In 14 states, the closure of the closest rural hospital or its obstetric unit would force many Medicaid patients to drive an hour or more to get to another hospital that provides inpatient maternity care, according to an analysis released this week.
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Nationwide, the median drive time between hospitals providing inpatient maternity care to Medicaid enrollees and the closest in-state alternative is 43 minutes for rural hospitals compared with 13 minutes for urban hospitals, the analysis found.
The study by KFF, a healthcare research organization, suggests that the closure of rural obstetrics units will accelerate as a result of the healthcare changes included in the broad tax and spending measure President Donald Trump signed last summer. That law will reduce some payments to hospitals and cut Medicaid enrollment by introducing work requirements.
Already, rural obstetric services are diminishing at a rapid rate: From 2010 to 2022, 238 rural hospitals closed their obstetrics units while only 26 hospitals opened new units. In 2023, almost of rural counties did not have a hospital offering obstetrics services.
NC has plenty of doctors and nurses to deliver babies, but rural counties still go without
by the Government Accountability Office cited low Medicaid reimbursement rates and the challenge of recruiting and retaining providers as major factors.
Brittni Frederiksen, the lead KFF researcher for the report, said in an interview that rural hospitals already operate on thin margins, and that the additional cuts could push some of them over the edge.
“There are likely going to be rural hospitals that close their obstetric units or have to close the entire hospital, and so people will have greater distances to travel to safely deliver a baby,” said Frederiksen, an associate director at KFF who specializes in women’s health policy.
The states with the longest potential driving times, according to the KFF analysis, are Alaska, Nevada and North Dakota. The other states where the median trip would be an hour or more are Arizona, Colorado, Florida, Hawaii, Massachusetts, Montana, New Hampshire, New Mexico, Vermont, Virginia, and Wyoming.
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The states with the shortest drive times are New Jersey, Louisiana, and Ohio.
A lack of access to maternity care can lead to increased maternal mortality, low birthweight and premature births.
The United States has one of the worst maternal mortality rates among higher-income countries, at 17.9 deaths per 100,000 live births in 2024, according to the federal Centers for Medicare and Medicaid Services. The U.S. rate is double, or even triple, the rate in most other high-income countries, according to The Commonwealth Fund, a philanthropic and research group.
Outcomes are even worse for women on Medicaid, the government insurance program for people with lower incomes. A of Medicaid patients who gave birth in 2023 and 2024 found that those patients experienced more complications, such as high blood pressure and gestational diabetes, than women with private insurance.
“We already have a maternal health crisis in this country, and already have very poor outcomes when it comes to delivering babies safely in this country. And then in rural areas, in particular, people already have to travel long distances to deliver,” Frederiksen said.
“Anytime you increase the distance to delivery, you know the likelihood that it could result in poor outcomes increases.”
Stateline reporter Shalina Chatlani can be reached at [email protected].
This story was originally produced by Stateline, which is part of States Newsroom, a nonprofit news network which includes NC Newsline, and is supported by grants and a coalition of donors as a 501c(3) public charity.
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