Missouri’s Rural Health Care Faces Continued Strain

Rural health care in Missouri is under sustained strain.

Over the past several years, the industry has faced workforce shortages, rising labor and supply costs driven by inflation, inadequate reimbursement, and increasing regulatory and cybersecurity demands. For small rural hospitals operating on thin margins, those pressures compound quickly.

The closures tell the story.

Since 2014, 10 rural hospitals in Missouri have shut their doors. Four of those were in central Missouri in just the last six years:

• I-70 Community Hospital in Sweet Springs (2019)
• Pinnacle Regional Hospital in Boonville (2020)
• Callaway Community Hospital in Fulton (2022)
• Audrain Community Hospital in Mexico (2022)

In several cases, closures came with little warning. Physicians were displaced. Hundreds of employees lost their jobs. Communities lost local emergency rooms, inpatient beds, and critical access points to care.

The outlook remains uncertain.

According to a January 2026 report from the Center for Healthcare Quality & Payment Reform, 50% of Missouri’s remaining 58 rural hospitals are at risk of closing, and 21% are projected to close within the next two to three years.

Missouri is not alone in facing rural hospital instability, but the concentration of risk places renewed urgency on the state’s response.

A Warning From the Past

In 1945, Harry S. Truman cautioned:

“Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection.”

Truman was speaking to a national access problem. Today, in rural Missouri, the issue is not theoretical, it is geographic. When hospitals close, access disappears in practical terms. Residents travel farther for emergency care. Local physicians relocate. Economic anchors weaken.

Supporters of new legislation argue that when access begins to erode, a structural response is necessary.

MU Health Care’s Proposal

MU Health Care, part of the University of Missouri, is seeking legislation that would establish a defined framework for collaboration across a 25-county region of central Missouri.

Rep. Jeff Knight and Senators Kurtis Gregory and Stephen Webber are offering legislation this year to help with that framework. 

The proposal would authorize the University’s Board of Curators to acquire, manage, lease, purchase, sell, contract for, or otherwise participate in the ownership or operation of hospitals and medical facilities within that region.

The legislation would also provide “state action immunity,” shielding authorized collaborations from federal and state antitrust liability in those counties.

Participation would be voluntary. No hospital would be compelled into an agreement, and supporters emphasize the framework is not designed for hostile takeovers. Instead, it is intended to allow earlier intervention and coordinated stabilization efforts before financial distress turns into permanent closure.

MU Health Care has already taken steps in this direction. After closures in Boonville, Fulton, and Mexico, it opened clinics to preserve access where possible. It also made a substantial investment to stabilize Capital Region Medical Center and its network of clinics in Jefferson City when they faced significant financial losses.

Advocates contend that if a formal collaboration structure had existed earlier, it could have created opportunities to act before some of those closures occurred. They also point out that other states operate under similar statutory frameworks without sustained Federal Trade Commission resistance.

A Missouri Decision

Federal oversight remains part of the broader discussion. Antitrust laws are designed to prevent harmful consolidation, and any structural change in hospital markets invites scrutiny.

Supporters argue, however, that Missouri’s rural hospital crisis presents a different challenge: not over-concentration, but disappearance.

Here again, Truman’s words offer perspective:

“The least government is the best government. We should have just as little as we can get along with.”

Backers of the proposal say the legislation reflects that principle, a state-level solution crafted for Missouri communities, overseen by a governor-appointed Board of Curators, and limited to a defined region facing instability.

The Stakes

Over the last decade, Missouri has already lost 10 rural hospitals.

With half of the remaining facilities considered at risk the state faces a clear choice: allow closures to continue on a case-by-case basis, or create a framework that enables coordinated intervention before hospitals reach the brink.

The debate over MU Health Care’s proposal ultimately centers on access, whether rural Missourians will continue to have hospitals serving their communities, or whether more towns will join the growing list of places where the nearest inpatient bed is miles down the road.

The closures of the past six years show what happens when financial instability goes unresolved. The legislation now under consideration represents an attempt to prevent the next set of doors from closing.