WASHINGTON, Oct 11: Maternity wards across the United States are facing mounting financial pressure, with healthcare experts warning that changes to federal Medicaid funding could accelerate hospital closures and reduce access to essential pregnancy and childbirth services, particularly in rural communities.
An analysis by the nonprofit organisation Protect Our Care indicates that 52 maternity units have closed since the announcement of the HR1 legislation in July 2025, while eight additional closures have been announced. The figures have renewed concerns about the availability of safe and timely maternity care for women living far from major medical centres.
The legislation, which is scheduled to take full effect in the new year, introduces stricter eligibility checks and work requirements for many adults receiving Medicaid coverage while reducing federal funding available to states for the programme.
Medicaid is a government health insurance programme that provides coverage to eligible low-income individuals and families. It plays a particularly important role in maternity services, covering approximately 40 per cent of births in the United States.
Healthcare advocates say that reductions in funding could place additional pressure on hospitals already struggling with rising operating costs, staffing shortages and the financial challenges of maintaining specialised maternity departments.
The concern is especially pronounced in rural areas, where hospitals often serve large geographic regions with fewer alternative facilities available to patients.
Rural communities face growing difficulties
Maternity services require specialised staff, round-the-clock availability and facilities capable of responding to emergencies involving mothers and newborns. Maintaining these services can be expensive, even when the number of deliveries is relatively low.
Hospitals in rural communities may have difficulty covering these costs because they serve smaller populations and have fewer opportunities to spread expenses across a large number of patients.
According to the March of Dimes, 31 rural hospitals providing labour and delivery services have been identified as being at risk. If these facilities close, 96 counties could be left without a local labour and delivery unit.
Such closures can force pregnant women to travel longer distances for routine appointments, labour assessments and childbirth. The additional journey may be particularly challenging for families without reliable transport or the financial means to arrange accommodation near a hospital.
Distance can become a critical concern when labour begins unexpectedly or complications develop rapidly. Women experiencing severe bleeding, dangerously high blood pressure or other pregnancy-related emergencies may require immediate assessment and treatment.
When local maternity services disappear, emergency departments and ambulance services may also face additional pressure as they try to transport patients to facilities capable of providing obstetric care.
Erin Jones, senior director of legislative and strategic counsel at the March of Dimes, warned that reduced funding and restrictions on how states finance Medicaid could put further pressure on hospitals and healthcare budgets.
She said the loss of maternity services could leave communities with fewer options for safe childbirth and specialised pregnancy care.
Medicaid changes add to hospitals’ financial strain
The impending policy changes are expected to affect both healthcare providers and eligible patients. Under the legislation, many adults covered through Medicaid will face new work requirements and more frequent eligibility reviews, while states will receive less federal financial support for the programme.
Hospitals that depend on Medicaid reimbursements may experience additional financial difficulties if coverage losses reduce the number of insured patients or increase the amount of uncompensated care they provide.
Maternity departments are particularly vulnerable because they must maintain staff and facilities around the clock, regardless of how many deliveries take place on a particular day.
These departments require obstetricians, nurses, anaesthesia services, newborn care and access to emergency procedures. Hospitals may also need to maintain operating rooms and specialised equipment for unexpected complications.
If a maternity unit is unable to cover its costs, hospital administrators may consider consolidating services or closing the department entirely.
Vaishu Jawahar, director of policy and programmes at Protect Our Care, said reductions in Medicaid funding could leave hospitals operating at a loss and force difficult decisions about which services they can continue to provide.
Two hospitals cited in the report, Centra Southside Community Hospital in Virginia and St Mary’s Sacred Heart Hospital in rural north-east Georgia, have already permanently closed their maternity wards, with upcoming federal policy changes cited among the reasons.
Healthcare advocates fear that further closures could occur before and after the new requirements take full effect.
The eventual impact will depend on how the changes affect state budgets, hospital finances, patient coverage and the availability of alternative maternity services.
Pregnant women could face coverage confusion
Although the new work requirements are intended to exempt pregnant women, healthcare experts have raised concerns about the way eligibility categories operate.
Benjamin Sommers, a professor of healthcare economics at Harvard T.H. Chan School of Public Health, said women could lose coverage if they are enrolled through Medicaid expansion and their pregnancy is not properly reflected in the state’s records.
