WASHINGTON, D.C. — Nearly 600 nursing homes across the United States face an elevated risk of shutting down if more than $800 billion in proposed Medicaid reductions over the next decade are enacted into law, according to a new analysis from Brown University released Friday.
The study, led by Vincent Mor, PhD, a prominent long-term care researcher in Brown University's Department of Health Services, Policy & Practice, was commissioned by Democratic Senate leadership. It identifies 579 skilled nursing facilities that meet a troubling combination of financial and quality indicators — high Medicaid dependency, low occupancy, and poor federal ratings — that make them especially vulnerable to funding reductions, according to the analysis.
The Scope of the Threat
The budget reconciliation bill currently under debate in the Senate aims to slash Medicaid spending by more than $800 billion over the coming decade. The Congressional Budget Office indicated this week that cuts of that magnitude would compel states to reduce payments to healthcare providers, as reported by McKnight's Long-Term Care News.
According to the Brown University findings, the researchers identified 1,749 skilled nursing facilities nationally where Medicaid covers more than 85 percent of residents. These highly Medicaid-dependent homes are disproportionately located in urban areas and clustered in states including Illinois, Texas, California, and Georgia, according to the analysis.
The 579 facilities deemed at highest risk share three critical vulnerabilities: Medicaid payer shares exceeding 85 percent, occupancy rates below 80 percent, and ratings of just one or two stars under CMS's Five-Star Quality Rating System.
Nursing homes already operate at a financial disadvantage when caring for Medicaid patients. A 2024 study found the average Medicaid reimbursement rate covers only 82 cents for every dollar spent on patient care, according to industry research. The proposed cuts would further erode states' ability to supplement those payments, particularly by restricting the use of provider taxes that many states rely on to bolster their Medicaid funding pools.
"The Medicaid nursing home benefit is the last line of defense protecting American seniors and those with disabilities from destitution," said Senate Finance Committee Ranking Member Ron Wyden (D-OR) in a statement accompanying the report's release. "These nursing homes are already walking on an economic tightrope, and many will be forced to close their doors."
The potential loss of 579 facilities would represent approximately a 4 percent reduction in the nation's nursing home supply — compounding a 5 percent decline over the past decade driven partly by the COVID-19 pandemic, according to the Brown analysis. This contraction would come precisely as the nation's senior population is growing rapidly.
Georgia Among Hardest Hit
Georgia stands as one of the states most exposed to the proposed cuts. According to reporting by FOX 5 Atlanta, 37 nursing homes in Georgia have been identified as at elevated risk of closure under the Medicaid reduction proposals. The state's concentration of vulnerable facilities reflects broader national patterns of Medicaid dependency in the South.
The Brown University analysis warned that the cuts could create a destructive cycle. States would likely be forced to reduce non-mandatory home- and community-based services, pushing more patients toward institutional care. Yet at the same time, those states would have fewer resources to fund the nursing homes absorbing that increased demand, according to the researchers.
"Whether states freeze payment rates or reduce them, given likely labor cost inflation, providers will have more difficulty hiring staff, who are already becoming increasingly difficult to find and recruit," Mor wrote in the analysis. He noted that facilities with predominantly Medicaid populations, low occupancy, and poor quality ratings would become trapped in a worsening fiscal spiral — able to attract only more Medicaid patients while receiving inadequate reimbursement.
CMS Inspection History
The potential impact of Medicaid cuts on facilities across Georgia can be illustrated by examining individual homes in the state. Brown Health and Rehabilitation, a 144-bed nonprofit nursing home in Royston, Georgia, currently holds an overall CMS rating of 4 out of 5 stars, with a health inspection rating of 4 stars. However, its staffing rating sits at just 2 out of 5 stars, and its quality measures rating is also 2 out of 5 — indicators of the workforce and care quality challenges that pervade the industry.
According to CMS records, Brown Health and Rehabilitation has accumulated 31 deficiencies across 7 inspections. The facility's most recent inspection on September 11, 2025, resulted in citations for failing to timely report suspected abuse, neglect, or theft and for deficiencies in its infection prevention and control program.
An earlier inspection in April 2024 found the facility failed to respond appropriately to all alleged violations, did not transmit resident assessment data to the state within the required seven-day window, and did not develop complete care plans within seven days of comprehensive assessments as federal regulations require.
While Brown Health and Rehabilitation's overall rating places it above the lowest-performing tier most immediately threatened by closure, its staffing and quality shortfalls reflect the systemic challenges facing nursing homes that depend heavily on Medicaid reimbursement. Facilities operating on thin margins often struggle to recruit and retain adequate staff, which can directly affect care quality — a pattern the Brown University researchers warned would only intensify under further funding reductions.
Ownership & Operations
Brown Health and Rehabilitation operates as a nonprofit entity, distinguishing it from the for-profit facilities that make up the majority of the nursing home industry. Research has consistently shown that Medicaid-reliant for-profit facilities tend to experience greater quality challenges when reimbursement rates are inadequate. Nonprofit facilities, while generally performing somewhat better on quality measures, remain vulnerable to the same financial pressures when Medicaid funding contracts.
The Brown University analysis noted that the consequences extend well beyond the facilities themselves. When a nursing home closes, residents — many of them frail and elderly — must be transferred to other facilities, often at greater distances from their families and communities. In rural areas like Royston, Georgia, alternative care options may be extremely limited.
Resources for Families
Families concerned about the quality of care at a nursing home or the potential impact of funding changes on a loved one's facility can access several resources. The Georgia Long-Term Care Ombudsman program assists residents and families with complaints, questions, and advocacy. The Georgia ombudsman can be reached at 1-888-454-5826.
The national Long-Term Care Ombudsman Resource Center, available at ltcombudsman.org, provides state-by-state information and can help families connect with local advocates. The national Elder Care Locator hotline at 1-800-677-1116 also connects callers with local services for older adults.
Federal regulations require nursing homes to maintain publicly accessible inspection reports and quality ratings through the CMS Care Compare website. Families can review any facility's full inspection history, staffing data, and quality measures to make informed decisions about care.
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