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Delano District Skilled Nursing Facility

All states › California › Delano › Delano District Skilled Nursing Facility

1509 Tokay Street Delano, CA 93215 · Kern County

(661) 720-2100

All 3 nursing homes in Delano, CA (3 take Medicaid)

Accepts Medicare Accepts Medicaid 141 certified beds Non profit

CMS certification number 555479 · See this home on Medicare Care Compare

Ratings come from CMS and are updated monthly; these are from October 2026. Check the latest inspection report and visit in person before you decide.

Is Delano District Skilled Nursing Facility a good nursing home? Reviews, ratings and inspection record

There are no official resident reviews of nursing homes: Medicare's Care Compare publishes inspections, staffing and quality data instead. Here is what that record shows for Delano District Skilled Nursing Facility as of October 2026.

CMS rates it 1 out of 5 stars overall, below the California average of 3.2. Inspectors issued 64 citations in the last three years. CMS imposed 2 penalties, including $17,966 in fines, in that time. For short-term rehab patients CMS rates quality 2 out of 5; for long-term residents, 4 out of 5. Those results differ a lot, so ask about the unit your family member would be on.

Online reviews from families and residents are on Google Maps and other sites; they reflect individual experiences and aren't checked by CMS. The full inspection reports, including what inspectors observed, are on Medicare Care Compare.

Staffing

Nursing staff spend about 4.72 hours per resident per day at Delano District Skilled Nursing Facility, above the California median of 4.27 (US median: 3.72). About 0.40 of those hours are from registered nurses. On weekends it falls to 4.37 hours, 8% below its all-week average.

Nursing care per resident per day 4.72 hours
Above the California median of 4.27 Registered nurses, licensed practical nurses and aides combined, from payroll records.
Registered nurse hours 0.40 per resident a day RNs handle assessments, medications and changes in condition.
Weekend nursing care 4.37 hours Per resident a day. A big drop from weekdays can mean thin weekend staffing.
Nursing staff turnover — Share of nursing staff who left over a year. Lower usually means steadier care.
Registered nurse turnover — Share of registered nurses who left over a year.
Administrators who left — Frequent leadership changes are worth asking about on a visit.

About this nursing home

Certified beds141
Residents per day 124 About 88% of beds filled, on average
OwnershipNon profit - Corporation
Payment acceptedMedicare and Medicaid
Certified sinceNovember 1991
Legal business nameNORTH KERN SOUTH TULARE HOSPITAL DISTRICT

Paying for care at Delano District Skilled Nursing Facility: Medicare and Medicaid

Delano District Skilled Nursing Facility is certified for both Medicare and Medicaid. Medicare Part A can cover a short skilled-nursing or rehab stay here after a qualifying hospital stay of at least three inpatient days (observation days don't count), for up to 100 days per benefit period. Medicaid can pay for long-term care for residents who meet California's income and asset rules. Being certified doesn't guarantee a Medicaid bed is open, so ask whether the home accepts residents whose Medicaid application is still pending.

In 2026 Medicare covers days 1–20 in full after the Part A deductible ($1,736 per benefit period); for days 21–100 you pay $217 a day; after day 100 you pay all costs. Medicare doesn't pay for long-term custodial care. Medicare's coverage rules.

Health inspections

The most recent standard inspection was on February 6, 2025 and found 10 deficiencies, plus 14 from complaint inspections in the same period. In total, inspectors issued 64 citations in the last three years.

Each citation has a scope and severity letter from A to L. A–C: potential for minimal harm. D–F: potential for more than minimal harm. G–I: actual harm. J–L: immediate jeopardy to resident health or safety.

What the inspections found

Over the last three years, inspectors issued 64 citations at Delano District Skilled Nursing Facility across 32 inspection dates, 38 of them from complaint investigations. 2 were at the actual-harm level (G–I), most recently on June 5, 2024. The most common areas cited were resident rights (13) and freedom from abuse, neglect, and exploitation (12). The most serious was cited under the CMS rule to "ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents" (tag F0689, level G, June 5, 2024). 12 citations were under CMS's abuse, neglect and exploitation rules.

April 2, 2026 · 1 citation · includes complaint inspection

DEnsure each resident must receive and the facility must provide necessary behavioral health care and services.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0740 · Complaint inspection · Deficient, Provider has date of correction (Apr 21, 2026)

March 24, 2026 · 2 citations · includes complaint inspection

DEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0689 · Complaint inspection · Deficient, Provider has date of correction (May 15, 2026)

DGive their staff education on dementia care, and what abuse, neglect, and exploitation are; and how to report abuse, neglect, and exploitation.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0943 · Complaint inspection · Deficient, Provider has date of correction (May 15, 2026)

March 19, 2026 · 2 citations · includes complaint inspection

DTimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0609 · Complaint inspection · Deficient, Provider has date of correction (Apr 15, 2026)

DDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0656 · Complaint inspection · Deficient, Provider has date of correction (Apr 15, 2026)

March 3, 2026 · 1 citation · includes complaint inspection

DHelp the resident with transportation to and from laboratory services outside of the facility.

