Creator: Mark Parkinson

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Is Illinois the Worst State in the USA to Own a Nursing Home?

Freestyle3 min readMar 3, 2026
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For 20 years, Illinois has ranked among the toughest states to operate a nursing home. Low Medicaid rates, harsh media scrutiny, and a punitive regulatory climate have made an already challenging environment even more difficult for providers.

For the last 20 years, people have told me that Illinois is at or near the top of the list for the worst states in the country to operate a nursing home. The reputation has been well deserved. Despite being a blue state, the Medicaid rate has consistently been one of the lowest. Add to that fact the brutal media climate, which has seen relentless attacks on the sector. And, like most states, providers feel punished by the regulators there.

The head scratcher of all of this is trying to understand the Medicaid rate. A weak rate in a blue state? One explanation was that Illinois providers have been divided. For decades there were three associations of roughly the same size serving the state. In addition, there was a very large provider that wasn’t a part of any association but had a huge influence in the state capital. Having four different voices lobbying almost never works, and Illinois is Exhibit A for that.

But times are changing and brighter days may be ahead. That’s because the providers are coming together. One association, the Health Care Council of Illinois (HCCI), now represents more than 500 of the 700-odd SNFs in the state. Under the leadership of Executive Director Matt Pickering, and co-chairs, Jonathon Aaron and Daniel Weiss, there is now one predominant voice in Springfield (the state capital).

But, have conditions improved? Park Place Live is pleased to announce an answer to that question with the unveiling of a new data-based video series where we will do a deep dive on a state to analyze what it’s like to own and operate there. We are featuring Illinois as our first state and will be focusing on the Land of Lincoln for all of March.

Over the next four weeks we will release these videos:

March 3 - Matt Pickering, who gives an overview of Illinois.

March 10 - Jonathan Aaron on what it’s like to own/operate in Illinois.

March 17 - Steven Littlehale, chief innovation officer, Zimmet Healthcare Services Group, delves into the state’s regulatory environment AND gives Illinois a grade via a VERY cool new tool he created to objectively analyze what it’s like to operate in any given state.

March 24 - Marc Zimmet, CEO, Zimmet Healthcare Services Group, performs a thorough analysis on the Illinois Medicaid system and will grade the state as well.

By the end of March, we will have both subjective and objective data points and be able to intelligently answer the question: Is Illinois the worst state in which to operate?

The answer may surprise you and the providers of Illinois. Tune in to find out.


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Is Illinois the Worst State in the USA to Own a Nursing Home? - News Now | Park Place