Background: The availability of dialysis facilities and distance traveled to receive care can impact health outcomes for patients with newly onset kidney failure. We examine recent changes in county-level number of dialysis facilities between 2012 and 2019, and assess the association between county-level dialysis facility supply and the distance incident kidney failure patients travel to receive care. Methods: We conducted a cross-sectional study of 828,427 adult patients initiating in-center hemodialysis for incident kidney failure between January 1, 2012 and December 31, 2019. We calculated the annual county-level number of dialysis facilities, and counties were categorized as having 0, 1, 2, or 3 or more dialysis facilities at the time of treatment initiation. We then measured the distance traveled between a patient's home address and dialysis facility at treatment initiation (in miles) and evaluated the association between county-level number of dialysis facilities and distance traveled to initiate treatment. Results: The average annual county-level number of facilities increased from 1.8 to 2.3 between 2012 and 2019. In our study period, 4.8% of incident adult kidney failure patients resided in a county that had zero dialysis facilities between 2012 to 2019. Compared to counties with three or more dialysis facilities, patients living in counties with no facilities in our study period traveled 14.3 miles (95% CI: 13.4 to 15.2) further for treatment. Conclusions: Kidney failure patients in counties that had no dialysis facilities traveled further, limiting their access to dialysis. Counties with no dialysis facilities at the end of the study period were more rural and had higher poverty than other counties.