Potential for more than minimal harm · Administration Deficiencies · Tag F0774 · Complaint inspection · Deficient, Provider has date of correction (Mar 13, 2026)

January 15, 2026 · 1 citation · includes complaint inspection

DDevelop and implement policies and procedures to prevent abuse, neglect, and theft.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0607 · Complaint inspection · Deficient, Provider has date of correction (Feb 25, 2026)

January 6, 2026 · 3 citations · includes complaint inspection

DReasonably accommodate the needs and preferences of each resident.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0558 · Complaint inspection · Deficient, Provider has date of correction (Mar 4, 2026)

DTimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0609 · Complaint inspection · Deficient, Provider has date of correction (Mar 4, 2026)

DEnsure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.

Potential for more than minimal harm · Nursing and Physician Services Deficiencies · Tag F0726 · Complaint inspection · Deficient, Provider has date of correction (Mar 4, 2026)

December 12, 2025 · 1 citation · includes complaint inspection

EDevelop and implement policies and procedures to prevent abuse, neglect, and theft.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0607 · Complaint inspection · Deficient, Provider has date of correction (Feb 25, 2026)

November 20, 2025 · 1 citation · includes complaint inspection

EDevelop and implement policies and procedures to prevent abuse, neglect, and theft.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0607 · Complaint inspection · Deficient, Provider has date of correction (Jan 12, 2026)

November 14, 2025 · 2 citations · includes complaint inspection

FProvide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0628 · Complaint inspection · Deficient, Provider has date of correction (Jan 13, 2026)

DEnsure the transfer/discharge meets the resident's needs/preferences and that the resident is prepared for a safe transfer/discharge.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0627 · Complaint inspection · Deficient, Provider has date of correction (Jan 13, 2026)

August 5, 2025 · 1 citation · includes complaint inspection

DTimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0609 · Complaint inspection · Deficient, Provider has date of correction (Oct 9, 2025)

February 6, 2025 · 10 citations

EReasonably accommodate the needs and preferences of each resident.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0558 · Deficient, Provider has date of correction (Feb 20, 2025)

EProvide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0755 · Deficient, Provider has date of correction (Feb 20, 2025)

EProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Potential for more than minimal harm · Nutrition and Dietary Deficiencies · Tag F0812 · Deficient, Provider has date of correction (Feb 20, 2025)

EProvide and implement an infection prevention and control program.

Potential for more than minimal harm · Infection Control Deficiencies · Tag F0880 · Deficient, Provider has date of correction (Feb 20, 2025)

EEducate residents and staff on COVID-19 vaccination, offer the COVID-19 vaccine to eligible residents and staff after education, and properly document each resident and staff member's vaccination status.

Potential for more than minimal harm · Infection Control Deficiencies · Tag F0887 · Deficient, Provider has date of correction (Feb 20, 2025)

DEnsure each resident receives an accurate assessment.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0641 · Deficient, Provider has date of correction (Feb 20, 2025)

DProvide enough food/fluids to maintain a resident's health.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0692 · Deficient, Provider has date of correction (Feb 20, 2025)

DProvide safe and appropriate respiratory care for a resident when needed.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0695 · Deficient, Provider has date of correction (Feb 20, 2025)

DEnsure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.

Potential for more than minimal harm · Nursing and Physician Services Deficiencies · Tag F0726 · Deficient, Provider has date of correction (Feb 20, 2025)

DProvide special eating equipment and utensils for residents who need them and appropriate assistance.

Potential for more than minimal harm · Nutrition and Dietary Deficiencies · Tag F0810 · Deficient, Provider has date of correction (Feb 20, 2025)

December 16, 2024 · 1 citation · includes complaint inspection

EHonor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0584 · Complaint inspection · Deficient, Provider has date of correction (Jan 24, 2025)

November 18, 2024 · 2 citations · includes complaint inspection

DHonor the resident's right to be treated with respect and dignity and to retain and use personal possessions.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0557 · Complaint inspection · Deficient, Provider has date of correction (Dec 27, 2024)

DDevelop and implement policies and procedures to prevent abuse, neglect, and theft.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0607 · Complaint inspection · Deficient, Provider has date of correction (Dec 27, 2024)

September 27, 2024 · 1 citation · includes complaint inspection

DMake sure that the nursing home area is safe, easy to use, clean and comfortable for residents, staff and the public.

