Five-Star Ratings by State
How CMS star ratings are spread across each state, and how each state’s health inspection cut points have moved since 2019. To work a rating through, use the Five-Star Calculator.
Stars by state
Health inspection stars are graded within each state, so they look alike everywhere. Staffing and quality measure stars use national bands and do differ by state, partly because of state policy (Medicaid payment, staffing rules, assessment timing), not care alone.
Health inspection cut points over time
A cut point is the inspection score of the home at that rank in its state, so it moves with what surveyors cite. A rising line means homes at that rank are being cited for more. It reflects inspections, not care itself, and two changes in how scores are built are marked.
This month’s cut points for every state
How each rating is calculated
- Health inspection. Citations from the last two standard surveys (weighted ¾ and ¼) and three years of complaints earn points by severity. Homes are ranked within their state: best 10% get 5 stars, bottom 20% get 1.
- Staffing. Nurse and RN hours, weekend hours, and staff turnover earn up to 380 points on fixed national bands.
- Quality measures. Fifteen long- and short-stay measures earn up to 2,300 points against fixed national thresholds.
- Overall. Starts from health inspection; staffing and quality measures add or remove a star at 5 or 1 star.
Work a rating through in the Five-Star Calculator.
Questions
Why can two nursing homes with the same inspection score have different star ratings?
Health inspection stars are graded against other homes in the same state, so the same score earns different stars in different states. CMS also recalibrates each state's cut points every month but holds a home's rating until its own score changes, so two homes in one state can be rated on cut points from different months.
Is a 5-star rating in one state the same as in another?
Not for health inspections: about the best 10 percent of each state's homes get 5 stars, whatever the state's overall results. Staffing and quality measure stars use the same national point bands everywhere, so those compare across states. The overall rating mixes the two.
Star counts are the ratings CMS published on Care Compare; cut points are CMS’s monthly state tables. Ten months since 2019 are missing from CMS’s archive; the chart repeats the month before for those. No individual nursing home is shown. BARA Analytics is independent and is not affiliated with or endorsed by CMS.