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BUSINESS SEGMENTS
 12 Months Ended
Dec. 31, 2023
Segment Reporting [Abstract]  
BUSINESS SEGMENTS BUSINESS SEGMENTS
The Company has two reportable segments: (1) skilled services, which includes the operation of skilled nursing facilities and rehabilitation therapy services and (2) Standard Bearer, which is comprised of selected real estate properties owned by Standard Bearer and leased to skilled nursing and senior living operators.

As of December 31, 2023, the skilled services segment includes 259 skilled nursing operations and 27 campus operations that provide both skilled nursing and rehabilitative care services and senior living services. The Company's Standard Bearer segment consists of 108 owned real estate properties.
The Company also reports an “All Other” category that includes results from its senior living operations, which includes 11 stand-alone senior living operations and the senior living operations at 27 campus operations that provide both skilled nursing and rehabilitative care services and senior living services. In addition, the "All Other" category includes mobile diagnostics, medical transportation, other real estate and other ancillary operations. Services included in the “All Other” category are insignificant individually, and therefore do not constitute a reportable segment.

The Company’s reportable segments are significant operating segments that offer differentiated services. The Company's CODM reviews financial information for each operating segment to evaluate performance and allocate capital resources. This structure reflects its current operational and financial management and provides the best structure to maximize the quality of care and investment strategy provided, while maintaining financial discipline. The Company's CODM does not review assets by segment in his resource allocation and therefore assets by segment are not disclosed below.

The accounting policies of the reportable segments are the same as those described in Note 2, Summary of Significant Accounting Policies. Intercompany revenue is eliminated in consolidation, along with corresponding intercompany expenses. Segment income and loss is defined as profit or loss from operations before provision for income taxes, excluding gain or loss from sale of real estate, real estate insurance recoveries and losses and impairment charges from operations. Included in segment income for Standard Bearer is expense for intercompany services provided by the Service Center as described in Note 6, Standard Bearer, as it is part of the CODM financial information.

The following tables set forth financial information for the segments:
 Year Ended December 31, 2023
 Skilled ServicesStandard Bearer
All Other (1)
Intercompany EliminationTotal
Service revenue(2)
$3,578,855 $— $144,667 $(15,451)$3,708,071 
Rental revenue(3)
— 82,486 11,137 (72,339)21,284 
TOTAL REVENUE$3,578,855 $82,486 $155,804 $(87,790)$3,729,355 
Segment income (loss)464,925 29,065 (221,251)— 272,739 
Gain on sale of assets and insurance recoveries from real estate, net
23 
Income before provision for income taxes$272,762 
Depreciation and amortization38,766 25,205 8,416 — 72,387 
Interest expense(4)
$— $19,761 $1,228 $(12,902)$8,087 
(1) All Other primarily includes all ancillary operations, stand-alone senior living operations and the Service Center.
(2) Intercompany service revenue represents service revenue generated by ancillary operations provided to the Company's independent subsidiaries and management service revenue generated by the Service Center with Standard Bearer. Intercompany service revenue is eliminated in consolidation along with corresponding intercompany cost of service.
(3) All Other rental revenue includes rental revenue associated with the Company's subleases to third parties of $3,897 for the year ended December 31, 2023. Intercompany rental revenue represents rental income generated by both Standard Bearer and other real estate properties with the Company's independent subsidiaries. Intercompany rental revenue is eliminated in consolidation along with corresponding intercompany rent expense.
(4) Included in interest expense in Standard Bearer is interest expense incurred from intercompany debt arrangements between Standard Bearer and The Ensign Group, Inc. Intercompany interest expense is eliminated in the "Intercompany Elimination" column.
 Year Ended December 31, 2022
 Skilled ServicesStandard Bearer
All Other (1)
Intercompany EliminationTotal
Service revenue(2)
$2,906,215 $— $115,214 $(12,718)$3,008,711 
Rental revenue(3)
— 72,937 7,396 (63,576)16,757 
TOTAL REVENUE$2,906,215 $72,937 $122,610 $(76,294)$3,025,468 
Segment income (loss)408,732 27,871 (150,781)— 285,822 
Gain on sale of assets and insurance recoveries from real estate, net
3,267 
Income before provision for income taxes$289,089 
Depreciation and amortization33,224 21,613 7,518 — 62,355 
Interest expense(4)
$— $15,707 $1,870 $(8,646)$8,931 
(1) All Other primarily includes all ancillary operations, stand-alone senior living operations and the Service Center.
(2) Intercompany service revenue represents service revenue generated by ancillary operations provided to the Company's independent subsidiaries and management service revenue generated by the Service Center with Standard Bearer. Intercompany service revenue is eliminated in consolidation along with corresponding intercompany cost of service.
(3) Intercompany rental revenue represents rental income generated by both Standard Bearer and other real estate properties with the Company's independent subsidiaries. Intercompany rental revenue is eliminated in consolidation along with corresponding intercompany rent expense.
(4) Included in interest expense in Standard Bearer is interest expense incurred from intercompany debt arrangements between Standard Bearer and The Ensign Group, Inc. Intercompany interest expense is eliminated in the "Intercompany Elimination" column.
 
