Disclaimer: General educational research only — not legal, medical or financial advice. A fine is not a verdict on a facility’s overall care. Always visit and check current inspection reports.
Estate Planning Data & Research → Nursing Home Fines by State
Federal regulators fined nursing homes $454,984,026 across 12,989 fines for inspections dated from Sept. 17, 2023 to Aug. 17, 2026 (CMS Provider Data Catalog, September 2026 release). Behind that total are real differences by state, from $78 of fines per certified bed in Arizona to $976 in Vermont.
If a parent may need a facility, that matters for a reason that isn’t about the fines themselves: the person you name as health care agent will be the one reading inspection reports, asking questions and signing papers. This page gives the numbers and then the planning step that goes with them.
Choosing a facility is a decision made under pressure. Naming an agent, putting powers of attorney in place and writing down wishes are decisions you can make calmly now. A will or living trust is the other half: it decides who receives what is left, and a trust can also name someone to manage money if you can’t. Compare a will and a living trust here.
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Cite this page URL when reusing findings. Not a substitute for official sources or professional advice.
Key findings
- $454,929,943 in fines for the 50 states and D.C. ($54,083 more in Puerto Rico and Guam) across 12,986 fines.
- 44.3% of nursing homes got at least one fine (6,507 of 14,680 currently participating homes). In South Dakota it’s 75.0%, in Alabama 15.6%.
- Illinois has the largest total ($73,934,986), then Texas ($51,954,195), California ($27,944,206), Ohio ($24,323,545) and Missouri ($18,225,767). Big states have more homes, so totals partly track size.
- Per certified bed, Vermont ($976) and Illinois ($870) lead the country, ahead of Montana, South Dakota and Alaska. The national figure is $290 per bed.
- The typical fine is modest and a few are large. The median fine is $16,039 and the average is $35,032. The largest single fine in the file is $713,795.
- 2,429 payment denials (the government stopping payment for new admissions at a facility for a period) were also issued.
- A fine is a signal, not a rating. Some homes get fines because inspectors found serious problems. The file doesn’t say what the violation was, and it doesn’t say whether a fine was per-day or per-instance, paid, reduced or contested.
What the data are
CMS publishes a list of fines and payment denials for each nursing home that takes Medicare or Medicaid, going back three years. In the file, the “penalty date” is the date of the inspection that led to the penalty, not the date of payment. We used the fines (not payment denials) for dollar totals.
Fines per bed divides each state’s fines by its total certified beds, taken from CMS’s Provider Information file for the same month. It adjusts for state size, so a state with many homes isn’t automatically at the top. It isn’t an adjustment for how serious violations were, how often homes are inspected, or how aggressively a state agency recommends fines.
States with the largest fine totals
| Rank | State | Total fines | Nursing homes with a fine | Fines per bed |
|---|---|---|---|---|
| 1 | Illinois | $73,934,986 | 68.8% | $870 |
| 2 | Texas | $51,954,195 | 68.5% | $389 |
| 3 | California | $27,944,206 | 39.5% | $243 |
| 4 | Ohio | $24,323,545 | 32.0% | $300 |
| 5 | Missouri | $18,225,767 | 42.7% | $364 |
| 6 | Pennsylvania | $16,907,525 | 43.8% | $204 |
| 7 | Florida | $16,906,487 | 38.2% | $200 |
| 8 | Wisconsin | $15,552,379 | 43.0% | $628 |
| 9 | North Carolina | $15,342,355 | 56.1% | $350 |
| 10 | New York | $13,680,799 | 30.9% | $123 |
States with the highest fines per certified bed
| Rank | State | Fines per certified bed | Total fines | Certified beds |
|---|---|---|---|---|
| 1 | Vermont | $976 | $2,881,039 | 2,951 |
| 2 | Illinois | $870 | $73,934,986 | 84,984 |
| 3 | Montana | $679 | $3,392,214 | 4,997 |
| 4 | South Dakota | $670 | $3,918,278 | 5,848 |
| 5 | Alaska | $652 | $531,436 | 815 |
| 6 | Delaware | $630 | $2,970,511 | 4,717 |
| 7 | Wisconsin | $628 | $15,552,379 | 24,756 |
| 8 | Washington | $541 | $10,158,197 | 18,781 |
| 9 | Rhode Island | $536 | $4,388,281 | 8,190 |
| 10 | District of Columbia | $508 | $1,261,943 | 2,485 |
And the lowest:
| State | Fines per certified bed | Total fines |
|---|---|---|
| Arizona | $78 | $1,249,958 |
| New Hampshire | $79 | $578,772 |
| Arkansas | $84 | $2,035,267 |
| Indiana | $91 | $4,432,030 |
| Maine | $99 | $576,125 |
What to do before you choose a facility
You can check any home’s fines for free before a placement decision:
- Look the facility up on Medicare’s Care Compare (Medicare.gov) and read its inspection results and any listed penalties. Compare more than one home.
