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Sabra Health Care REIT, Inc. (SBRA)

Q1 2021 Earnings Call· Thu, May 6, 2021

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Transcript

Operator

Operator

Good day, ladies and gentlemen, and welcome to the Sabra Health Care REIT First Quarter 2021 Earnings Conference Call. I would now like to turn the call over to Michael Costa, EVP Finance and Chief Accounting Officer. Please go ahead, Mr. Costa.

Michael Costa

Management

Thank you. Before we begin, I want to remind you that, we will be making forward-looking statements in our comments and in response to your questions concerning our expectations regarding our future financial position and results of operations, including the expected impacts of the ongoing COVID-19 pandemic, our expectations regarding our tenants and operators and our expectations regarding our acquisition, disposition and investment plans. These forward-looking statements are based on management's current expectations, and are subject to risks and uncertainties that could cause actual results to differ materially, including the risks listed in our Form 10-K for the year ended December 31, 2020 as well as in our earnings press release included as Exhibit 99.1 to the Form 8-K we furnished with SEC yesterday. We undertake no obligation to update our forward-looking statements to reflect subsequent events or circumstances, and you should not assume later in the quarter that the comments we make today are still valid. In addition, references will be made during the call to non-GAAP financial results. Investors are encouraged to review these non-GAAP financial measures, as well as the explanation and reconciliation of these measures to the comparable GAAP results included in the financials page of the Investors section of our website at www.sabrahealth.com. Our Form 10-Q, earnings release, and supplement, can also be accessed in the Investor section of our website. And with that, let me turn the call over to Rick Matros, Chairman and CEO of Sabra Health Care REIT.

Rick Matros

Management

Thanks, Mike, and thanks for joining us everyone. I appreciate it. Just a quick note that this is the first reporting period where we got all four quarters of the pandemic included in our statistics and our financials. Let me start with an update on live edge. On the last call which obviously was not long ago we talked about that's something that would be pending in terms of a decision in the near-term, given the impact of the pandemic, particularly the latest surge on the managed portfolio. Both we and importantly TPG have decided that we really need to give the portfolio some time to recover. And so, there's not really a timeframe on it, but I would expect that at this point, we just want to see some recovery at some trajectory over the next few months. At this point, the any offer that we will be able to make them is really not much of an offer. And if we were to acquire the remaining 51%, it would certainly be at levels well below the strike price under the old option, they'd like to do a little bit a little bit better. So, we're still in the same position that we've been in all along. That is if we could strike a price at the right price, then we'll have some nice runway to grow with the portfolio. And if not, then we'll have plenty of proceeds to produce for other investments, and it will have a minimal impact on the balance of our senior housing versus our skilled nursing. So either way, we feel like we're in a good position, but do fully agree that this just isn't the right time to put something like this on the market. So, that's it for now and we…

Talya Nevo-Hacohen

Management

Thank you, Rick. Sabra's senior housing managed portfolio continued to experience operating pressures in the first quarter of 2021 due to the global pandemic. However, when we look at the quarterly operating results on a more detailed basis, as well as April results, we see an inflection point in occupancy. We have stressed over the past quarters that, the challenge facing senior housing is occupancy and that improving occupancy is the vector that will drive the sector's economic recovery. Simultaneous trends of higher move-ins, fewer move-outs, and increasing interest in seniors housing driving tours and leave underlie the start of the occupancy recovery with normalizing expenses, further enhancing margin. As we expected, the successful distribution of vaccine has been the linchpin for the turnaround in senior housing in the United States. The headline numbers on a quarter-over-quarter basis are as follows. Occupancy in the first quarter of 2021, excluding two non-stabilized communities was 73.1%, compared to 76.4% in the prior quarter. REVPOR also excluding two non-stabilized communities declined sequentially by 1.7% to 3,718 from 3,783, but was slightly higher than in the first quarter of 2020. Cash net operating income declined 33.4% sequentially and margin declined by 6% compared to the prior quarter in part because of continued costs related to COVID and lack of grant income in the first quarter of 2021. The details indicate a more settled story. The rate of occupancy declines slowed over the course of the quarter in our total wholly owned portfolio than occupancy improved in April. From December 2020 to December 2021, occupancy declined 1.7% to 75.9%. From January, 2021 to February, 2021, occupancy declined 0.9% to 75.1%. From February, 2021 to March 2021 occupancy was flat at 75.1% and from March 2021 to April 2021, occupancy increased by 0.6% to 75.7%. From…

