The Geography of CMS Five-Star Nursing Homes
CMS's highest overall rating is far more common in some states than others. This report measures that spread — and explains why CMS itself cautions against reading it as a state-by-state quality ranking.
What the state-level data shows
- Facilities analyzed
- 14,700
- CMS-certified
- Rated 5★, nationally
- 20.7%
- 3,039 facilities
- Highest state share
- 40.5%
- Hawaii
- Lowest state share
- 9.4%
- Louisiana
Where five-star facilities are most common
The share of each state's certified nursing homes holding the CMS five-star overall rating.
Highest 5-star share, by state
States where the largest share of facilities hold CMS's top overall rating.
CMS-reported data · updated 2026-08-03 · site-calculated context, not a CMS rating
Methodology
Where they are least common
States where CMS's top overall rating is rare.
Lowest 5-star share, by state
States where few facilities hold the top overall rating.
A low share does not establish that a state's care is worse — survey practices differ by state, and the overall rating leans on state-administered inspections.
CMS-reported data · updated 2026-08-03 · site-calculated context, not a CMS rating
Methodology
Why cross-state comparison is unreliable
The caveat is not fine print — it is the finding.
The CMS overall star rating is anchored on the health-inspection rating, and health inspections are conducted by each state’s own survey agency under its own staffing, backlog, and enforcement conditions. CMS additionally scores the inspection domain relative to other facilities within the same state, which builds a state-by-state curve into the rating itself. Two identical facilities in different states can therefore carry different stars. That is why this site compares facilities against their own state and county on every state research page, and never publishes a state ranking. Within a state, the spread is meaningful; across states, it mixes care differences with process differences that public data cannot separate.
Limits of this analysis
What the public data can and cannot tell you.
These figures describe a dated CMS snapshot, not live conditions. Shares describe the CMS record, not the quality of care in any state, and nothing here recommends any facility or state. Confirm the current record on Medicare’s Care Compare. See Methodology and Data updates.