- Visit at different times of day. Ask what happened in the inspections that led to fines.
- Ask the state long-term care ombudsman. Every state has an ombudsman program that helps residents and families with complaints.
- Read the admission agreement before anyone signs it. See who owns your parent’s nursing home for what families should sign and not sign.
The planning step: name a health care agent before you need one
The family member who ends up researching and choosing a facility is often whoever happens to be nearest. If your parent can’t make decisions, the question becomes who has legal authority to.
- A health care power of attorney (or health care proxy) names a person to make medical decisions if you can’t. It’s what lets an agent talk to doctors, review records and, in many states, make care and placement decisions.
- A durable financial power of attorney names someone to pay bills and handle accounts. Be careful who you name: see power-of-attorney abuse watch.
- A living will or advance directive records your wishes about treatment. See end-of-life wishes by state.
- Without these, families may have to ask a court to appoint a guardian. See the incapacity gap.
Rules about who can decide, and what an agent can authorize, vary by state. Have documents prepared for the state where the person lives, and sign them while they can still do so.
Related costs and protections: nursing home costs by state · Medicaid estate recovery by state · nursing home capacity by state.
All states
Fines include only the “Fine” penalty type. “Nursing homes with a fine” counts homes with at least one fine in the three-year window. State comparisons are rough, since inspection practices and enforcement differ by state agency.
| State | Total fines | Number of fines | Nursing homes with a fine | Certified beds | Fines per bed | Average fine | Payment denials |
|---|---|---|---|---|---|---|---|
| Alabama | $2,758,515 | 71 | 35 of 224 (15.6%) | 26,504 | $104 | $38,852 | 14 |
| Alaska | $531,436 | 11 | 5 of 20 (25.0%) | 815 | $652 | $48,312 | 3 |
| Arizona | $1,249,958 | 63 | 38 of 140 (27.1%) | 15,994 | $78 | $19,841 | 4 |
| Arkansas | $2,035,267 | 104 | 73 of 221 (33.0%) | 24,169 | $84 | $19,570 | 12 |
| California | $27,944,206 | 955 | 460 of 1,165 (39.5%) | 114,991 | $243 | $29,261 | 283 |
| Colorado | $4,788,349 | 234 | 120 of 210 (57.1%) | 19,749 | $242 | $20,463 | 28 |
| Connecticut | $4,532,487 | 179 | 110 of 191 (57.6%) | 22,532 | $201 | $25,321 | 13 |
| Delaware | $2,970,511 | 65 | 32 of 44 (72.7%) | 4,717 | $630 | $45,700 | 5 |
| District of Columbia | $1,261,943 | 21 | 11 of 17 (64.7%) | 2,485 | $508 | $60,093 | 2 |
| Florida | $16,906,487 | 587 | 265 of 694 (38.2%) | 84,537 | $200 | $28,802 | 15 |
| Georgia | $4,538,517 | 210 | 120 of 356 (33.7%) | 39,462 | $115 | $21,612 | 45 |
| Hawaii | $831,590 | 32 | 21 of 43 (48.8%) | 4,248 | $196 | $25,987 | 0 |
| Idaho | $1,069,954 | 43 | 29 of 80 (36.2%) | 6,115 | $175 | $24,883 | 0 |
| Illinois | $73,934,986 | 1,455 | 458 of 666 (68.8%) | 84,984 | $870 | $50,814 | 491 |
| Indiana | $4,432,030 | 129 | 93 of 507 (18.3%) | 48,825 | $91 | $34,357 | 41 |
| Iowa | $7,463,626 | 222 | 142 of 387 (36.7%) | 25,131 | $297 | $33,620 | 73 |
| Kansas | $6,047,179 | 319 | 147 of 296 (49.7%) | 18,031 | $335 | $18,957 | 38 |
