Analysis Shows Extended Distances for Rural Medicaid Patients Seeking Maternity Care
A new analysis from the Kaiser Family Foundation identifies 14 states where closure of rural hospital obstetric units would force many Medicaid-enrolled pregnant women to drive an hour or more to reach maternity care—a distance that experts say increases risk of complications during pregnancy and delivery.
The analysis, released this week, highlights a worsening maternity care crisis in rural America. From 2010 to 2022, rural hospitals shuttered 238 obstetric units while only 26 opened new services. By 2023, nearly half of rural counties no longer had hospitals offering obstetrics services, according to the KFF findings.
The states most affected—Alaska, Nevada, and North Dakota—face the longest potential travel times for pregnant Medicaid patients seeking delivery care. Montana, Wyoming, Arizona, Colorado, New Mexico, and other rural-heavy states also appear on the list of 14 states where median driving distances exceed one hour between a closed hospital’s service area and the nearest alternative maternity facility.
“Anytime you increase the distance to delivery, you know the likelihood that it could result in poor outcomes increases,” told the Idaho Capital Sun Brittni Frederiksen, KFF associate director, as reported by the source. Frederiksen also noted that “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.”
Economic Pressures Behind Unit Closures
Low Medicaid reimbursement rates and difficulty recruiting and retaining obstetric providers stand as the primary drivers of unit closures, according to a 2022 Government Accountability Office report. The financial squeeze has forced rural hospitals nationwide to make difficult choices about which services to maintain.
For context, the median driving time between rural hospitals providing maternity care and their closest in-state alternative stands at 43 minutes for Medicaid patients. Urban hospitals, by contrast, sit a median 13 minutes apart from comparable alternatives. States with shorter median distances—New Jersey, Louisiana, and Ohio—benefit from denser hospital networks.
Maternal Health Outcomes at Risk
The expansion of travel distances comes against the backdrop of a rising U.S. maternal mortality rate. The nation recorded 17.9 maternal deaths per 100,000 live births in 2024, reflecting persistent disparities in pregnancy care access and outcomes.
A survey of Medicaid patients who gave birth in 2023 and 2024 found that women covered by Medicaid experienced significantly more pregnancy and delivery complications than those with private insurance, underscoring how access barriers translate to real health consequences.
For rural Idaho and neighboring states, the concern is acute. Idaho residents living in sparsely populated counties already face substantial distances to regional medical centers. Further obstetric unit closures at rural hospitals would force pregnant women and their families to choose between extended travel during labor or seeking care at distant facilities—decisions that can affect maternal and infant outcomes during critical moments.
What Comes Next
The analysis serves as a warning to state policymakers and hospital administrators that the current economics of rural obstetric care are unsustainable without intervention. States and the federal government face growing pressure to address Medicaid reimbursement rates and provider recruitment challenges before more rural hospital obstetric units close. Rural health advocates and maternal health experts are expected to use the KFF findings to push for policy solutions aimed at stabilizing maternity services in underserved areas.