Year Ended December 31, 2021
 Skilled ServicesStandard Bearer
All Other (1)
Intercompany EliminationTotal
Service revenue(2)
$2,523,234 $— $95,276 $(7,034)$2,611,476 
Rental revenue(3)
— 58,127 7,409 (49,551)15,985 
TOTAL REVENUE$2,523,234 $58,127 $102,685 $(56,585)$2,627,461 
Segment income (loss)373,603 31,876 (147,915)— 257,564 
Gain on real estate insurance recoveries440 
Income before provision for income taxes $258,004 
Depreciation and amortization30,681 17,558 7,746 — 55,985 
Interest expense$— $6,842 $7 $— $6,849 
(1) All Other primarily includes all ancillary operations, stand-alone senior living operations and the Service Center.
(2) Intercompany service revenue represents service revenue generated by ancillary operations provided to the Company's independent subsidiaries and management service revenue generated by the Service Center with Standard Bearer. Intercompany service revenue is eliminated in consolidation along with corresponding intercompany cost of service.
(3) Intercompany rental revenue represents rental income generated by both Standard Bearer and other real estate properties with the Company's independent subsidiaries. Intercompany rental revenue is eliminated in consolidation along with corresponding intercompany rent expense.

Service revenue by major payor source were as follows:
 Year Ended December 31, 2023
 Skilled Services
All Other (3)
Total Service RevenueRevenue %
Medicaid(1)
$1,429,473 $29,976 $1,459,449 39.4 %
Medicare985,749 — 985,749 26.6 
Medicaid-skilled245,663 — 245,663 6.6 
Subtotal2,660,885 29,976 2,690,861 72.6 
Managed care666,129 — 666,129 18.0 
Private and other(2)
251,841 99,240 351,081 9.4 
TOTAL SERVICE REVENUE$3,578,855 $129,216 $3,708,071 100.0 %
(1) Medicaid payor includes revenue generated from senior living operations and revenue related to state relief funding.
(2) Private and other payors also includes revenue from senior living operations and all payors generated in other ancillary services.
(3) All Other incorporates intercompany eliminations.
 Year Ended December 31, 2022
 Skilled Services
All Other (3)
Total Service RevenueRevenue %
Medicaid(1)
$1,158,309 $24,847 $1,183,156 39.3 %
Medicare832,160 — 832,160 27.7 
Medicaid-skilled200,878 — 200,878 6.7 
Subtotal2,191,347 24,847 2,216,194 73.7 
Managed care525,710 — 525,710 17.5 
Private and other(2)
189,158 77,649 266,807 8.8 
TOTAL SERVICE REVENUE$2,906,215 $102,496 $3,008,711 100.0 %
(1) Medicaid payor includes revenue generated from senior living operations and revenue related to state relief funding.
(2) Private and other payors also includes revenue from senior living operations and all payors generated in other ancillary services.
(3) All Other incorporates intercompany eliminations.
 
Year Ended December 31, 2021
 Skilled Services
All Other (3)
Total Service RevenueRevenue %
Medicaid(1)
$1,007,061 $15,399 $1,022,460 39.2 %
Medicare727,103 — 727,103 27.8 
Medicaid-skilled172,770 — 172,770 6.6 
Subtotal1,906,934 15,399 1,922,333 73.6 
Managed care456,728 — 456,728 17.5 
Private and other(2)
159,572 72,843 232,415 8.9 
TOTAL SERVICE REVENUE$2,523,234 $88,242 $2,611,476 100.0 %
(1) Medicaid payor includes revenue generated from senior living operations and revenue related to state relief funding.
(2) Private and other payors also includes revenue from senior living operations and all payors generated in other ancillary services.
(3) All Other incorporates intercompany eliminations.