The Trump administration on Tuesday rolled out a national plan to overhaul kidney care, promising to catch kidney disease earlier, break open a dialysis market dominated by two companies and push more patients toward transplants.
Health and Human Services Secretary Robert F. Kennedy Jr. unveiled the Kidney Care National Plan during a visit to JPS Health Network in Fort Worth, Texas, timed to National Kidney Week. The plan builds on a 2019 executive order from President Trump’s first term that set out to shift kidney care away from in-center dialysis.
“Our goal is simple: preserve kidney health, give patients more choices, and help more Americans avoid kidney failure and live longer, healthier lives,” Kennedy said in the HHS announcement.
What is the Kidney Care National Plan?
It is a department-wide strategy, not a new law or regulation. Agencies including the Centers for Medicare & Medicaid Services, the Food and Drug Administration and the Health Resources and Services Administration will use it to guide future payment, research and regulatory decisions.
The plan has three parts: preventing kidney failure, restoring competition in dialysis, and reforming the organ transplant system. Many of the steps are framed as things HHS “will consider,” such as reviews, studies and possible rule changes.
How many Americans have kidney disease?
About 37 million American adults have chronic kidney disease, and HHS estimates that 87% of them do not know it. Kidney disease was the eighth leading cause of death in the country in 2024.
Roughly 831,000 Americans were living with kidney failure in 2023, according to the department. Those patients need dialysis or a transplant to survive, and about 90,000 people are on the waiting list for a kidney. Fewer than half of patients who start dialysis are alive five years later, HHS says.
Diabetes and high blood pressure drive much of it, which is why the plan ties kidney health to the administration’s Make America Healthy Again push, including the new federal dietary guidelines.
How would the plan catch kidney disease earlier?
HHS says prevention offers the biggest payoff but often goes unfunded, because of how Medicare works. Since 1972, Medicare has covered Americans with kidney failure regardless of age, but most people with earlier-stage disease do not qualify until their kidneys fail. In the department’s words, the one paying for prevention is rarely the one that benefits.
To change that, HHS says it will consider:
- commissioning a systematic review of kidney disease screening for people with diabetes, high blood pressure, heart disease or a family history of kidney failure,
- new payment models that reward prevention and better dialysis care,
- working with researchers to accept more validated “surrogate endpoints,” which could let the FDA approve promising kidney drugs sooner, and
- research pathways for new diagnostics and precision-medicine treatments.
What changes are coming for dialysis patients?
This is where the plan is most pointed. HHS says two companies control about 74% of the U.S. dialysis market, and that as of 2019 roughly a third of Americans lived in areas where the only dialysis provider was one of those two firms. The plan does not name them. The country’s two largest dialysis chains are DaVita and Fresenius Kidney Care.
HHS says it will look at streamlining the federal conditions dialysis facilities must meet, making it easier to certify home-based care, allowing dialysis in new kinds of settings, and investigating “anticompetitive payment and legal strategies” used by the largest firms to win higher payments.
Home dialysis has already grown, from 10.5% of patients in 2017 to 16% in 2023, according to HHS. That fits a wider shift of care into the home, a trend we examined in our report on Americans moving to home medical equipment.
How would kidney transplants change?
HHS calls transplantation the best treatment for kidney failure. A transplant can more than double life expectancy at less than half the annual cost of dialysis, the department says. Transplants rose 24% from 2019 to 2023, and a federal analysis released the same day tied about 2,000 extra transplants a year to the 2019 order.
The plan takes aim at organ procurement organizations, the nonprofits that recover organs from deceased donors. HHS calls them regional monopolies with little pressure to improve. It plans to keep breaking up the national transplant network’s contracts among multiple vendors, fast-track certification of new procurement groups, and create an Organ Donation Corruption and Safety Task Force with law enforcement.
The department also wants to make living donation easier through a National Transplant Expansion Strategy, building on the HOLD Act passed in February. HHS noted that transplant hospitals are not currently required to tell patients whether they are listed as “active” or “inactive” on the waiting list.
What are kidney groups saying?
The National Kidney Foundation welcomed the focus on early detection, home dialysis and living donation. “For too long, America has invested far more in treating kidney failure than in preventing it,” said Dr. Jesse Roach, the group’s senior vice president for government relations.
The foundation also pointed out the plan’s limits. It sets policy direction, the group said, and most of its recommendations call for more review. It does not create new payment rates, coverage requirements, funding or deadlines. For patients, real changes depend on the rules and payment decisions that follow.
Key takeaways
- HHS launched the Kidney Care National Plan on Oct. 20, 2026, with three goals: prevent kidney failure, add competition in dialysis and reform transplants.
- About 37 million U.S. adults have chronic kidney disease, and most do not know it.
- HHS says two companies control about 74% of dialysis and plans to look at rules and practices that limit competition and home dialysis.
- The plan is a roadmap, not a regulation. New payment rates, coverage rules and deadlines would have to come later.
Frequently asked questions
What is the HHS Kidney Care National Plan?
It is a strategy released by the U.S. Department of Health and Human Services on Oct. 20, 2026 to guide federal action on kidney disease. It focuses on earlier detection, more competition and home options in dialysis, and reforms to the organ transplant system.
Does the Kidney Care National Plan change Medicare coverage?
Not yet. The plan sets direction and lists actions HHS will consider. The National Kidney Foundation noted it does not establish new payment rates, coverage requirements, funding or deadlines.
How many people in the U.S. have kidney disease?
HHS estimates about 37 million American adults have chronic kidney disease, and 87% of them do not know it. About 831,000 Americans were living with kidney failure in 2023.
Will the plan make it easier to get a kidney transplant?
That is one of its goals. HHS plans to hold organ procurement groups more accountable, certify new ones faster and make living donation easier.