Harold Andrews

Management

Thank you, Talya. I'll give a quick overview of the numbers for Q1 and then provide additional color on our guidance for the second quarter of 2021. But first, I want to note that we collected 99.9% of our forecasted rents from the start of a pandemic in February 2020 through April 2021. I would like to point out that we have one operator in New York states, with at least three skilled nursing, transitional care facilities from us and who has decided to exit the business. These operations generate approximately $3.8 million of annual cash rates, and we expect to utilize deposits continue to pay the rents through June 2021. We're in the process of transitioning new three facilities to one of our top operators. He has significant operations in the state of New York. We expect this transition to take some time duty extended approval process in New York, which could result of a period of time when we are collecting no roots from these operations. Recovery from the impact of a pandemic will also take time, reducing the waste generated after the transition is completed when unknown period of time. We expect risk to return to the current level of your future, but not likely to occur in 2021. Given that this portfolio represents less than 1% of our total NOI is impact from the loss rate during this transition and stabilization period is not expected to be material. After the numbers for the quarter for the three months ended March 31, 2021, we recorded total revenues, rental revenues and NOI of $152.4 million, $113.4 million and $121.3 million, respectively, as compared to $152.1 million, $110.7 million and $124 million for the fourth quarter of 2020. The increase in total revenues and rental revenues of $0.3 million…

Operator

Operator

Thank you. [Operator instructions] Our first question comes from the line of Juan Sanabria of BMO Capital Markets. Your line is open.

Juan Sanabria

Analyst

Maybe just to start with the question for Harold. Apologies if I missed this, as you read through the numbers. Is there any one time numbers to the positive? I heard you mentioned a provision for losses and loan losses that up the first quarter relative to the second quarter guide given you're expecting staff to improve?

Harold Andrews

Management

No, Juan, as there's there was nothing in there. That was kind of one time out of the ordinary you're looking at three pure true operating results in the second quarter. So, there was nothing that I would classify as one time. Like I said, we didn't actually didn't even get any without maybe we get some government funds in the quarter but that did not happen. So, it was purely their just their operations.

Michael Costa

Management

And Juan, I take your permission to add something. Obviously, we see the commentary and the fact that we're you're really upbeat about recovering what we've seen so far. Although, we also don't know how much it's happening to the pent up demand, what's the actual trajectory is going to be over a longer period of time. And that the commentary, goes to losing out the EBITDA and some of the trends we're seeing, but our Q2 guidance is slightly down from Q1 actuals. And really what it comes down to is, like everybody else we've been really scarred the last year. And we don't see any reason to put out something that we say is optimistic. We're not even optimistic, but we're just more comfortable with putting something out there. That's conservative giving outs early these trends are. So it's really as simple as that there's just no upside, we don't think they are putting ourselves out there any more than we did for Q2. So you alluded to that in your question. So go ahead and finish out what you're asking.

Juan Sanabria

Analyst

I think I get it. But no kind of product of cash rent accrual or cash rent paying from previous period in the first quarter of a thing that would dip away or fall off in the second quarter just to double check?

Harold Andrews

Management

You're going to see some level of variability in cash collections from the cash basis. So if you kind of go back to the prior few quarters, you'll see this kind of little up and down quarter-over-quarter, but nothing significant there that we're expecting any call back.

Juan Sanabria

Analyst

Great. And then I guess maybe one for Rick on the SNF occupancy, I take your point on the largest operators being the bulk. Could you give the change year-to-date for the total SNF portfolio occupancy is and/or what the change has been from the trough to today in occupancy?

