Where Nursing Homes Cost the Most (and Least) in 2026

State medians: CareScout 2025 Cost of Care Survey · Updated October 23, 2026

If you are pricing care for your mother or father right now, the state line on the map below is the single biggest lever on the bill.

Nursing home costs by state are not a gentle curve. They are a cliff. A semi-private room has a national median of $9,581 a month, yet families in Texas pay a median of $5,627 while families in Alaska pay $27,831. That is not a difference in room quality. It is a difference in wages, regulation, and what each state's Medicaid program pays the home. This page holds the full 2026 table for all 50 states, explains why the numbers spread so wide, and closes with what Medicaid covers wherever you live.

The national picture first

The national median is $9,581 a month for a semi-private room and $10,798 a month for a private room, per the CareScout 2025 Cost of Care Survey (fieldwork July to November 2025, released March 2026). The annual medians behind those monthly figures are $114,975 and $129,575. Monthly figures are the annual medians divided by 12: $114,975 / 12 = $9,581 and $129,575 / 12 = $10,798. A median means half of the surveyed homes charge more and half charge less, so your quotes will land on both sides of these lines. For the full picture of what the money buys and who pays it, start with our nursing home cost hub.

The 50-state table

This is the 2026 table: every state, both room types, drawn from the same CareScout survey so the figures are comparable across state lines. Find your state, then read the monthly figure as a planning number, not a quote. City prices can run well above the state median while rural homes price below it.

* Alaska's private-room median is published as N/A in the CareScout release itself.

Source: CareScout 2025 Cost of Care Survey state releases (March 2026). Monthly figures are the annual medians divided by 12. National medians: semi-private $114,975 a year ($9,581 a month); private $129,575 a year ($10,798 a month). The "vs national" column compares the semi-private monthly figure to the $9,581 national median.

How to read the table

The two monthly columns show the median for a semi-private room (shared with one other resident) and a private room. Nationally, the privacy premium is $10,798 - $9,581 = $1,217 a month, but it swings by state. In Mississippi the gap between room types is only $9,885 - $9,581 = $304 a month, while in Oregon it is $18,448 - $16,760 = $1,688 a month. If your parent strongly wants a private room, check both columns for your state, not just the first.

The "vs national" column compares each state's semi-private monthly median to the $9,581 national median. Texas at $3,954 below and Alaska at $18,250 above are the extremes. Note that Washington, DC has its own separate CareScout release ($146,730 a year, or $12,228 a month for a semi-private room); this table covers the 50 states only.

Why nursing home costs by state vary so much

Labor markets. Nursing labor is the largest cost inside a home's budget. In states where registered nurses and aides earn top wages, homes pass that cost to residents, and the medians follow. Rural states with thin labor pools sometimes pay premiums too, through agency staffing contracts that cost more than employed staff.

Staffing mandates. Some states require more staff hours per resident day than the federal floor, and several have raised their minimums in recent years. More mandated hours means a larger payroll every month, and that shows up directly in the table. New York and Connecticut sit near the top of the table partly for this reason.

Medicaid payment rates. Medicaid is the largest single payer of nursing home care. When a state sets its Medicaid daily rate below the cost of care, homes charge private-pay families more to close the gap. States with the thinnest Medicaid rates often show the widest distance between what Medicaid pays and what a family pays out of pocket.

Cost of living. Rent, food, insurance, and property costs run higher in coastal states and big metros, and facilities pay them like every other business. The table tracks cost of living closely: the Northeast and the West Coast sit at the top, while the South and much of the Midwest sit at the bottom.

Ownership mix. States where for-profit chains hold a larger share of beds tend to post higher private-pay prices than states where nonprofit and county-run homes dominate the bed supply. Ownership does not decide quality, but it shapes pricing strategy.

The cheapest and most expensive states

The cheapest five states cluster in the South and the Midwest. The most expensive five pair Alaska with the Northeast and the Pacific. All figures are 2026 semi-private medians, with the arithmetic shown (annual / 12).

