In a time when an estimated 25% of rural hospitals are feeling considerable financial constraints and changes in insurance availability and Medicaid reimbursements may make those worse, Seward County’s Memorial Health Care Systems is healthy.
MHCS CEO Roger J. Reamer said in a recent interview the hospital and health care system will likely face challenges in the next few years, but compared to many rural hospitals, they are in good shape.
Reamer said the reason for that is a combination of strong financial management, continued investment in services, Nebraska’s approach to matching Medicaid funds and Seward County’s demographics.
“Everybody has got the same challenge when it comes to costs rising faster than payers are willing to up the private pay,” Reamer said.
Healthcare personnel, pharmaceutical and other costs required to care for patients are increasing.
Despite a congressional allocation of $10 billion annually through 2030 to be divided equally among the 50 states, many rural hospitals, providers and clinics anticipate significant cuts in Medicaid to impact their patients.
Reamer said Memorial Health Care System has been financially stable in an environment where it has gotten harder to remain so.
“In our case, we have a good demographic,” Reamer said. “We are a younger population than maybe some other rural communities.”
Plus, Seward County’s population is steady or growing.
All of that means the county has a higher likelihood of balancing patients using Medicare and Medicaid with privately insured patients.
Rural counties where populations are steady or decreasing, or where more residents are paying for their healthcare through Medicare and Medicaid, have bigger challenges.
“We are kind of the right size, we are kind of the right demographic, and we manage our costs very well,” Reamer said.
Federal funds help
Reamer said the 2024 Legislature’s enactment of LB1087 opened the door for an estimated $1 billion increase in federal funds for Nebraska that in turn increases reimbursement rates for hospital services.
That legislation created the Hospital Quality Assurance and Access Assessment Fund in which hospital payments to the pooled fund add to the state’s match enabling more federal funding for healthcare. Several other states use a similar allocation model
It’s possible, he said, that a hospital that is doing well may pay a higher assessment than some of the hospitals receiving more in federal funding, but the program provides an influx of funding for hospitals that are less stable financially.
“It was just time for the state of Nebraska to get on board and that is a little bit of a lifeline,” Reamer said.
Still, recent news reports have indicated around 300 rural hospitals across the country risk closure as Medicaid funding is cut and the supports for health insurance options under the Affordable Care Act were allowed to expire.
Investing in services
Keeping its designation as one of Nebraska’s 69 critical access hospitals based on size and services makes a difference for MHCS.
“The organization as a whole has been smart about financial management while keeping in mind we have to have the facilities to serve the people,” Reamer said.
The critical access designation “protects us from getting paid a lot less than what it costs” to provide those services, Reamer said.
It also assures the breadth and quality of care offered here.
Over the years, MHCS has added a dozen specialty clinics and other out-patient and testing services to meet local patients’ needs, as well as maintaining 24 inpatient hospital beds and offering skilled care for patients who have had an acute hospital stay of three days or more and require ongoing inpatient care.
It is one of only 23 Nebraska hospitals delivering babies. Here again, Reamer points to the advantage of a more balanced demographic in the county. Rural hospitals with higher levels of Medicaid and Medicare patients have smaller margins to reinvest in services.
MHCS also provides out-patient treatment and surgeries as well as clinical facilities in Seward, Milford and Utica with nine family practice physicians and five family practice physician assistants, nurses and other staff.
It received its 10th top 100 Critical Access Hospital listing in 2025 by iVantage Health Analytics, and was recognized for performance leadership quality by Chartis Center for Rural Health Performance Leadership in 2025, as noted on the MHCS website.
It has been among the top 20 critical care hospitals cited by the National Rural Health Association three times, most recently in 2023.
Stewarding hospital
finances
MHCS files annual cost reports that determine how the hospital will be paid for services the next year. If a hospital is judged to have been paid too much or too little in the previous year, it might receive a settlement.
Reamer said cost containment, an array of services and high quality care are key to being financially responsible.
Like other hospitals, MHCS faces challenges in recruiting and retaining staff and often contracts with traveling nurses to fill shifts. They have also created scholarship and work opportunities for nursing, laboratory and radiology students with Southeast Community College.
“Until the market improves, that is going to be part of the strategy,” Reamer said. “We still do pretty good at filling other positions.”
Across the system, Reamer said 289 people are employed in 215 full-time equivalent positions.
“We have to be good stewards as a rural facility,” Reamer said.
“If you were in business and all you ever got was part of the costs for what you do, how long” could you continue to do the work, Reamer said.
As a non-profit health care system, MHCS does not have a business model that requires a financial return to stakeholders. It is governed by a board elected by system members who have made a gift of $100 or more over the years.
Reamer attributes the system’s financial standing to “a lot of work by a lot of people over many years.”
“It doesn’t mean we don’t fret about them,” Reamer said of the hospital’s finances. But he said MHCS should withstand some of the shifts in the industry that could harm other hospitals.
He noted that MHCS has a good investment portfolio and benefits annually from the Langworthy Trust gifts, which are designated for capital improvements at the hospital.
The hospital’s annual capital plan, which can run up to $2 million per year, is reviewed annually to determine the best investments with the Langworthy funds, he said.
Reamer has led the health care system for 26 years and has been recognized for his work many times. Most recently, he was listed among Becker’s 9 Critical Access Hospital CEO’s to know in 2024.
