More rural hospital closures could add an hour or more to the drive for many Medicaid patients seeking inpatient maternity care, a new analysis shows.
Medicaid Enrollees Face Longer Trips After Closures
The report finds the median travel time from a rural facility offering obstetric services to the nearest in‑state alternative is 43 minutes. By contrast, urban sites average just 13 minutes. Those numbers reflect the distance many pregnant women would need to travel if the nearest obstetric unit shuts down.
Fourteen states would see a median drive of at least an hour for Medicaid recipients after the loss of the closest rural hospital or its birth unit. The states with the longest projected trips include Alaska, Nevada and North Dakota.
Policy Shifts May Speed Up Unit Losses
A broad tax and spending measure signed last summer is expected to cut certain hospital payments and introduce work requirements that could lower Medicaid enrollment. Those changes are projected to strain already thin margins at rural facilities, according to the analysis.
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From 2010 through 2022, 238 rural hospitals closed their obstetric units while only 26 opened new ones. By 2023, nearly half of rural counties lacked any hospital that provided such services.
Experts note that low reimbursement rates and difficulty recruiting providers have been persistent challenges, a point highlighted in a 2022 Government Accountability Office report.
Given the data, one can reasonably expect that further reductions in funding may push additional facilities to suspend or shutter their birth services. If that happens, the distance to a safe delivery location could increase, potentially affecting outcomes for low‑income families.
Considering how communities might adapt is prudent. Some may explore tele‑health partnerships or regional transport programs, but such measures require sustained investment and coordination. Without clear policy support, the gap in access could widen, leaving vulnerable patients with fewer options.
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Limited access to maternity care is linked to higher rates of maternal mortality, low birthweight and premature births. The United States recorded 17.9 deaths per 100,000 live births in 2024, according to the Centers for Medicare and Medicaid Services, a rate among the worst of high‑income nations.
Outcomes are poorer for women on Medicaid. A recent survey of Medicaid patients who gave birth in 2023‑2024 found higher incidences of complications such as high blood pressure and gestational diabetes compared with those holding private insurance.
- 238 rural obstetric units closed (2010‑2022)
- 26 new units opened in the same period
- Median rural drive time: 43 minutes
- Median urban drive time: 13 minutes
“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 Brittni Frederiksen, an associate director at KFF who specializes in women’s health policy.
She added, “Anytime you increase the distance to delivery, you know the likelihood that it could result in poor outcomes increases.”