A woman who becomes pregnant while enrolled in another Medicaid category may assume that her coverage is protected because she has heard that pregnant women are exempt from the new requirements. However, if the state has not recorded her pregnancy or moved her into the appropriate eligibility category, she could still face administrative problems.
This creates a risk that some patients may experience interruptions in coverage even when they believe they qualify for protection.
Frequent eligibility checks can also create additional administrative burdens for patients and state agencies. People may need to provide documents, update personal information or respond to requests within specified periods to maintain their benefits.
For pregnant women, a lapse in insurance can complicate access to prenatal appointments, diagnostic tests, prescribed medicines and specialist consultations.
Regular prenatal care helps healthcare professionals monitor the health of both mother and baby, identify potential complications and arrange appropriate treatment. Missed appointments can delay the detection of conditions that require closer observation.
Healthcare policy experts have therefore stressed the importance of clear communication, accurate records and effective systems for helping eligible patients retain coverage.
Maternal health remains a major public health concern
The United States continues to face significant challenges in maternal health. The latest figures cited in the report put the country’s maternal mortality rate at 17.9 deaths per 100,000 live births.
Maternal mortality refers to deaths related to pregnancy or its management. Such deaths can result from complications during pregnancy, childbirth or the period following delivery.
Access to timely medical attention is an important factor in preventing avoidable deaths and serious complications. Conditions such as haemorrhage, blood clots, infections and pregnancy-related hypertension can require rapid intervention.
The availability of specialised services is also important for women with high-risk pregnancies, who may need additional monitoring or access to hospitals equipped to manage complex medical conditions.
When maternity units close, patients may have to travel farther for care or depend on facilities that are already handling large numbers of cases.
The effects may not be evenly distributed. Families with limited incomes, people living in remote areas and those without reliable transport may face greater obstacles than patients who can afford private services or travel to larger cities.
Healthcare advocates warn that funding pressures could deepen existing disparities if communities lose access to nearby maternity departments without adequate alternatives being established.
Gaps in maternal health data raise further concerns
The report also highlights concerns about the collection of information used to monitor pregnancy outcomes and maternal and infant health.
In early 2025, the team responsible for the US Centers for Disease Control and Prevention’s Pregnancy Risk Assessment Monitoring System was placed on administrative leave by the Trump administration.
The surveillance programme collects information about women’s experiences before, during and after pregnancy. Its data has been used to study maternal health, identify risk factors and understand differences in outcomes among populations.
According to an upcoming report by academics and former CDC staff cited by The Guardian, the disruption affected the collection and management of information that had supported maternal and infant health research for more than four decades.
Rita Hamad, a professor of social epidemiology and public policy at Harvard T.H. Chan School of Public Health and a co-author of the report, warned that the interruption could make it harder to assess recent trends.
Without consistent data, researchers may struggle to determine whether policy changes are associated with worsening outcomes, identify the communities experiencing the greatest difficulties or evaluate whether corrective measures are working.
Reliable surveillance is important not only for understanding maternal mortality but also for tracking prenatal care, postpartum experiences and other factors that influence the well-being of mothers and babies.
The loss of information could make it more difficult for policymakers to respond quickly if access to services deteriorates.
Hospitals and policymakers face difficult decisions
The debate over Medicaid funding highlights the challenge of balancing government spending with the need to maintain essential healthcare services.
State governments may have to make difficult choices if federal funding falls while demand for medical care remains high. Hospitals, meanwhile, must decide how to maintain services that require specialised staff and significant financial resources.
Healthcare advocates have called attention to the importance of protecting maternity services, particularly in regions where the closure of a single department could leave a large population without nearby childbirth facilities.
Possible responses include improving coordination between hospitals, supporting rural healthcare providers and strengthening referral and emergency transport arrangements. However, the effectiveness of these measures will depend on local circumstances and the resources available.
Hospitals may also need to work with state authorities to help patients understand their insurance eligibility and avoid preventable interruptions in coverage.
For families, clear information about available maternity services, insurance requirements and emergency arrangements can help reduce uncertainty during pregnancy.
The coming months will be important in determining how the Medicaid changes affect healthcare providers and patients. Hospital finances, insurance enrolment and the availability of maternity services will be key indicators of the policy’s impact.
The central concern raised by healthcare experts is that financial and administrative changes should not leave pregnant women without timely access to essential care. Maintaining a reliable network of maternity services will remain a critical public health priority, particularly for rural communities with limited alternatives.