Skilled nursing Medicaid rates in Illinois sit in the lower half of the national ranking. Illinois HFS lists $248.95 a day for a nursing home stay, effective October 1, 2026. That ranks 14th of 21 ranked states and is 11.9% below the national median of $282.59.
Illinois is a state where the per diem is only the starting point. Plans negotiate their own nursing facility rates, CMS has approved a state directed payment for nursing facilities every year since 2023, and HFS has raised specific rate components and add-ons. For an Illinois operator, Medicaid revenue depends as much on plan contracts and directed payments as on the published figure.
The Illinois Medicaid nursing home rate per day
The $248.95 figure is published without a billing code, the usual form for a facility per diem, and its October 1, 2026 effective date makes it one of the freshest rates in our skilled nursing data. The Illinois Medicaid rates page shows the rate with a link to its source document; every rate is compiled from official state Medicaid publications.
A 14th-place rank and an 11.9% gap below the median put Illinois behind the high-paying group: New Mexico ($826.00), Colorado ($419.22), Rhode Island ($381.06), Washington ($373.84) and Kentucky ($365.78). It is well above the lowest ranked states, Connecticut ($107.21), Michigan ($99.90) and Arkansas ($70.00).
Illinois Medicaid skilled nursing reimbursement: plans negotiate
Illinois's managed-care rule for nursing facilities is that plans negotiate; the published rate applies out of network. Our data counts 71 plans in Illinois, a large managed-care market, including Aetna Better Health of Illinois, Blue Cross Community Health Plans and others.
That rule has clear consequences:
- In network, the contract sets the rate. A facility in a plan's network is paid what its contract says, which can be above or below the HFS per diem.
- Out of network, the HFS rate applies. The published $248.95 becomes the reference when a facility serves a plan member without a contract.
- Negotiating leverage matters. Facilities with strong quality results, specialized units or scarce capacity in a market are in a better position to contract above the published rate.
The Illinois managed care page lists the plans and the rules for other service lines.
Directed payments for Illinois nursing facilities
The change record for Illinois is dominated by CMS approvals of state directed payments (SDPs) for nursing facilities:
- IL_Fee_NF_Renewal_20260101-20261231, approved July 17, 2026, for calendar year 2026.
- IL_Fee_NF2_Renewal_20250101-20251231, approved May 23, 2025, for 2025.
- IL_Fee_NF2_Renewal_20240101-20241231, approved February 26, 2024, and IL_Fee_NF2_Amend_20240101-20241231, approved September 12, 2025, both for 2024.
- IL_Fee_NF2_Amend_20230101-20231231, approved May 1, 2025, for 2023.
A state directed payment requires managed-care plans to pay providers in a specified way, on top of or in place of negotiated terms. Two points stand out. The program has been renewed every year, which gives operators some confidence it will continue. And approvals often land well into, or after, the year they cover: the 2026 renewal was approved in July, and the 2023 amendment in May 2025. Facilities should expect directed payment revenue to arrive on a lag.
For budgeting, that suggests a conservative approach: model the per diem and contracted rates as core revenue, and treat the directed payment as a separate line that is recognized once the year's approval is in hand. The pattern of annual renewals since 2023 makes the program a reasonable planning assumption, but not one to spend before CMS signs off.
HFS also issued provider notice prn240718b, a Nursing Facility Support Component Rate Increase and Ventilator Add-on Rate Increase effective January 1, 2024. Facilities with ventilator-dependent residents receive an add-on beyond the base per diem.
Labor costs in Illinois nursing homes
May 2025 federal occupational data shows a mixed picture for Illinois.
| Role | Illinois | US median |
|---|---|---|
| Registered nurse | $46.15 | $46.90 |
| Licensed practical nurse | $36.06 | $30.96 |
| Nursing assistant (CNA) | $22.10 | $20.32 |
Registered nurses earn slightly less than the national median, but licensed practical nurses and nursing assistants earn more. Since nursing assistants deliver most hands-on care, the CNA wage of $22.10 an hour drives most direct care cost, and it sits above the national figure.
That combination is the core Illinois challenge: an 11.9% below-median per diem paired with above-median wages for the largest part of the workforce. Directed payments and add-ons help close the gap, which is why tracking them matters. A facility that relies only on the published per diem, without strong plan contracts or add-on revenue, carries the full weight of that mismatch.
Illinois against the top and bottom states
For comparison, Kentucky, ranked 5th at $365.78, is the closest high-paying state geographically. Michigan, a Great Lakes neighbor, appears at $99.90 under code G9685, a figure that likely represents a component of payment. Arkansas anchors the bottom at $70.00. The national skilled nursing overview compares every state, and our methodology explains why only 21 of 44 states can be ranked.
Updated 2026-10-05