Rick Matros

Management

We don't have a number for the total one. That's still being reconciled and people operated in a different methodologies and things like that. Over the course of the pandemic, our manage portfolio and our top operators have gotten really good at giving us just really right on data that we've required. And we've asked more of them because they have the infrastructure. There are small operators that we have. We just haven't pushed them because they have much more limited resources and they have their hands full. So it's positive. It's just not as positive as this, but we don't have an actual number.

Juan Sanabria

Analyst

And just one last thing for me. Anybody on the watch list, we've had some hiccups with some of your triple net peers that have come to light. You mentioned the SIP operators in New York. Anything else to flag those that you guys are watching or that we should know about?

Rick Matros

Management

I'll make one comment and then Harold can jump in. So one, the answer is no, we've had remarkable consistency in our watch list, that was in place pre-pandemic now through the pandemic. Comment I want to make about the one operator. This has less to do with sort of their operational performance. But this particular operator, the CEO, who I've known for a long time, it's been in the business for decades, and certainly could have retired before this. And the pandemic, he called me and just said the pandemic just finished him off, just can't handle it anymore. He's stressed, he just depressed, he just can't deal with it. And so that's what precipitated the move, as opposed to sort of any concerns about operation. So if you hadn't made that phone call, and I'm not sure, this would be happening. So Harold do you have anything else?

Harold Andrews

Management

No. I don't have anything to add. As you said, Rick, the watch list have been very stable, and there's not maternal concerns that we have with our operators. So I think as you said well.

Operator

Operator

Our next question comes from the line of Rich Anderson of SMBC.

Rich Anderson

Analyst

I appreciate the comments from the front end of this on CMS and whatever you want to call it a call back on the 5% upside of revenue. But what do you gauge as being the Russia like I don't quite understand. It's hard enough to pinpoint things under normal times, with all the noise, both on the revenue side and on the expense side. How are they able to really kind of come up with an informed conclusion and also do you expected there to be some sort of concrete sort of law by October 1st of this year? Or do you think it gets pushed a year out because of all the confusion out there?

Rick Matros

Management

Yes. So to your original point, I think some of us sort of reacted the same way why not just let this year pass and then start looking at the data, whether it's the 5% caught them by surprise maybe that was the case. But we all saw rising almost from day one. So, we knew that that number was going to continue to grow over the course of the pandemic. But, if you actually read this full track of the proposed rule, they're pretty tempered in their comments. I know some of the headlights haven't been, but they're pretty tempered in their comments are very conciliatory, and in fact, more conciliatory in the proposed rule than I've ever seen in my career. So, is it possible if something happens this October, maybe, I don't think, it's going to be major. They really have made a point of indicating that, they don't want to do anything to disrupt the recovery, the industry. And so, yes, I was surprised. But their approach, I think is quite tempered.

Rich Anderson

Analyst

Okay. You mentioned, the number, the top seven operators making a big chunk of the business. You also mentioned, you have a bunch that are owners of one or two or operators of one or two facilities. Is there an opportunity to sell more and kind of consolidate your portfolio a little bit and maybe not be having some of those one-off situations perhaps as a way to finance it and live, and if that does sort of come to fruition?

Rick Matros

Management

Well, one from a timing perspective, so I'll take the second part first. From a timing perspective, I don't think that, I don't think Enlivant all that far off, right. So I don't think we would get much done in charge of sales to raise much money, but the other more important as a part of the answer, I think is that, we like our operators and we haven't had surprises with our operator in pandemic. When we identified, this goes back four years, when we did CCP, it's hard to believe it's that long. We identified who we wanted to do certain things with seller or restructure or whatever. And then, we would be going and it's been stable ever since. So, I think some of what we see out there. So there's about 32 of those operators out of which 16 of them showing occupancy increases, the other 16 flat or maybe slightly down, but those are very market specific. And a lot of that has to do with local department of health officials, where they haven't age restrictions yet, because as I said in my opening comments, easing a cohort restrictions of leading indicator with centers increase. So it's not like there is something inherently wrong or troubling about those operators. This stuff will pass and those environments will normalize, and they'll probably start spiking once those restrictions are listed just as we've seen some spiking with our larger operators with the pent up demand.

