 | 53.0% | 54.8% | 22.9 | $20,876 | 2.72 |
| 25 | Massachusetts | 58.5 | 341 | 49.9% | 55.7% | 30.4 | $36,630 | 3.05 |
| 26 | Maryland | 57.6 | 221 | 39.8% | 52.5% | 51.6 | $22,972 | 3.14 |
| 27 | Louisiana | 57.3 | 266 | 51.5% | 51.9% | 25.0 | $49,913 | 2.51 |
| 28 | Wisconsin | 57 | 323 | 43.7% | 65.9% | 27.4 | $39,833 | 2.99 |
| 29 | California | 55.9 | 1,164 | 44.5% | 53.1% | 49.7 | $26,375 | 3.17 |
| 30 | Missouri | 54.6 | 487 | 46.6% | 57.5% | 35.8 | $33,481 | 2.48 |
| 31 | North Carolina | 53.6 | 420 | 58.3% | 59.8% | 19.2 | $38,899 | 2.94 |
| 32 | Kansas | 52.7 | 296 | 52.0% | 69.6% | 27.3 | $22,557 | 3.03 |
| 33 | West Virginia | 52.5 | 123 | 51.2% | 57.7% | 42.7 | $28,238 | 2.95 |
| 34 | Oregon | 51.2 | 128 | 51.6% | 64.1% | 34.1 | $27,599 | 3.10 |
| 35 | Hawaii | 50.6 | 42 | 54.8% | 66.7% | 35.4 | $20,921 | 3.59 |
| 36 | Michigan | 50.3 | 423 | 48.7% | 68.6% | 32.6 | $33,031 | 3.16 |
| 37 | Utah | 49.7 | 97 | 54.6% | 70.1% | 26.7 | $25,896 | 3.32 |
| 38 | Connecticut | 48.6 | 191 | 51.8% | 63.4% | 36.1 | $18,685 | 3.04 |
| 39 | North Dakota | 46.6 | 72 | 59.7% | 72.2% | 16.6 | $27,715 | 3.23 |
| 40 | Texas | 37.9 | 1,176 | 70.0% | 70.7% | 27.2 | $49,788 | 2.71 |
| 41 | South Dakota | 37.5 | 96 | 71.9% | 80.2% | 16.2 | $33,893 | 2.78 |
| 42 | Colorado | 36.7 | 210 | 64.8% | 80.5% | 25.0 | $25,496 | 3.15 |
| 43 | Washington | 36.4 | 193 | 62.2% | 71.5% | 49.2 | $54,992 | 3.30 |
| 44 | Wyoming | 36 | 36 | 66.7% | 75.0% | 19.9 | $22,587 | 2.97 |
| 45 | New Mexico | 31.4 | 68 | 64.7% | 72.1% | 49.7 | $42,745 | 2.85 |
| 46 | Rhode Island | 29.1 | 72 | 70.8% | 81.9% | 28.5 | $67,559 | 2.90 |
| 47 | Delaware | 26.9 | 44 | 72.7% | 75.0% | 36.8 | $62,853 | 3.28 |
| 48 | Montana | 26.3 | 61 | 75.4% | 78.7% | 31.3 | $54,689 | 2.92 |
| 49 | Vermont | 24.9 | 33 | 75.8% | 66.7% | 27.9 | $92,710 | 2.84 |
| 50 | District of Columbia | 17.9 | 17 | 76.5% | 82.4% | 62.8 | $70,333 | 3.53 |
| 51 | Illinois | 14.1 | 667 | 70.8% | 86.8% | 37.7 | $105,530 | 2.56 |
Download the full state table (CSV)
Rankings are computed from the CMS Provider Data Catalog record for every active Medicare certified nursing home (14,695 facilities). Six enforcement metrics are normalized across states and combined with fixed, disclosed weights: share of facilities with federal civil money penalties (30%), share with severe deficiencies (25%), average deficiencies per facility (15%), average federal fines per facility (15%), share with a CMS abuse citation icon (10%), and share in the Special Focus Facility program (5%). The Safety Score scales the combined enforcement burden to 100, where 100 represents the lightest burden. Every input is a federal verdict; zReports adds no editorial judgment, and facilities are never contacted and cannot pay to change a result. Data refreshed 2026-08-24.
Companion peer archived analysis: Federal Penalty Patterns Across Medicare Certified Nursing Homes (SSRN 7255298). Datasets and methodology: zreports.org/research. Journalists: state and city level cuts available on request at press@zreports.org. All research CC BY 4.0 — free to republish with attribution.
Every nursing home in this study has a free public record page. Search any facility by name at zreports.org and see its official inspection, penalty, and enforcement history before you decide. Free, no signup, and no facility can pay to change a grade.
ZREPORTS CONSUMER RECORDS DATABASE™ · COMPUTED FROM OFFICIAL RECORDS · FACILITIES ARE NEVER CONTACTED AND CANNOT PAY TO CHANGE SCORES