CREIGHTON, NEBRASKA — Avera Creighton Hospital in Creighton, Nebraska, is facing financial peril as Medicaid reimbursement cuts strain its budget. The critical access hospital is among hundreds of rural hospitals across the country facing closures after years of funding problems and is now looking to new federal and state rural health grants to sustain operations.

Last summer, the Trump administration cut Medicaid funding, reducing reimbursements for hospitals. In response to outcry over the cuts, Republican lawmakers created $50 billion in new rural health grants through the Rural Health Transformation Program, which allocates $10 billion per year to states over five years.

The $50 billion program total falls short of the $137 billion in losses rural hospitals expect to incur over the next decade, according to health research nonprofit KFF. Dr. Ben Young, an infectious disease specialist and policy expert, said of the grants: "It won't pay to keep the lights on. It won't turn the lights back on once they've been turned off."

Theresa Guenther, CEO of Avera Creighton Hospital, said the facility is not in danger of closing. "Medicaid cuts will have an impact to us, and we — as well as many others — will have to figure out what that looks like moving forward," Guenther said.

Nebraska received $218 million for the first installment of the rural health grants. The state plans to spend $90 million on healthier school food options, recruiting more health care workers, and mobile sensors to remotely monitor chronically ill patients in rural areas. The program also offers $10 million grants to rural critical access hospitals at risk of closing to eliminate inpatient care services.

Separately, new Medicaid work requirements taking effect in 2027 are expected to result in millions of people losing Medicaid benefits. The Trump administration said the new requirements will crack down on fraudsters rather than cut off eligible enrollees.

For residents of Creighton, the hospital's future carries personal stakes. Rick and Jane Saint John moved to Creighton primarily because of the hospital. The couple has a child with nonverbal autism and epilepsy who requires up to three hospital visits per week, and Jane Saint John is employed at the facility. Three years ago, doctors at the hospital saved her life after she contracted bacterial pneumonia; doctors said her organs would have begun to shut down if she had waited another day for care.

"If we had had to drive the hour to the Yankton, South Dakota hospital, it could have cost her her life," Rick Saint John said. "The hospital is very important to this community, and for more than just medical care."