One in five active nursing homes received one star
CMS listed 14,683 active nursing homes across the 50 states and Washington, D.C., in the July 2026 Provider Information file. Of those, 2,976 had the lowest overall rating. Illinois recorded the highest proportion at 36.4%, followed by Missouri at 34.0% and Louisiana at 34.0%.
The overall star rating combines health inspections, staffing, and quality measures, but the components do not carry equal weight. CMS starts with the health inspection rating and then adjusts the result using staffing and quality measures. A one-star overall rating is therefore a broad signal, not proof of a particular incident or legal violation.
Inspection findings tell a different story
Washington, D.C., averaged 23.8 health deficiencies in the latest standard survey cycle, the highest result in this state-level table. Maryland averaged 17.2, New Mexico 17.1, Washington state 16.2, and California 15.4. These rankings do not mirror the one-star list because the metrics answer different questions.
Deficiency counts also need context. State survey agencies conduct inspections, facility complexity varies, and a simple count does not reflect the severity of every citation. The map reports the average number recorded in the most recent inspection cycle, while the CMS rating methodology applies additional weights and inspection history.
Fines were highly concentrated
The active facilities in the study carried about $464 million in fines from the previous three years. Illinois accounted for roughly $75.9 million, more than any other state, followed by Texas at $57.0 million and California at $29.5 million.
Raw totals favor large states, so the explorer also displays fines per active facility. Illinois remained highest on that measure at approximately $113,857 per facility. Vermont ranked second at about $92,507, while Washington, D.C., ranked third at about $78,690. A fine records enforcement activity. It does not show whether a resident later received compensation through a private claim.
The CMS abuse icon is a warning, not a verdict
CMS applied its abuse icon to 1,435 facilities in this snapshot. Illinois had the highest state share at 27.0%, narrowly ahead of Arizona at 26.4%. The icon identifies facilities cited for abuse that led to resident harm within the past year, or potential harm during each of the past two years, under CMS criteria.
The presence of the icon deserves attention, but its absence does not guarantee that no neglect or abuse occurred. Ratings and inspections are screening tools. Families evaluating a facility should inspect the underlying reports, visit in person, ask about staffing and turnover, and document specific concerns.
What the ranking can, and cannot, establish
This study compares public regulatory measures at state level. It cannot identify the safest home for an individual resident, prove negligence, estimate a nursing home settlement, or show every event that went unreported. It also does not treat every deficiency as equally serious.
The results describe currently active Medicare or Medicaid-certified facilities. Homes that closed before the July 2026 file are absent even if they incurred penalties earlier in the three-year enforcement window. State totals can also change each month as CMS refreshes ratings and enforcement data.
Methodology
Claimelo downloaded the CMS Provider Information file processed July 1, 2026. We retained currently active facilities in the 50 states and Washington, D.C., and excluded Puerto Rico and other U.S. territories to maintain a consistent 51-jurisdiction comparison.
The one-star share divides facilities with an overall rating of one by all facilities with a reported overall rating. Average deficiencies use the field for total health deficiencies in Rating Cycle 1, the latest standard health survey cycle. Fines per facility divide the total dollar amount of fines reported for the prior three years by the number of active facilities in the state.
The abuse-icon share divides facilities marked “Y” in the CMS Abuse Icon field by all active facilities in that state. Special Focus Facilities and candidates are included in the downloadable table but not combined into a proprietary score. Claimelo did not impute missing ratings or staffing values. Calculations use unrounded values, while displayed figures are rounded.
Sources and reproducibility
Journalists and researchers may quote the findings with attribution to Claimelo and a link to this page. Questions and corrections can be submitted through our About and Methodology page.