Oregon Skilled Nursing Medicaid Rates and Reimbursement (2026)

Skilled nursing Medicaid rates in Oregon are among the highest in the country. The state's published daily rate for a nursing home stay is $568.23, effective July 1, 2026, compared with a national median of $282.59 among states with a comparable figure. Oregon is not part of the 21-state ranking, but its per diem is higher than every ranked state except New Mexico.

Oregon pairs that high rate with nursing wages far above the national median, prior authorization rules on its nursing facility codes and a rate schedule that rises twice a year. The headline rate is generous; the margin it leaves depends on how well a facility manages labor and authorizations.

The $568.23 per diem is Oregon's published payment for one nursing home resident day. It covers nursing at three licensure levels, room and board, dietary, housekeeping, activities, administration and capital.

Oregon publishes nursing facility rates on its Aging and People with Disabilities (APD) Medicaid long-term services and supports rate schedule, alongside other long-term care services. The state's fee-for-service nursing facility rates effective July 1, 2026 were published June 23, 2026, a week before they took effect. The Oregon state page lists the published rates and links each to its source document.

Our national ranking covers the 21 states where a single daily figure can be compared like for like. Oregon is shown against the median instead, but the comparison is clear: at $568.23, it sits above every ranked state except New Mexico's $826.00, and well above the next group, which runs from Kentucky's $365.78 to Colorado's $419.22.

That position matters for any multi-state operator. A per diem this far above the median means each Oregon Medicaid day carries roughly the revenue that only a handful of states provide. The question is how much of it labor absorbs, covered below.

Oregon updates the APD Medicaid LTSS rate schedule every January and July. The last four updates have all been increases:

What the cadence means

Revenue per Medicaid day keeps pace with costs more closely than in a state with one annual update, and operators get two natural points a year to revisit budgets and staffing plans.

What the trend means

The 2025 increases were larger than those in 2026. The January 2026 update was the smallest of the four, followed by a 4.0% rise in July. Operators should treat the next January schedule as the key signal of whether that slower pace continues. In a labor market as tight as Oregon's, the gap between rate growth and wage growth decides whether margins widen or narrow.

Oregon's high per diem is matched by high labor costs. Its May 2025 wages are above the national median at every nursing level:

• Registered nurses: $62.02 an hour, against $46.90 nationally.
• Licensed practical nurses: $38.69, against $30.96.
• Nursing assistants (CNAs): $23.96, against $20.32.

The registered nurse figure stands out. Licensed practical nurses and nursing assistants also earn substantially more than their national counterparts, and aides provide most direct-care hours.

That context changes how the $568.23 rate should be read. A per diem that looks generous by national standards is buying staff time in one of the most expensive nursing labor markets in the country. Oregon's rate and its wages are high together, so the margin on a Medicaid day is narrower than the headline comparison suggests.

Because labor absorbs so much of the per diem, staffing decisions carry more financial weight in Oregon than almost anywhere else.

Staffing mix

The registered nurse premium is the largest in relative terms. Facilities should make sure RN hours go to work that requires an RN, with licensed practical nurses and aides covering the rest within their scope. A small shift in mix can move cost per resident day meaningfully.

Retention over agency

Agency nurses fill gaps but usually cost more than employed staff, and in Oregon's market the premium is steep. Retention programs, predictable schedules and career paths for aides tend to pay back through lower agency use.

Matching raises to the schedule

With rates rising each January and July, facilities can time wage adjustments to follow the schedule. That keeps raises funded and makes the link between rate increases and pay visible to staff.

Oregon's nursing facility codes carry recorded prior authorization rules:

• Code 190: 4 prior authorization rules, no published unit limit.
• Code 194: 4 prior authorization rules, no published unit limit.

A Medicaid nursing facility stay in Oregon is subject to authorization steps beyond eligibility alone. Facilities should confirm authorization is in place before admission or as early as possible in the stay, since claims for unauthorized days are at risk of denial.

Authorization also interacts with the twice-yearly rate schedule. A stay that spans January 1 or July 1 is paid at two different per diems, and an authorization that lapses near a schedule change can leave days unpaid at either rate. Billing teams should track authorization end dates alongside the APD effective dates so that both line up for every resident day.

Prior authorization is a process risk, and a simple workflow reduces it.

1. Check at referral. Confirm Medicaid eligibility and start authorization before the resident arrives whenever possible.
2. Track end dates. Keep a single list of every resident's authorization period, reviewed weekly.
3. Renew early. Begin renewals well before an authorization lapses.
4. Reconcile denials. Review each denied day to find whether the cause was timing, documentation or eligibility, and fix the step that failed.

At $568.23 a day, each denied day is costly, which makes this work among the highest-return administrative tasks in an Oregon facility.

A high Medicaid rate changes the usual relationship between payers in a nursing home.

Medicaid is not the weak payer

In most states, long-stay Medicaid residents are the lowest-paying part of the census, and facilities lean on Medicare short stays and private-pay residents to cover costs. In Oregon, the gap between Medicaid and other payers is much narrower. A facility with a high Medicaid share is not automatically at a disadvantage, which supports stable long-stay care.

Private pay pricing

Private-pay residents pay the facility's own rate. With a Medicaid per diem this high, private pricing has to sit well above it to make sense, and residents who spend down from private pay to Medicaid during a long stay cause a smaller revenue drop than they would in a low-rate state. That makes the transition easier to plan.

Occupancy still decides the margin

Fixed staffing means each empty bed spreads cost across fewer paying residents. In a market where the staff on every shift are paid well above the national median, the cost of an empty bed is unusually high. Census management, from referral response time to discharge planning, deserves weekly attention.

Authorization and census together

Because stays need authorization, a facility can have an occupied bed that is not yet a paid bed. Tracking paid census separately from physical census shows how much revenue is waiting on authorization at any time, and where to focus follow-up.

Most Oregon Health Plan members receive medical care through coordinated care organizations (CCOs), Oregon's risk-based managed care model, operated by organizations such as Health Share of Oregon, AllCare CCO and PacificSource Community Solutions. Nursing facilities sit outside them: in Oregon, nursing facilities are paid directly by the state, outside managed care.

For a nursing facility, the APD schedule is the payment for a Medicaid resident day, with no plan-level negotiation. Home and community-based services and personal care are also paid directly by the state, while hospital inpatient and home health are lines where plans negotiate and the published rate applies out of network. Oregon's PACE program covers long-term care for its own enrollees. We record 17 plans and related arrangements in Oregon; the Oregon managed care page explains each line.

The APD long-term services and supports schedule also prices in-home and community care, which competes with nursing facilities for the same population. As those services grow, residents who enter facilities tend to need more care, which raises staffing hours per resident day in a market where each hour is expensive. See Oregon home care rates, Oregon home health rates and Oregon hospice rates.

New Mexico leads the ranked states at $826.00, followed by Colorado ($419.22), Rhode Island ($381.06), Washington ($373.84) and Kentucky ($365.78). The lowest ranked figures are Connecticut ($107.21), Michigan ($99.90) and Arkansas ($70.00).

Oregon's northern neighbor Washington, also a high-wage state, publishes $373.84, which makes the Oregon rate stand out even within the Pacific Northwest. California offers the other West Coast comparison. The skilled nursing industry hub shows every state.

Rates on this page are compiled from official state Medicaid publications, and each rate links to its source document. Rate changes come from the APD Medicaid LTSS rate schedules and the state's fee-for-service nursing facility rate publication. Oregon's figures are part of all 61,297 current Oregon Medicaid rates, drawn from 71 source documents with history back to 1995.

Our methodology explains how states are compared, and pricing covers access to the full Oregon dataset.