Rich Anderson

Analyst

Okay, last quick question. You mentioned group activities. Are you seeing any amount of concurrent therapy starting to take shape in your facilities?

Rick Matros

Management

We are seeing some and it's really all over the place, as you would expect with restriction evenings, kind of all over the place, but it is happening. And so that's going to be obviously super helpful with labor costs, and just overall expenses within the facility. So, I think we're hopeful that as some of these states that and municipalities are having age restrictions to this award that have suffered in any way by hearing so that the CDC guidelines will become more uniform. And then what we may have some trajectory that we can actually quantify and do something with, which we, if we just don't have. And I also say to that point, and my opening comment about so is that still have COVID, it's really heartening that, if you think about, you still got a pretty decent percentage of the workforce that isn't vaccinated. And so you have to assume that there is some exposure to community spread, we're seeing it we're seeing. Obviously, Michigan that's by, in-spite from Washington and in parts of Oregon and other places around the country, but it's not impacting buildings, it really goes to the efficacy of the vaccine, that you have facilities with 90 year olds that have an awful lot of issues. And you're really frail individuals. And it's all holding up. So, that's what we feel really good about. And for those facilities that have been able to use restrictions more so than others to same thing, there's no positive COVID cases. There's nothing happening that's negative.

Operator

Operator

Thank you. Our next question comes from Nick Joseph of Citi. Your question please.

Nick Joseph

Analyst

Thank you. Appreciate the updated comments on Enlivant. Are there any contractual timing considerations for the JV?

Rick Matros

Management

No.

Nick Joseph

Analyst

You can both wait and see on the recovery before making a decision.

Rick Matros

Management

Right, I don't anticipate that they're going to, this is a very, this is a vintage trend. So, I don't expect they're going to wait until this is fully recovered. I think I want to see some recovery and maybe some trajectory. So, there's a case to be made whether it's to us as a buyer or someone else that there's evaluation here that at least gives them something.

Nick Joseph

Analyst

Okay, but always, there's some flexibility there. Then just on the I guess, the positive commentary overall, I just wonder if you can kind of marry that with leverage thoughts and issuing ATM equity to kind of keep the leverage levels where they are, versus letting it drift a little higher in the near-term?

Rick Matros

Management

Harold, do you want to take that?

Harold Andrews

Management

Sure. So, I think it kind of goes back to what some of disconnects that people might see also in a positive tone in the fact that our earnings are basically flat quarter-over-quarter. And a lot of that is driven by the share count shares that we've issued in the first quarter shares that we will issue the second quarter to fund acquisitions and maintain leverage. And so there is, as we start to see clarity on recovery in our managed portfolio then we can begin to look at leverage on a little bit longer term basis, and start to see that equity issuance needed to manage that moderate. So I think we're already starting to feel like it will start to moderate now that we've got, as Rick pointed out early on, the pandemic is in there for the full 12 months, which is how we calculate EBITDA for leverage. But remember, we still saw EBITDA decline as the pandemic progressed. So we're still fighting that a little bit in our equity issues. But I think as we start to see it recovers, start to see performance improve and we can really evaluate where we're at, as well as then we started thinking about how the joint venture will play out, that will give us another opportunity to look at how financing that may occur or exiting would naturally be leveraged and have an impact on our equity issues. So leverage is still an important aspect for us to maintain it below the rating agency levels, and we've issued equity in the past to do that. We'll continue to do that if it's necessary. But I think we're starting to see, as we come into the pandemic, that should start to abate and we'll be able to start to get back to where we're only funding acquisition through.

