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BUSINESS SEGMENTS
 3 Months Ended
Mar. 31, 2024
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 March 31, 2024, the skilled services segment includes 264 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 109 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.

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 impairment of long-lived assets. 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:
 Three Months Ended March 31, 2024
 Skilled ServicesStandard Bearer
All Other(1)
Intercompany EliminationTotal
Service revenue(2)
$969,602 $— $39,626 $(4,743)$1,004,485 
Rental revenue(3)
— 22,201 2,946 (19,460)5,687 
TOTAL REVENUE$969,602 $22,201 $42,572 $(24,203)$1,010,172 
Segment income (loss)126,809 7,258 (42,620)— 91,447 
Impairment of long-lived assets
(1,849)
Income before provision for income taxes $89,598 
Depreciation and amortization10,536 6,829 2,292 — 19,657 
Interest expense(4)
$— $5,977 $272 $(4,285)$1,964 
(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 $1,080 for the three months ended March 31, 2024. 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.
 Three Months Ended March 31, 2023
 Skilled ServicesStandard Bearer
All Other (1)
Intercompany EliminationTotal
Service revenue(2)
$850,923 $— $34,533 $(3,538)$881,918 
Rental revenue(3)
— 19,717 2,563 (17,357)4,923 
TOTAL REVENUE$850,923 $19,717 $37,096 $(20,895)$886,841 
Segment income (loss)113,345 7,219 (42,182)— 78,382 
Depreciation and amortization9,064 5,966 2,082 — 17,112 
Interest expense(4)
$— $4,569 $311 $(2,844)$2,036 
(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 $708 for the three months ended March 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.
Service revenue by major payor source were as follows:
 Three Months Ended March 31, 2024
 Skilled Services
All Other (3)
Total Service RevenueRevenue %
Medicaid(1)
$382,118 $8,045 $390,163 38.8 %
Medicare265,583 — 265,583 26.4 
Medicaid-skilled63,309 — 63,309 6.4 
Subtotal711,010 8,045 719,055 71.6 
Managed care188,104 — 188,104 18.7 
Private and other(2)
70,488 26,838 97,326 9.7 
TOTAL SERVICE REVENUE$969,602 $34,883 $1,004,485 100.0 %
(1) Medicaid payor includes revenue generated from 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.
(3) All Other incorporates intercompany eliminations.

 Three Months Ended March 31, 2023
 Skilled Services
All Other (3)
Total Service RevenueRevenue %
Medicaid(1)
$333,445 $6,819 $340,264 38.6 %
Medicare247,723 — 247,723 28.1 
Medicaid-skilled57,927 — 57,927 6.6 
Subtotal639,095 6,819 645,914 73.3 
Managed care156,663 — 156,663 17.8 
Private and other(2)
55,165 24,176 79,341 8.9 
TOTAL SERVICE REVENUE$850,923 $30,995 $881,918 100.0 %
(1) Medicaid payor includes revenue generated from 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.
(3) All Other incorporates intercompany eliminations.