Potential for more than minimal harm · Environmental Deficiencies · Tag F0921 · Complaint inspection · Deficient, Provider has date of correction (Oct 21, 2024)

September 19, 2024 · 1 citation · includes complaint inspection

DEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0689 · Complaint inspection · Deficient, Provider has date of correction (Oct 8, 2024)

September 18, 2024 · 2 citations · includes complaint inspection

ETimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0609 · Complaint inspection · Deficient, Provider has date of correction (Oct 21, 2024)

EProvide or obtain dental services for each resident.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0791 · Complaint inspection · Deficient, Provider has date of correction (Oct 21, 2024)

September 4, 2024 · 2 citations · includes complaint inspection

EHonor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0550 · Complaint inspection · Deficient, Provider has date of correction (Oct 10, 2024)

DEnsure that nurses and nurse aides have the appropriate competencies to care for every resident in a way that maximizes each resident's well being.

Potential for more than minimal harm · Nursing and Physician Services Deficiencies · Tag F0726 · Complaint inspection · Deficient, Provider has date of correction (Oct 10, 2024)

August 8, 2024 · 1 citation · includes complaint inspection

DEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0689 · Complaint inspection · Deficient, Provider has date of correction (Sep 18, 2024)

July 19, 2024 · 1 citation · includes complaint inspection

DEnsure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0761 · Complaint inspection · Deficient, Provider has date of correction (Aug 23, 2024)

June 27, 2024 · 1 citation · includes complaint inspection

DHonor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0584 · Complaint inspection · Deficient, Provider has date of correction (Jul 18, 2024)

June 20, 2024 · 1 citation · includes complaint inspection

DTimely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0609 · Complaint inspection · Deficient, Provider has date of correction (Jul 19, 2024)

June 5, 2024 · 1 citation, includes actual harm · includes complaint inspection

GEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Actual harm · Quality of Life and Care Deficiencies · Tag F0689 · Complaint inspection · Deficient, Provider has date of correction (Jul 3, 2024)

May 29, 2024 · 1 citation · includes complaint inspection

EMake sure there is a pest control program to prevent/deal with mice, insects, or other pests.

Potential for more than minimal harm · Environmental Deficiencies · Tag F0925 · Complaint inspection · Deficient, Provider has date of correction (Jun 27, 2024)

April 2, 2024 · 1 citation · includes complaint inspection

DHonor the resident's right to be treated with respect and dignity and to retain and use personal possessions.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0557 · Complaint inspection · Deficient, Provider has date of correction (Apr 17, 2024)

March 6, 2024 · 2 citations, includes actual harm · includes complaint inspection

GProvide appropriate treatment and care according to orders, resident’s preferences and goals.

Actual harm · Quality of Life and Care Deficiencies · Tag F0684 · Complaint inspection · Deficient, Provider has date of correction (Mar 22, 2024)

EHonor the resident's right to be treated with respect and dignity and to retain and use personal possessions.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0557 · Complaint inspection · Deficient, Provider has date of correction (Mar 22, 2024)

January 11, 2024 · 10 citations · includes complaint inspection

DImmediately tell the resident, the resident's doctor, and a family member of situations (injury/decline/room, etc.) that affect the resident.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0580 · Complaint inspection · Deficient, Provider has date of correction (Jan 31, 2024)

DEnsure each resident receives an accurate assessment.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0641 · Deficient, Provider has date of correction (Jan 31, 2024)

DCoordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0644 · Deficient, Provider has date of correction (Jan 31, 2024)

DCreate and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0655 · Deficient, Provider has date of correction (Jan 31, 2024)

DDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0656 · Deficient, Provider has date of correction (Jan 31, 2024)

DEnsure services provided by the nursing facility meet professional standards of quality.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0658 · Deficient, Provider has date of correction (Jan 31, 2024)

DProvide appropriate pressure ulcer care and prevent new ulcers from developing.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0686 · Deficient, Provider has date of correction (Jan 31, 2024)

DEnsure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0689 · Deficient, Provider has date of correction (Jan 31, 2024)

DProvide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0755 · Deficient, Provider has date of correction (Jan 31, 2024)

DEnsure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0761 · Deficient, Provider has date of correction (Jan 31, 2024)

January 3, 2024 · 1 citation

DProvide and implement an infection prevention and control program.

Potential for more than minimal harm · Infection Control Deficiencies · Tag F0880 · Infection control · Deficient, Provider has date of correction (Jan 19, 2024)

November 13, 2023 · 1 citation · includes complaint inspection

EDevelop and implement policies and procedures to prevent abuse, neglect, and theft.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0607 · Complaint inspection · Deficient, Provider has date of correction (Nov 24, 2023)

November 6, 2023 · 1 citation · includes complaint inspection

DNot transfer or discharge a resident without an adequate reason; and must provide documentation and convey specific information when a resident is transferred or discharged.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0622 · Complaint inspection · Deficient, Provider has date of correction (Nov 29, 2023)

October 20, 2023 · 1 citation · includes complaint inspection

EDevelop and implement policies and procedures to prevent abuse, neglect, and theft.