Rick Matros

Management

And Nick, I would just add to that, while we're not sort of loosening up, if you will, as soon as some folks might like us to really since the pandemic started, we determined at that point in time that we were going to take an extremely conservative stance on everything to do with our balance sheet with liquidity. We were the first ones cut the dividends. And so everything was being for us was being about being a good and conservative steward of our capital. So that we would be actually in a stronger position to ease off not to stop growing the Company again. And we're going to be in a really good position to house points as EBITDA continues to grow with the recovery. And our leverage will then naturally drop even more. Now we're going to be in a position to have a lot more to play with there, on the leverage side, whether we decide to keep it where it is, or it'll be lower than it is now as EBITDA he grows to want to keep it lower. We're just going to have some real optionality. There's nothing historically that I prefer more as a CEO that optionality.

Operator

Operator

Our next question comes from Steven Valiquette of Barclays. Your line is open.

Steven Valiquette

Analyst

Just to come back quickly on that question of the 2Q '21 FFO guidance being down a little bit sequentially from the first quarter. You mentioned that you're taking a bit more of a conservative stance is due to the pandemic. But I guess, I'm just curious whether the concern is more on the risk of rank collections in the triple net portfolio? Or is it more perhaps REVPOR or pricing on the shop asset? Because it seems like from an occupancy standpoint, there's pretty good visibility for Sabra and really the entire industry, for occupancy to improve sequentially. So I'm just guessing the cost of this is more tied to raise then or collections just want to confirm that? Thanks.

Harold Andrews

Management

I'll take that. It's just cautious overall. I would say that we don't have any concerns over with collections that are material. But at the same time, we do have marriage portfolio, cash basis, tenants, to pay as they're able to, so you do see volatility that we want to be careful with and our expectations there. And, as I alluded to a little bit earlier, part of what you're seeing in the dynamic is just a function of the digital shares being issued official shares that are outstanding today that were issued in the first quarter and then expectation of some additional shares next quarter. So the fact that we're within a penny on an absolute dollar basis, it's much closer to flat. And as Rick as said, let's being cautious of our expectations across the board, but there aren't any specific triple net operators, do we have significant concerns with? And it's just a matter of cash basis that might have some timing differences as well.

Rick Matros

Management

And just quick comments on I make on that is we don't have concerns about and for the quarter that's held up pretty well, so that can be some discounting but we don't have the kind of operators that to give it away some so that's not a concern. But the other thing relative to manage portfolio, we're just weeks away from hitting our bottom. So, it's just not that much time for something that's been this damaging to the business.

Steven Valiquette

Analyst

Okay, got it. Okay. It just helps to get a confirmation around that and your thought pattern. So appreciate it. Thanks.

Rick Matros

Management

Thank you.

Operator

Operator

Thank you. Our next question comes from Lukas Hartwich of Green Street. Your line is open.

Lukas Hartwich

Analyst

Thanks. Hey, I was hoping if you could just talk a little bit more about the opportunity set for behavioral health hospital acquisitions. Is there much deal flow in that segment?

Talya Nevo-Hacohen

Management

I'll take that. The answer is that, we're seeing more deal flow than we've seen in prior years. Certainly in addiction treatment, there is a lot of interest by a lot of capital sources and it's a sector that is evolving quite rapidly and an opportunity for a lot of roll-ups of operators, because it's been a relatively small scale and very localized in its approach and the operating model there has really evolved very rapidly, even over the course of the last five years. So, there is a lot of interests there. There are opportunities there, and we are seeing more transactions in that sector than we've ever seen before. So, I'd say for the time being, yes.

Lukas Hartwich

Analyst

That's helpful. And then on the acquisition in Alaska, just curious what the challenges are with asset managing. I think that's your only property in Alaska is pretty far away. So maybe we can just talked about the challenges after managing that property, and then maybe I'm assuming you made that acquisition with the hope to add more properties in that state. So, maybe touch on that as well.

Talya Nevo-Hacohen

Management

Sure. So, there may be an opportunity to expand that property and add some additional units, specifically IL units, that's something that will see overtime if make sense, which gives us a bit of a campus there, which would be nice. Frankly, we -- our asset managers have toward the building prior to closing and they don't seem to be hesitant at all about making the trip up to Alaska, given all that we have in the Pacific Northwest it adds further, but it's not that much further, if you're already up in Washington and Oregon.

