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BUSINESS SEGMENTS
 12 Months Ended
Dec. 31, 2022
Segment Reporting [Abstract]  
BUSINESS SEGMENTS BUSINESS SEGMENTS
In conjunction with the formation of Standard Bearer in January 2022, the Company's Chief Executive Officer, who is its chief operating decision maker, or CODM, began reviewing the results of Standard Bearer instead of all real estate properties. Accordingly, the Company revised its former real estate segment to include only real estate properties that are part of Standard Bearer. This change in organizational structure demonstrates that Standard Bearer's real estate is a core part of the Company's expansion of its real estate investment strategy. As of the first quarter of 2022, 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. Segment information for prior periods has been recast to reflect the change of the Company’s segment structure.

As of December 31, 2022, the skilled services segment includes 234 skilled nursing operations and 26 campus operations that provide both skilled nursing and rehabilitative care services and senior living services. The Company's Standard Bearer segment consists of 103 owned real estate properties. These properties include 75 operations the Company operated and managed and 29 senior living operations that are leased to and operated by third parties. Of the 29 real estate operations leased to third parties, one senior living operation is located on the same real estate property as a skilled nursing facility that the Company owns and operates.

The Company also reports an “All Other” category that includes results from its senior living operations, which includes eleven stand-alone senior living operations and the senior living operations at 26 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 7, 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, 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 real estate assets and insurance recoveries, net3,267 
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 affiliated wholly-owned healthcare facilities 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 affiliated wholly-owned healthcare facilities. 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. The 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 affiliated wholly-owned healthcare facilities. 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 affiliated wholly-owned healthcare facilities. Intercompany rental revenue is eliminated in consolidation along with corresponding intercompany rent expense.
 
Year Ended December 31, 2020
 Skilled ServicesStandard Bearer
All Other(1)
Intercompany EliminationTotal
Service revenue(2)
$2,288,182 $— $105,548 $(6,291)$2,387,439 
Rental revenue(3)
— 54,104 7,171 (46,118)15,157 
TOTAL REVENUE$2,288,182 $54,104 $112,719 $(52,409)$2,402,596 
Segment income (loss)327,812 27,299 (134,752)— 220,359 
Loss on sale of real estate and impairment charges(2,753)
Income before provision for income taxes $217,606 
Depreciation and amortization28,585 16,134 9,852 — 54,571 
Interest expense$— $9,350 $12 $— $9,362 
(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 affiliated wholly-owned healthcare facilities. 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 affiliated wholly-owned healthcare facilities. 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, 2022
 Skilled ServicesOther Service Revenue 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 FMAP and other COVID-19 related state funding.
(2) Private and other payors also includes revenue from senior living operations and all payors generated in other ancillary services.

 Year Ended December 31, 2021
 Skilled ServicesOther Service Revenue 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 FMAP and other COVID-19 related state funding.
(2) Private and other payors also includes revenue from senior living operations and all payors generated in other ancillary services.
 
Year Ended December 31, 2020
 Skilled ServicesOther Service Revenue Total Service RevenueRevenue %
Medicaid(1)
$886,991 $13,258 $900,249 37.7 %
Medicare727,374 — 727,374 30.5 
Medicaid-skilled149,846 — 149,846 6.3 
Subtotal1,764,211 13,258 1,777,469 74.5 
Managed care367,095 — 367,095 15.4 
Private and other(2)
156,876 85,999 242,875 10.1 
TOTAL SERVICE REVENUE$2,288,182 $99,257 $2,387,439 100.0 %
(1) Medicaid payor includes revenue generated from senior living operations and revenue related to FMAP and other COVID-19 related state funding.
(2) Private and other payors also includes revenue from senior living operations and all payors generated in other ancillary services.