| Kentucky | $4,104,594 | 188 | 90 of 267 (33.7%) | 25,400 | $162 | $21,833 | 25 |
| Louisiana | $12,400,596 | 228 | 129 of 265 (48.7%) | 32,239 | $385 | $54,389 | 43 |
| Maine | $576,125 | 31 | 27 of 78 (34.6%) | 5,830 | $99 | $18,585 | 9 |
| Maryland | $4,847,524 | 140 | 89 of 221 (40.3%) | 27,235 | $178 | $34,625 | 9 |
| Massachusetts | $11,684,409 | 258 | 164 of 341 (48.1%) | 40,920 | $286 | $45,288 | 7 |
| Michigan | $12,396,545 | 278 | 157 of 422 (37.2%) | 44,006 | $282 | $44,592 | 158 |
| Minnesota | $8,283,380 | 271 | 143 of 338 (42.3%) | 24,057 | $344 | $30,566 | 63 |
| Mississippi | $3,480,591 | 229 | 108 of 202 (53.5%) | 17,511 | $199 | $15,199 | 21 |
| Missouri | $18,225,767 | 411 | 208 of 487 (42.7%) | 50,053 | $364 | $44,345 | 159 |
| Montana | $3,392,214 | 93 | 42 of 61 (68.9%) | 4,997 | $679 | $36,475 | 14 |
| Nebraska | $2,155,569 | 76 | 44 of 180 (24.4%) | 13,715 | $157 | $28,363 | 49 |
| Nevada | $920,844 | 33 | 25 of 66 (37.9%) | 7,235 | $127 | $27,904 | 1 |
| New Hampshire | $578,772 | 40 | 23 of 73 (31.5%) | 7,326 | $79 | $14,469 | 2 |
| New Jersey | $12,154,241 | 260 | 142 of 348 (40.8%) | 50,998 | $238 | $46,747 | 8 |
| New Mexico | $3,117,721 | 90 | 41 of 68 (60.3%) | 6,891 | $452 | $34,641 | 20 |
| New York | $13,680,799 | 320 | 183 of 593 (30.9%) | 111,413 | $123 | $42,752 | 21 |
| North Carolina | $15,342,355 | 487 | 235 of 419 (56.1%) | 43,850 | $350 | $31,504 | 75 |
| North Dakota | $1,989,283 | 77 | 45 of 72 (62.5%) | 4,909 | $405 | $25,835 | 3 |
| Ohio | $24,323,545 | 534 | 295 of 922 (32.0%) | 81,115 | $300 | $45,550 | 184 |
| Oklahoma | $5,169,812 | 251 | 145 of 283 (51.2%) | 27,555 | $188 | $20,597 | 53 |
| Oregon | $3,522,821 | 98 | 63 of 128 (49.2%) | 10,602 | $332 | $35,947 | 6 |
| Pennsylvania | $16,907,525 | 522 | 287 of 656 (43.8%) | 83,064 | $204 | $32,390 | 49 |
| Rhode Island | $4,388,281 | 151 | 53 of 72 (73.6%) | 8,190 | $536 | $29,061 | 20 |
| South Carolina | $2,773,701 | 204 | 99 of 187 (52.9%) | 19,589 | $142 | $13,597 | 11 |
| South Dakota | $3,918,278 | 178 | 72 of 96 (75.0%) | 5,848 | $670 | $22,013 | 0 |
| Tennessee | $6,940,796 | 161 | 110 of 303 (36.3%) | 34,613 | $201 | $43,111 | 31 |
| Texas | $51,954,195 | 1,716 | 806 of 1,177 (68.5%) | 133,493 | $389 | $30,276 | 145 |
| Utah | $2,323,572 | 85 | 50 of 97 (51.5%) | 8,379 | $277 | $27,336 | 15 |
| Vermont | $2,881,039 | 42 | 24 of 33 (72.7%) | 2,951 | $976 | $68,596 | 7 |
| Virginia | $6,845,748 | 154 | 103 of 289 (35.6%) | 32,648 | $210 | $44,453 | 11 |
| Washington | $10,158,197 | 233 | 117 of 193 (60.6%) | 18,781 | $541 | $43,597 | 30 |
| West Virginia | $3,629,084 | 98 | 64 of 123 (52.0%) | 10,717 | $339 | $37,031 | 3 |
| Wisconsin | $15,552,379 | 306 | 139 of 323 (43.0%) | 24,756 | $628 | $50,825 | 101 |
| Wyoming | $1,012,600 | 43 | 26 of 36 (72.2%) | 2,938 | $345 | $23,549 | 9 |
| United States (50 states + D.C.) | $454,929,943 | 12,986 | 6,507 of 14,680 (44.3%) | 1,567,113 | $290 | $35,032 | 2,429 |
What this means if you’re planning
Related: Older adults living alone, by state · Home care cost vs. retirement income · Medicaid home equity by state
Methodology