Rick Matros

Management

Lukas if you haven’t [indiscernible] it’s really phenomenal.

Lukas Hartwich

Analyst

Thank you.

Operator

Operator

Our next question comes from Todd Stender of Wells Fargo. Please go ahead.

Todd Stender

Analyst

Hi. Thanks and totally recognize it's a little premature to get too enthusiastic about the positive move in trends. But when you look at holiday, there're two good months March and April. What are you hearing from holiday, right now? And how are they ramping their marketing efforts, just you've got seasonal demand potentially coming sound that you get a little bit of upside? Just any color, if you can provide.

Talya Nevo-Hacohen

Management

I can take that. So, one of the things that's really interesting about the last year is that large operators and including Enlivant and it is very much so holiday in this basket, have shifted a lot of efforts to, to digital sales. For one, the outreach became different during the pandemic, because you weren't talking to people want face-to-face. But they really move to owning attitudes is sort of the whole optimization on their website and focusing on outreach through their website, as opposed to referral agencies that were much more to whom they were much more beholden in the past. So it's hard for me to say to you here today, and given the trends that we've described, how all that's going to play out as people start to open their doors and start to come out and really look, how the referral sources may shift or continue to move in the direction that they have been a little last year and how that impacts move in. What we do know is that move out as a result of debt frankly have declined and we expect that to move to a normalized level for sure. Together PT equation is that to the extent that residents stayed in buildings, because they there was a fear of moving to higher level of care, for example, because they were safe, where they worked, and I didn't want to change, there may be some pent up new doubts as a result of the meeting needing a higher level of care.

Todd Stender

Analyst

Understood, that's helpful. I guess just switching gears when I look at the cash yields on your senior housing facilities. One, the one you bought in Q1 and then you've already bought one in Q2 are pretty high in the high sevens, but it sounds like they include earn outs. Do you have more of a year one kind of initial going in yield?

Talya Nevo-Hacohen

Management

So far, we just concluded what we think is the stabilized number, which includes in earn outs.

Todd Stender

Analyst

Okay and that would be more one like a stabilized in year gosh or three or four months?

Talya Nevo-Hacohen

Management

Yes, it's sort of a 12 to 18 month window for both of those assets.

Operator

Operator

Thank you. Our next question comes from Joshua Dennerlein of Bank of America. Your question please.

Joshua Dennerlein

Analyst

Rick, last quarter, you've kind of provided your thoughts on when you thought SNF and senior housing occupancy will return to pre-pandemic levels. Any updated thoughts on that front you could share?

Rick Matros

Management

Yes, I actually still feel the same waywith the caveat being that my guess is as good as anybody's, and we don't have enough time yet to really have a trajectory that we can project over a number of months. So, I still believe that skill size, sometime in the first quarter of '22 will be either back to pre-COVID occupancy levels, or pretty close to senior housing. Likewise, I still think it's going to be the latter half of '22. So, when I say pretty close, either asset class, I mean, close enough that you're the markets going to feel like yes, we're going to get there.

Joshua Dennerlein

Analyst

Do you think it will be choppy or do you think it's kind of steady and do you see right over the summer or any kind of color?

Rick Matros

Management

So that's the tough part contingent, that's in different factors. One, how much has pent up demand impact? When you look at a pretty significant increase with our top operators, it feels like there's some pent up demand in there, right? The other piece of it is, is acute, has acute effects, sometimes acuity is normalized, because we're still getting people that are so much typically may used to be, that may impact like the state and shorten it a little bit. So you've got pent up demand which is helping, then you got potential pressure, I'd like to stay, all of which to say is, I think it's going to be a little choppy, I would expect that. And in the summer on the school side, as you know, normally have a dip in occupancy to get to where we are and given all the delays and surgeries and things like that. I'm not sure we're going to see that same. So my hope is that, sometime in the summer months, it'll be kind of steady growth that you can really start projecting off of.

Joshua Dennerlein

Analyst

On SNF side, how are you thinking about SNF mix going forward? Like, do you think we see more Medicare patients come back first, because they're being discharged from the hospitals and maybe before they were? Or is it somewhere there kind of crosslink going on?