Potential for more than minimal harm · Freedom from Abuse, Neglect, and Exploitation Deficiencies · Tag F0607 · Complaint inspection · Deficient, Provider has date of correction (Nov 3, 2023)

October 3, 2023 · 1 citation · includes complaint inspection

DEnsure services provided by the nursing facility meet professional standards of quality.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0658 · Complaint inspection · Deficient, Provider has date of correction (Oct 16, 2023)

January 6, 2022 · 6 citations

FProcure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

Potential for more than minimal harm · Nutrition and Dietary Deficiencies · Tag F0812 · Deficient, Provider has date of correction (Feb 2, 2022)

EEnsure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.

Potential for more than minimal harm · Pharmacy Service Deficiencies · Tag F0761 · Deficient, Provider has date of correction (Feb 2, 2022)

DHonor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.

Potential for more than minimal harm · Resident Rights Deficiencies · Tag F0578 · Deficient, Provider has date of correction (Feb 2, 2022)

DDevelop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.

Potential for more than minimal harm · Resident Assessment and Care Planning Deficiencies · Tag F0656 · Deficient, Provider has date of correction (Feb 2, 2022)

DProvide appropriate treatment and care according to orders, resident’s preferences and goals.

Potential for more than minimal harm · Quality of Life and Care Deficiencies · Tag F0684 · Deficient, Provider has date of correction (Feb 2, 2022)

DProvide and implement an infection prevention and control program.

Potential for more than minimal harm · Infection Control Deficiencies · Tag F0880 · Deficient, Provider has date of correction (Feb 2, 2022)

Questions to ask on a tour of Delano District Skilled Nursing Facility

  1. Inspectors cited the home at the actual-harm level on June 5, 2024 under the rule on quality of life and care. What changed afterwards, and can I see the plan of correction?
  2. CMS cited the home under its abuse and neglect rules on March 24, 2026. How are staff trained, and how are concerns reported?
  3. CMS rates staffing 2 out of 5. How many residents does each nurse aide care for on day, evening and night shifts?
  4. CMS rates short-stay quality 2 out of 5. How often do rehab patients go back to the hospital, and how many therapy sessions a week are typical?
  5. Do you have a Medicaid bed open now, and will you admit someone whose Medicaid application is still pending?
  6. When is the first care-plan meeting, and can family attend?

Questions come from this home's CMS data: its inspections, staffing and ownership record.

Fines and payment denials

2 penalties in the last three years, including $17,966 in fines.

DateTypeAmount or length
May 29, 2024 Fine $9,318
Jan 3, 2024 Fine $8,648

Rating history

CMS monthOverallInspectionStaffingQuality
October 2026 1/5 1/5 2/5 3/5
August 2026 1/5 1/5 3/5 3/5
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Location

Hospitals near Delano District Skilled Nursing Facility

The Medicare-certified hospitals closest to this nursing home, with their CMS data. Ask the home which hospital it usually sends residents to.

Hospital ratings, ER visit times and more at Hospitals In Each State
Source: CMS Care Compare. Distances are approximate.

Nearby nursing homes

Adventist Health Delano Delano · 0.1 mi away ★★☆☆☆ Inspection 2/5 · Staffing 3/5 51 beds · Medicaid
Valley View Care Center Delano · 1.1 mi away ★★☆☆☆ Inspection 2/5 · Staffing 2/5 53 beds · Medicaid
Shafter Nursing Care Shafter · 17.8 mi away ★★★★☆ Inspection 4/5 · Staffing 3/5 99 beds · Medicaid
Gateway Post Acute Porterville · 23.2 mi away ★★★☆☆ Inspection 2/5 · Staffing 2/5 62 beds · Medicaid
River Walk Care Center Porterville · 24.2 mi away ★★☆☆☆ Inspection 2/5 · Staffing 2/5 99 beds · Medicaid

More nursing homes near Delano District Skilled Nursing Facility ›   All nursing homes in Delano ›

Compare Delano District Skilled Nursing Facility with the 3 closest homes side by side ›

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Source: CMS Provider Data Catalog (provider information, health deficiencies, penalties), October 2026. Inspection citations and penalties cover the last three years. Nursing Homes In Each State is independent and not affiliated with CMS or Medicare. About the data · Report a problem with this listing. Is this your nursing home? Feature it here.

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https://www.nursinghomesineachstate.com/california/delano/delano-district-skilled-nursing-facility/ · Data: CMS, October 2026 · Nursing Homes In Each State, not affiliated with CMS or Medicare.