Skilled nursing Medicaid rates in Washington are among the highest in the country. The state's published daily rate for a nursing home stay is $373.84, effective July 1, 2026. That ranks Washington 4th of the 21 states with a comparable daily rate and puts it 32.3% above the national median of $282.59.
Washington pairs that high rate with a twice-yearly rate cycle, a statutory rate system and a nursing labor market far more expensive than the national norm. Every rate here is compiled from official state Medicaid publications and linked to its source document.
Washington Medicaid nursing home rate per day: $373.84
The $373.84 per diem is Washington Medicaid's payment for one nursing home resident day. It covers nursing at three licensure levels, room and board, dietary, housekeeping, activities, administration and capital.
Washington's nursing facility rates are set by the Department of Social and Health Services (DSHS) under the state's nursing facility payment statute, and are published separately from the Apple Health fee-for-service schedules. Rates are set facility by facility, so the statewide figure is a reference point and each facility should confirm its own rate in the current DSHS letter. The Washington state page lists the published rates.
The twice-yearly rate cycle
Washington updates nursing facility Medicaid rates every July 1 and January 1. DSHS announces each set in a Dear Administrator letter, and the Health Care Authority (HCA) files the matching state plan amendment:
| Notice | Effective |
|---|---|
| Dear Administrator letter NH Rates #2025-001 | July 1, 2025 |
| HCA SPA 25-0022, Nursing Facility Rates (WSR 25-14-043) | July 1, 2025 |
| Dear Administrator letter NH Rates #2025-002 | January 1, 2026 |
| Dear Administrator letter NH Rates #2026-001 | July 1, 2026 |
| HCA SPA 26-0017, Nursing Facility Rates (WSR 26-14-087) | July 1, 2026 |
The July 2025 amendment, SPA 25-0022, was noticed with a 9.27% change and submitted to CMS on September 22, 2025. SPA 26-0017 followed with a public notice on June 30, 2026 for the July 2026 rate year.
For operators, the cycle has a predictable rhythm: the July letter carries the annual rate update tied to a state plan amendment, and the January letter adjusts rates mid-year. Each letter arrives shortly before its effective date. The July 2026 letter, for example, was issued June 25, 2026. Facilities should check every letter against their own rate and remittances.
The labor market behind the rate
Washington's May 2025 wages are well above the national median at every nursing level:
- Registered nurses: $59.71 an hour, against $46.90 nationally.
- Licensed practical nurses: $39.98, against $30.96.
- Nursing assistants (CNAs): $23.65, against $20.32.
All three are well above the national figures, and they reshape how the rate should be read. Washington's per diem is 32.3% above the median, but registered nurses, licensed practical nurses and nursing assistants all earn substantially more than their national counterparts. Because staff costs are the largest part of nursing home spending, much of the higher rate is absorbed by higher wages. The margin on a Washington Medicaid day is therefore closer to the national norm than the rank suggests.
The 9.27% change in the July 2025 amendment is consistent with a rate system trying to keep pace with that labor market.
The registered nurse gap is the widest of the three, which matters most for facilities with heavy clinical needs, such as those admitting residents directly from hospitals. Nursing assistant wages, the largest single labor line in most facilities, are also well above the national median. Operators budgeting for the next rate year should model wage growth against the twice-yearly rate updates rather than assume that the per diem alone will cover rising pay.
Paid by the state, outside managed care
Washington Apple Health, the state's Medicaid program, enrolls most members in managed care plans such as Community Health Plan of Washington, Coordinated Care and Amerigroup. Nursing facilities sit outside that system: in Washington, nursing facilities are paid directly by the state, outside managed care.
The DSHS per diem is therefore the payment for a Medicaid resident day, whichever plan a resident uses for other services. There is no plan-level negotiation over the nursing facility rate. We record 51 plans and related arrangements in Washington. The Washington managed care page explains how each service line is paid.
Washington among the top states
| State | Daily rate |
|---|---|
| New Mexico | $826.00 |
| Colorado | $419.22 |
| Rhode Island | $381.06 |
| Washington | $373.84 |
| Kentucky | $365.78 |
| National median | $282.59 |
Washington sits in a tight cluster with Colorado, Rhode Island and Kentucky, all between $365.78 and $419.22, while New Mexico's $826.00 stands alone. At the bottom of the ranking, Connecticut lists $107.21, Michigan $99.90 and Arkansas $70.00. Of the 44 states with a published nursing home rate, 21 are ranked on a single daily figure.
For a Washington operator, the two numbers to watch are the next January letter and the progress of SPA 26-0017 at CMS. Both determine whether the per diem keeps pace with a labor market that sits well above national levels.
See the skilled nursing industry hub for every state and the methodology page for how rates are compared.
Updated 2026-10-05