Long Island, New York — More than half of the nursing homes on Long Island are operating at a financial loss — and the gap between what it costs to care for a Medicaid resident and what the state actually pays keeps widening.
That is the central finding in a new analysis by Stuart Almer, president and CEO of Gurwin Jewish Nursing & Rehabilitation Center and one of the most prominent voices in New York long-term care. The numbers are stark: Long Island nursing homes lose an average of $85 per Medicaid resident, per day. Medicaid — the program that covers the majority of nursing home residents — reimburses facilities at roughly 75 cents on the dollar compared to the actual cost of care.
The result: 54% of Long Island nursing homes are now running in the red.
A Decade of Closures
The financial strain has real consequences. Since 2014, at least 40 nursing homes have closed across New York State. Long Island has already seen two of those closures in recent years, and operators say the trajectory is getting worse. Facilities have responded by restricting admissions and temporarily closing beds — stopgap measures that delay the inevitable for some homes.
The problem is structural. Medicaid reimbursement rates haven’t kept pace with rising labor costs, inflation, or the increasing clinical complexity of nursing home residents. For nonprofit facilities — which tend to maintain higher staffing levels than for-profit operators — the financial math is especially punishing.
Industry reports have noted for years that this gap isn’t a temporary budget problem. It’s a chronic mismatch between what the government promises to pay and what quality care actually costs.
The Budget Window Is Now
New York State is currently negotiating its annual budget, and nursing home advocates are making a final push for a significant Medicaid funding increase. The state’s Health Facilities Association has called for hundreds of millions of dollars in new support, arguing that without action, the closures won’t stop.
The pressure is landing in a crowded fiscal landscape. Hospitals, home care programs, and a range of other healthcare interests are all competing for the same limited dollars. As industry sources have pointed out, New York’s nursing homes are fighting the state’s hospitals for a lifeline in the budget scramble — and the outcome is far from certain.
Advocates argue that the cost of inaction extends beyond any single facility. Every closure forces residents to relocate — often to facilities further from family — and adds pressure to hospitals that are already struggling with discharge delays.
What $85 a Day Actually Means
What makes Almer’s analysis land harder than the usual advocacy messaging is its precision. The $85-per-day figure isn’t an estimate — it’s what Long Island nursing homes absorb on every Medicaid resident, every single day, under the current reimbursement structure.
Multiply that across a 200-bed facility, and the daily shortfall runs into the tens of thousands of dollars. Over a year, it’s millions. For facilities already operating on thin margins, that’s the difference between staying open and closing the doors.
Whether the state budget delivers meaningful relief — or kicks the crisis another year down the road — will likely determine which Long Island nursing homes are still standing in 2027.
