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REVENUE AND ACCOUNTS RECEIVABLE
 12 Months Ended
Dec. 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 70.9%, 72.6% and 73.7% for the years ended December 31, 2024, 2023 and 2022, 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 years ended December 31, 2024, 2023 and 2022.

Service revenue for the years ended December 31, 2024, 2023 and 2022 is summarized in the following tables:
 Year Ended December 31,
202420232022
Revenue% of RevenueRevenue% of RevenueRevenue% of Revenue
Medicaid(1)(2)
$1,682,344 39.7 %$1,459,449 39.4 %$1,183,156 39.3 %
Medicare1,055,226 24.9 985,749 26.6 832,160 27.7 
Medicaid — skilled266,738 6.3 245,663 6.6 200,878 6.7 
Total Medicaid and Medicare$3,004,308 70.9 %$2,690,861 72.6 %$2,216,194 73.7 %
Managed care789,643 18.6 666,129 18.0 525,710 17.5 
Private and other(3)
443,574 10.5 351,081 9.4 266,807 8.8 
SERVICE REVENUE$4,237,525 100.0 %$3,708,071 100.0 %$3,008,711 100.0 %
(1) Medicaid payor includes revenue for senior living operations.
(2) Medicaid payor includes revenue related to state relief funding during the year ended December 31, 2023 and 2022.
(3) Private and other also includes revenue from senior living operations and all revenue generated in other ancillary services.
In addition to the service revenue above, the Company's rental revenue derived from triple-net lease arrangements with third parties is $22,960, $21,284 and $16,757 for the years ended December 31, 2024, 2023 and 2022.
State relief funding
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 in May 2023, the Company did not receive additional funding during the year ended December 31, 2024.
Revenues from these additional payments are recognized in accordance with ASC 606, subject to variable consideration constraints. In certain operations where the Company received additional payments that exceeded expenses incurred related to specific qualifiers, the Company recorded deferred revenue for the excess amount until additional expenses are incurred for recognition. Accordingly, the amount of state relief revenue recognized is limited to the actual related expenses incurred. As of years ended December 31, 2023 and 2022, the Company had $486 and $1,001 in unapplied state relief funds, respectively. During the years ended December 31, 2023 and 2022, the Company received an additional $64,238, and $81,057 in state relief funding and recognized $64,753, and $81,837, respectively, as revenue.
Federal relief funding
As part of the Coronavirus Aid, Relief, and Economic Security Act of 2020 (CARES Act), the Company deferred payment of the employer portion of social security taxes related to 2020. For the year ended December 31, 2022, the Company paid $24,155, which was the second and final payment associated with the deferred amount from 2020.
Balance Sheet Impact
Included in the Company’s 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 December 31, 2024 and 2023, or activity during the years ended December 31, 2024, 2023 and 2022.

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 and doubtful accounts. Accounts receivable as of December 31, 2024 and 2023, is summarized in the following table:
December 31,
20242023
Medicaid$228,872 $178,285 
Managed care139,711 125,907 
Medicare77,056 85,512 
Private and other payors132,693 104,683 
 $578,332 $494,387 
Less: allowance for doubtful accounts(8,435)(9,348)
ACCOUNTS RECEIVABLE, NET$569,897 $485,039