Fines. Centers for Medicare & Medicaid Services, Provider Data Catalog, Nursing Home “Penalties” dataset (g6vv-u9sr), file NH_Penalties_Sep2026, released Sept. 30, 2026 (processing date Sept. 1, 2026). It covers the last three years; the inspection dates in this file run from Sept. 17, 2023 to Aug. 17, 2026. We summed “Fine Amount” for rows with penalty type “Fine” (12,989 fines, $454,984,026; 12,986 fines and $454,929,943 in the 50 states and D.C.). Rows with penalty type “Payment Denial” (2,430) were counted separately.
Beds and homes. CMS Provider Data Catalog, Provider Information (4pq5-n9py), September 2026 release: number of certified beds and homes by state (14,680 homes and 1,567,113 certified beds in the 50 states and D.C.; 10 homes in Puerto Rico and Guam are excluded). All fines in the file are for homes in the current Provider Information list.
Rates. Fines per bed = state fines ÷ state certified beds (current). Share of homes fined = homes with at least one fine ÷ homes in the state.
What this doesn’t measure. Quality of care. Fines depend on what inspectors found, state enforcement practices and the facility’s compliance history. The file doesn’t include the reason for each fine, whether it was per-day or per-instance, or whether it was paid, reduced or appealed.
Frequently asked questions
How much have nursing homes been fined?
$454,984,026 in 12,989 fines for inspections from September 2023 through August 2026, according to CMS data. Illinois and Texas together account for about 28% of the total.
Does a fine mean a nursing home is bad?
Not by itself. It means regulators found problems that merited a penalty. Read the inspection report, check recent inspections, visit and ask questions.
Why does it matter for estate planning?
Because someone must make care decisions if a person can’t. A health care power of attorney names who, and a will or trust handles the rest.
Where can I look up a specific nursing home’s fines?
On Medicare’s Care Compare, which draws on the same CMS data.
Does Medicare pay for nursing home care?
Only for limited stays after a hospital stay. Long-term custodial care is mostly paid privately or by Medicaid. See nursing home costs by state.
Sources
U.S. government public-domain data only.
Data (pulled 2026-10-09)
- CMS Provider Data Catalog, Nursing Homes — Penalties (g6vv-u9sr), modified 2026-09-30, 15,419 rows (12,989 Fine, 2,430 Payment Denial): https://data.cms.gov/provider-data/dataset/g6vv-u9sr .
- CMS Provider Data Catalog, Nursing Homes — Provider Information (4pq5-n9py), modified 2026-09-30, 14,690 rows (certified beds, state): https://data.cms.gov/provider-data/dataset/4pq5-n9py .
- CMS Nursing Home Care Compare and PDC Consolidated Data Dictionary (Penalty Date = date of the inspection that triggered the penalty): https://data.cms.gov/provider-data/sites/default/files/data_dictionaries/nursing_home/NH_Data_Dictionary.pdf
Pages referenced
- Medicare Care Compare (nursing home search): https://www.medicare.gov/care-compare/
Cite this data
Family Estate Guide, “Nursing Home Fines by State: $455 Million in Three Years,” October 2026. https://familyestateguide.com/estate-planning-data/nursing-home-fines-by-state/
You’re welcome to reuse the tables with a link back to this page. CMS data are public.
Published October 9, 2026 by Family Estate Guide. Data vintage: CMS Provider Data Catalog, September 2026 release (modified Sept. 30, 2026). Pulled Oct. 9, 2026. Editorial standards.