Skilled Nursing Medicaid Rates in Kentucky (2026)

Skilled nursing Medicaid rates in Kentucky are among the strongest in the country relative to labor costs. Kentucky Medicaid lists $365.78 a day for a nursing home stay, effective October 1, 2025. That ranks 5th of 21 ranked states and is 29.4% above the national median of $282.59.

The distinctive part is the other side of the ledger: Kentucky nursing wages are below the national median at every licensure level. A top-five per diem paired with below-median wages is an uncommon combination, and it makes Kentucky one of the more favorable Medicaid markets for nursing facility operators, provided a facility can keep its costs under the state's price.

The $365.78 figure is published without a billing code, as is common for facility per diems, and covers a full Medicaid resident day: room, board, nursing care and the routine services a facility provides under its daily rate. Kentucky is the fifth of the top five ranked states:

Outside New Mexico, the top states sit in a tight band between $365.78 and $419.22, and Kentucky is inside it. Maryland follows just behind at $351.63. The Kentucky Medicaid rates page shows the rate with its source document.

A daily rate is the single number that most of a nursing home's Medicaid budget hangs on. Every Medicaid resident day is paid at that figure, so the rate multiplies across the whole census. Being 29.4% above the national median is a structural advantage that compounds every day of the year.

Occupancy and payer mix

Because the per diem is fixed for the day, the economics of a Kentucky facility turn on how many Medicaid days it fills and how that census mixes with Medicare and private-pay residents. A strong Medicaid rate narrows the gap between payers. That reduces the pressure many operators feel to chase short-stay Medicare admissions just to subsidize long-stay Medicaid residents.

What the rate does not cover

The daily rate is a facility payment. Physicians who see residents bill separately under the physician fee schedule, using nursing facility visit codes such as 99309. Therapy, pharmacy and some ancillary items can also fall outside the per diem depending on the state's rules. Treat the $365.78 as the facility's revenue per resident day, not the total Medicaid spend on that resident.

Kentucky pays nursing facilities under a price-based system defined in regulation: 907 KAR 1:065, Payments for price-based nursing facility services. The most recent amendment (52 Ky.R. 635, 1138) took effect January 22, 2026.

That changes the planning question. Instead of asking what its costs will justify, a facility asks how its costs compare with the state's price. Facilities below the price keep the difference; facilities above it absorb the gap. Cost control, staffing efficiency and occupancy become the levers that matter most in Kentucky, while cost reports matter less as a route to a higher rate.

A price-based system also makes rate changes easier to read. When the regulation is amended or a public notice moves the price, the change applies across facilities rather than arriving one cost report at a time. Watching the regulation and DMS notices is therefore the most reliable way to anticipate next year's revenue.

Kentucky's record shows a steady sequence of nursing facility actions over the last three years. A Nursing Facility Rate Freeze Public Notice took effect April 1, 2024. Long-term care public notices followed in 2024 and 2025, and the Long Term Care Public Notice 2025, published March 12, 2025, carried a July 1, 2025 effective date. On the same day, CMS approved SPA/directed payment 250004NursingFacility. A DMS provider letter on Assessment Rates Allowance Ancillary Change, effective July 1, 2024, adjusted the assessment and ancillary side of payment rather than the base per diem.

The pattern is a freeze in spring 2024, then annual long-term care notices each July with a CMS-approved payment on top. July 1 has become the date to plan around: it is when Kentucky's long-term care notices have taken effect two years running.

Reading a public notice

A public notice is the state's announcement that a payment change is coming, usually tied to a state plan amendment. Its stage tells you how firm it is: a proposed notice can still change, while a CMS-approved amendment or an enacted budget item is settled. Facilities should budget firmly on approved and enacted items and treat proposed notices as a likely range, not a certainty.

Kentucky's newest changes target ventilator care. The 2026-2028 budget (HB 500, 2026 Ky. Acts ch. 168), enacted April 14, 2026, funds Hospital-Based Ventilator Dependent Facilities with a 24.24% change effective January 1, 2026. DMS followed with a Ventilator Services Public Notice (26-0004) on July 1, 2026, carrying the same 24.24% change, still at the proposed stage.

For facilities with ventilator units, this is the largest rate movement in the recent record. For other facilities, the base price-based rate is the figure to track. The budget and the public notice carry the same percentage, so the notice reads as the implementing step for the budget item. Facilities with ventilator residents should confirm the new rate in their next rate notice and check whether it is retroactive to January 1.

