They counted on a rural dialysis unit to keep them alive. Then it closed

A hospital in Nebraska shut down the only dialysis unit for miles, upending lives. That's despite a new federal program that gave the state more than $200 million to improve rural health care access.

Mark Pieper lives outside Hay Springs, Nebraska, a town of 599 residents. For three and a half years, he drove 30 minutes three times a week to Chadron Hospital for dialysis treatment after cancer damaged his kidneys. When the hospital closed the service at the end of March, Pieper and 16 other patients lost their lifeline.

Pieper now drives an hour and a half to Scottsbluff for treatment, tripling his weekly time on the road to more than nine hours. Other patients made different choices. Jim Wright and his wife rented a home near Rapid City, South Dakota, so Wright could access dialysis during weekdays. Some nursing home residents relocated to facilities farther from their families.

The closure reflects a larger crisis in rural America, where chronic disease rates are high but health care access is limited. Jon Reiners, CEO of Chadron Hospital, said the decision to end dialysis services was financially necessary. He noted the timing was painful: Nebraska officials were celebrating the state's $219 million in first-year funding from the Trump administration's Rural Health Transformation Program when the closure was announced.

The five-year program aims to explore new approaches to rural health, not sustain existing services. States can use only 15% of their funding to pay providers for patient care, limiting its immediate impact on facilities like Chadron.

Context

The Rural Health Transformation Program, launched by the Trump administration in fall 2025, distributes $50 billion across five years to states for rural health initiatives. The program prioritizes innovation and pilot projects over direct support for struggling providers. Rural hospitals nationwide have faced mounting closures as patient volumes decline and operating costs rise.

What's Next

Pieper and other patients will continue traveling longer distances for dialysis. Wright's family plans to eventually sell their Nebraska home and relocate permanently closer to care. Chadron Hospital and other rural facilities continue evaluating which services can remain sustainable under current funding constraints.