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REVENUE AND ACCOUNTS RECEIVABLE
 3 Months Ended
Mar. 31, 2024
Revenue from Contract with Customer [Abstract]  
REVENUE AND ACCOUNTS RECEIVABLE REVENUE AND ACCOUNTS RECEIVABLE
The Company's service revenue is derived primarily from providing healthcare services to its patients. Revenue is recognized when services are provided to patients at the amount that reflects the consideration that the Company expects to be entitled from patients and third-party payors, including Medicaid, Medicare and insurers (private and Medicare replacement plans), in exchange for providing patient care.
Disaggregation of Revenue
The Company disaggregates revenue from contracts with its patients by payors. The Company has determined that disaggregating revenue into these categories achieves the disclosure objectives to depict how the nature, amount, timing and uncertainty of revenue and cash flows are affected by economic factors.
Revenue by Payor

The Company’s revenue is derived primarily from providing healthcare services to patients and is recognized on the date services are provided at amounts billable to individual patients, adjusted for estimates for variable consideration. For patients under reimbursement arrangements with third-party payors, including Medicaid, Medicare and private insurers, revenue is recorded based on contractually agreed-upon amounts or rates, adjusted for estimates for variable consideration, on a per patient, daily basis or as services are performed.

Revenue from the Medicare and Medicaid programs accounted for 71.6% and 73.3% of all service revenue for the three months ended March 31, 2024 and 2023, respectively. Settlements with Medicare and Medicaid payors for retroactive adjustments due to audits and reviews are considered variable consideration and are included in the determination of the estimated transaction price. These settlements are estimated based on the terms of the payment agreement with the payor, correspondence from the payor and the Company’s historical settlement activity. Consistent with healthcare industry practices, any changes to these revenue estimates are recorded in the period the change or adjustment becomes known based on the final settlement. The Company recorded adjustments to revenue which were not material to the Company's revenue for the three months ended March 31, 2024 and 2023.
Service revenue for the three months ended March 31, 2024 and 2023 is summarized in the following tables:
 Three Months Ended March 31,
20242023
Revenue% of RevenueRevenue% of Revenue
Medicaid(1)
$390,163 38.8 %$340,264 38.6 %
Medicare265,583 26.4 247,723 28.1 
Medicaid — skilled63,309 6.4 57,927 6.6 
Total Medicaid and Medicare719,055 71.6 645,914 73.3 
Managed care188,104 18.7 156,663 17.8 
Private and other(2)
97,326 9.7 79,341 8.9 
SERVICE REVENUE$1,004,485 100.0 %$881,918 100.0 %
(1) Medicaid payor includes revenue for senior living operations and revenue related to state relief funding.
(2) Private and other also includes revenue from senior living operations and all revenue generated in other ancillary services.
The Company's rental revenues are primarily generated by leasing healthcare-related properties through triple-net lease arrangements, under which the tenant is solely responsible for the costs related to the property. Rental revenue was $5,687 and $4,923, respectively, for the three months ended March 31, 2024 and 2023.
State relief funding
In 2023, the Company received state relief funding through Medicaid programs from various states, including healthcare relief funding under the American Rescue Plan Act (ARPA), increases in the Federal Medical Assistance Percentage (FMAP) under the Families First Coronavirus Response Act (FFCRA) and other state specific relief programs. The funding generally incorporates specific use requirements primarily for direct patient care including labor related expenses that are attributable to the COVID-19 pandemic or are associated with providing patient care. Due to the expiration of the COVID-19 Public Health Emergency on May 11, 2023, the Company did not receive additional funding during the three months ended March 31, 2024. The Company received $27,264 in state relief funding and recognized $26,358 as revenue during the three months ended March 31, 2023.
Balance Sheet Impact
Included in the Company’s condensed consolidated balance sheets are contract balances, comprised of billed accounts receivable and unbilled receivables, which are the result of the timing of revenue recognition, billings and cash collections, as well as, contract liabilities, which primarily represent payments the Company receives in advance of services provided. The Company had no material contract liabilities and contract assets as of March 31, 2024 and December 31, 2023, or activity during the three months ended March 31, 2024 and 2023.

Accounts receivable consist primarily of amounts due from Medicare and Medicaid programs, other government programs, managed care health plans and private payor sources, net of estimates for variable consideration. Accounts receivable as of March 31, 2024 and December 31, 2023, is summarized in the following table:
March 31, 2024December 31, 2023
Medicaid$188,524 $178,285 
Managed care135,691 125,907 
Medicare89,300 85,512 
Private and other payors115,387 104,683 
 528,902 494,387 
Less: allowance for doubtful accounts(9,463)(9,348)
ACCOUNTS RECEIVABLE, NET$519,439 $485,039