Kentucky also runs a Model Waiver II (ventilator-dependent) 1915(c) waiver, which serves ventilator-dependent people in the community. Facilities with ventilator units compete with that option for some residents, so the facility rate and the waiver both shape referral flows.

Kentucky nursing wages run below the US median at all three levels, based on May 2025 federal occupational data.

Nursing assistants provide most hands-on care, so the CNA wage of $18.45 an hour shapes direct care cost more than any other figure. The registered nurse gap is the widest of the three in dollars. Licensed practical nurses, who often handle medication passes, are closest to the national figure.

Set against a rate 29.4% above the median, these wages give Kentucky facilities more room than most to staff above minimums, raise CNA pay to compete locally, or invest in the building. Under a price-based system, that room belongs to facilities that keep costs below the price; a facility with high costs does not get them reimbursed simply by reporting them.

Statewide medians also hide local markets. Facilities near Louisville, Lexington or Cincinnati compete with hospitals for the same nurses, and their wage bill can sit well above the state median. Benchmark against local postings, not only the statewide figure.

Kentucky's managed-care rule for nursing facilities is that they are paid directly by the state, outside managed care. Our data counts 15 plans in Kentucky, and the named plans in this area are PACE organizations such as Bluegrass Care Navigators, BoldAge PACE, Horizon PACE and Senior CommUnity Care of Kentucky. None of them sets the nursing facility rate for the general Medicaid population.

For a facility, that means the state's price is the rate, without plan-by-plan negotiation, credentialing with several payers, or authorization rules that differ by plan. PACE organizations remain the exception, since they cover long-term care for their own enrollees under their own contracts. A facility that takes PACE residents should negotiate those contracts with the state per diem as its reference point.

The same rule applies to home and community-based services and personal care in Kentucky, while hospital inpatient and home health are lines where plans negotiate and the published rate applies out of network. The Kentucky managed care page lists the plans and the rules for every line.

Nursing facilities share the long-term care population with community programs. Kentucky's Home and Community Based (HCB) 1915(c) waiver, the Acquired Brain Injury Long Term Care 1915(c) waiver and the Michelle P. waiver all serve people who might otherwise need facility care. When waiver rates rise, more residents can stay home; when they lag, facilities see more admissions.

Operators planning occupancy should read the facility rate alongside the Kentucky home care Medicaid rates and Kentucky private duty nursing rates. Those pages show how the state prices the in-home alternatives that compete for the same residents.

At the other end of the ranking, Arkansas lists $70.00 a day, Michigan $99.90 under code G9685, and Connecticut $107.21. Missouri and Montana also rank in the bottom five. Kentucky's rate is several multiples of the lowest published figures.

Those comparisons matter most to multi-state operators deciding where to grow. The rate is not the only factor, since wages, occupancy and regulation all differ, but a facility's Medicaid revenue per day in Kentucky starts well ahead of most of the country. The national skilled nursing overview compares every state.

Kentucky's price-based design rewards facilities that plan around the published price.

1. Build the Medicaid budget from the per diem. Multiply projected Medicaid resident days by the current rate, then layer any ventilator or ancillary changes that apply to your building.
2. Compare cost per day with the price. Your margin is the gap between the two. Track staffing cost per resident day monthly, since labor is the largest component.
3. Watch July 1. Long-term care notices have taken effect on that date in 2024 and 2025. Build a placeholder for a mid-year change into the budget.
4. Use the state rate in PACE contracts. The per diem is the natural anchor for any PACE arrangement.
5. Track the regulation. Amendments to 907 KAR 1:065 change the price for everyone; read each one as it is filed.

Rates on this page are compiled from official state Medicaid publications, and each rate links to its source document. The Kentucky nursing facility figure comes from the Kentucky Medicaid Nursing Facility Rates workbook titled "October 1, 2025 Rates". Kentucky's nursing facility line holds 597 current rates, part of all 39,971 current Kentucky Medicaid rates drawn from 108 source documents, with history back to 2019.

Only 21 of 44 states can be ranked on a single nursing home figure, because many states set rates facility by facility or adjust them for resident acuity. Our methodology explains how rates are compared, and pricing covers access to the full Kentucky dataset and its history.