Rick Matros

Management

First of all, I don't want to get too technical. They're all Medicare patients when they come in. We have very few operators that take Medicaid only patients. So they're dual eligible for Medicare, Medicaid. So they come in under as a Medicare patient. And with changes over time is, let's say for some Medicare rehab patients, they maybe home after 20 days, okay. But if it's a patient has come in under Medicare initially, that has a lot of complex nursing issues, which is what PDPM was set up to service. Then once they stabilize, they still had too many other health issues to get through the skilled nursing facility. They're going to be there for the long-term and they will convert at that point for Medicare and Medicaid. And they'll be in a facility for you no longer in the facility. So that's kind of how that works.

Operator

Operator

Our next question comes from the line of Tayo Okusanya of Mizuho. Your line is open.

Tayo Okusanya

Analyst

I wanted to talk about the 5.5 kind of leverage target that you guys have set up for yourself. Is that something that's hard set in stone by the credit rating agencies in order for you to maintain your investment grade rating? Is there some flexibility around that, like I understand EBITDA going up as things improve. That gives you a little bit more flexibility. But the not the target itself that five limits like what was that come from? And why do you kind of limit yourself that way?

Rick Matros

Management

I'll take that. Tayo, it is not a hard limit by all the rating agencies, but it is what Fitch has identified for us is their target leverage added below that level for us to maintain our current credit rating. So if we were to move into an area where we had sustained leverage above that level, then they would downgrade, Sabra, absent other factors, but it's kind of with our profile today, if it went above that it was sustained at that level, when they were downgrade. And if you'll recall, they put us on a negative outlook, and that negative outlook was specifically because our leverage was above that level. And so, they were telegraphing either if we didn't get it down within the next 12, 18 months, they were going to downgrade our credit rating. And that's why we got so focused on it in 2019 and got it down below that level just before the pandemic. And so, when the pandemic hit and we started seeing issues with our performance in the managed portfolio, we knew we had to manage at that level. And then frankly had no expectation with Fitch would do anything with our ratings outlook until after the pandemic was behind us. But because we took such an aggressive stance on that, they actually removed the negative outlook, because we demonstrated to them our commitment to maintain it below that level. So, in the near-term, it's going to be where we keep our leverage below. I will add that, when they look at that level, it is exclusive of the joint venture. In other words, we're actually a fair amount below that today, but until we determine the course of action around that joint venture, and we're going to maintain including that joint…

Tayo Okusanya

Analyst

Got you. Okay. And then I apologize if I missed this earlier on. But, Rick, I mean, in regards to just state and local government kind of stepping up in regards to providing government support, local government support for the skilled nursing industry. Could you talk a little bit about just what you're heading out there, whether it's kind of still too early for state to make any major moves, just kind of given the sense that the federal government is probably going to be moving away from this overtime?

Rick Matros

Management

Yes. So, one, it is too early. However, the dialogue and tone had changed. I think there have been a couple of reasons for that. One, the state budgets just didn't take the kind of hit at the time of deficits that were projected the beginning of the pandemic. And so, when they get all this Medicaid in for the federal government, even though it may not be targeted to skilled nursing, it really provides them even additional relief, which gives them more room to do things for us. And I think, if you look at the number of states that the FMAP increases, I think it's about half the states might be off a little bit. We felt really good about that they looked at their states and chose to do that. So, there does seem to be an awareness that should be new, but it seems to be that Medicaid is historically underfunded in most states. So, I think the tone and dialogue has changed, but it's definitely too early to anticipate what might happen.

Operator

Operator

Thank you. At this time, I'd like to turn the call back over to CEO, Rick Matros for closing remarks, sir.

Rick Matros

Management

Thank you. Thank you for joining us. Appreciate your time today and your support. And as always, we're available for follow-up and hope everybody has a good weekend and continue to stay safe out there. Thank you.

Operator

Operator

This concludes today's conference call. Thank you for participating. You may now disconnect.