Cheapest five:

• Texas: $5,627 a month ($67,525 / 12 = $5,627)
• Missouri: $6,741 a month ($80,893 / 12 = $6,741)
• Oklahoma: $7,026 a month ($84,315 / 12 = $7,026)
• Arkansas: $7,452 a month ($89,425 / 12 = $7,452)
• Louisiana: $7,604 a month ($91,250 / 12 = $7,604)

Most expensive five:

• Alaska: $27,831 a month ($333,975 / 12 = $27,831)
• Oregon: $16,760 a month ($201,115 / 12 = $16,760)
• New York: $15,528 a month ($186,333 / 12 = $15,528)
• Hawaii: $15,473 a month ($185,679 / 12 = $15,473)
• Connecticut: $15,208 a month ($182,500 / 12 = $15,208)

One state sits exactly on the national median for a semi-private room: Mississippi at $9,581 a month ($114,975 / 12), a clean baseline for comparison. On the private-room side, Oregon has the highest median at $18,448 a month ($221,373 / 12), with Connecticut and New York tied next at $16,729 a month ($200,750 a year). Alaska publishes no private-room median at all. If your state's row surprises you, the state guide (coming soon) will break it down by metro, where the real quotes live.

The gap between Texas and Alaska is $27,831 - $5,627 = $22,204 a month, about $22,200, and the Alaska median is $27,831 / $5,627 = 4.95, roughly five times the Texas median. The state line really is the single biggest price lever in nursing home care. Moving across one border can cut the bill by a third or more.

What Medicaid covers in your state

Medicaid pays for nursing home room and board in every state for people who meet the state's income and asset rules. The rules themselves are state-run: income caps, asset limits, and the application process differ from one state to the next. Before Medicaid pays, the state runs a look-back (the five-year review of gifts and transfers) to check whether assets were moved to qualify sooner. For care at home or in assisted living, families use a waiver (the state program that pays for care outside a nursing home), but nursing home coverage is a mandatory Medicaid benefit and works in all 50 states. If your parent's stay looks like it will last beyond a short rehab, read how to qualify for a nursing home under Medicaid before the savings run down.

State guides are coming

Every state will get its own cost guide: the state medians from this table, metro breakdowns, the exact name of the state's Medicaid program with a link to the state agency, state VA resources, and a state-versus-national comparison with its own FAQs. We are writing the highest-volume states first: California, Florida, Illinois, Indiana, Massachusetts, Michigan, Ohio, Texas, New York, New Jersey, Maryland, Colorado, and Alabama. Until your state's guide is live, this table plus the national nursing home cost hub is the complete picture.

Frequently asked questions

Why is my state so much more expensive than the national median?

The state median is a starting point, not a quote. Inside your state, city prices can run well above the state median while rural homes price below it. One useful check: ask each home what share of its residents are on Medicaid. In states where Medicaid pays homes less than the cost of care, homes with a large Medicaid census charge private-pay families more to close the gap, so two homes in the same city can quote very different daily rates. Get the daily private-pay rate and the Medicaid acceptance policy from at least three homes before you compare states, not just state medians.

Do nursing home costs follow the same pattern as assisted living costs by state?

Broadly yes. The same wage and cost-of-living pressures push both, so the states at the top and bottom of this table usually sit near the top and bottom of assisted living tables too. The spread is wider for nursing homes, because round-the-clock licensed nursing staff costs more than the lighter staffing in assisted living. One practical difference: Medicaid covers nursing home room and board in every state, while assisted living coverage depends on state waiver programs, so the payer picture changes even when the state ranking looks familiar. Read this table side by side with our assisted living vs nursing home cost comparison before committing to either setting.

Can I move my parent to a cheaper state to save money?

Sometimes the math works, but Medicaid does not travel with you. Your parent must meet the new state's residency rules and file a new Medicaid application there, and the new state runs its own look-back, the five-year review of gifts and transfers, on the new application. You cannot hold Medicaid in two states at once, so coverage gaps are a real risk during the move, and the move also means new doctors and new distance from family. Talk to an elder-law attorney in the destination state before signing a lease or listing a home.

How often are these state medians updated?

CareScout runs the cost of care survey once a year. The figures on this page come from the 2025 survey published March 2, 2026, and the next release usually lands the following spring. We re-check every figure on this page against each new release and update the table when the numbers change. Bookmark this page and check back after the next spring release for the newest medians.

Next step: find your state in the table above, then open the nursing home cost hub to see how those numbers fit into the full plan, from rehab stays to Medicaid.