Cuts to Medicaid will Affect Care for Pregnant Women and Babies, Report Finds
Almost a quarter of women of childbearing age in Virginia's rural areas have Medicaid as sole health insurance.
By Adele Uphaus
MANAGING EDITOR AND CORRESPONDENT
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Cuts to Medicaid would further destabilize the already precarious healthcare system for pregnant women and babies in rural areas and small towns, including those in the Fredericksburg area.
According to a new report on Medicaid’s role in maternal and infant health in rural communities, almost a quarter—24.5%—of Virginia women of childbearing age living in such communities have Medicaid as their sole source of healthcare coverage.
That’s greater than the national average of 23.3%. Virginia is also one of nine states with the biggest differentials in Medicaid coverage between women in rural and metropolitan areas.
The report, from the Center for Children and Families at Georgetown University’s McCourt School of Public Policy, defines small towns/rural areas as “non-metropolitan counties with central urban areas of fewer than 50,000 people,” using the U.S. Census Bureau designation. Locally, that definition applies to Fredericksburg City and Caroline and King George counties.
“Women in rural areas already have difficulty accessing care because of the loss of labor delivery units and obstetrical capacity,” said Joan Alker, one of the lead authors on the report, in a webinar hosted Thursday by the Center for Children and Families. “This is a real challenge for rural communities and particularly in the face of very large cuts to Medicaid that Congress is contemplating right now.”
Since 2010, the percent of rural hospitals that do not offer obstetric care has been increasing, said Katy Kozhimannil, co-director of the Rural Health Research Center at the University of Minnesota, who participated in Thursday’s webinar.
“Between 2010 and 2022 there were 537 hospitals that lost their obstetrics programs,” Kozhimannil said. “Our research shows that by 2022, 52.4% of rural hopsitals did not offer obstetric care,” up from 43% in 2010.
According to a March article in Cardinal News, Virginia lost five labor and delivery units between 2018 to 2024, “due to the financial strain of maintaining these services.”
Obstetric care has high fixed costs, “requiring dedicated space, equipment, and trained staff” who must be constantly on-call, Kozhimannil said. “Revenues are variable and depend on the volume of births, which disadvantages lower birth-volume hospitals.”
Medicaid pays for almost half of all births in rural areas and 40% of those in urban areas, she continued, and it reimburses at a lower rate than private health care plans, which disadvantages facilities in rural areas. Cuts to Medicaid would make it even more difficult for facilities to stay open in these areas.
When a facility closes, the effects are felt by everyone, not just those with Medicaid, said Ryan Cross, vice president of government affairs and advocacy for Franciscan Missionaries of Our Lady Health System, during Thursday’s webinar.
“It all comes back to the Medicaid dollar,” Cross said. “Every dollar is critical, not for market share, but to meet community need and save lives. When Medicaid is cut, everyone is affected. That commercially insured patient will also have to drive further if a hospital is closed.”
Access to maternity care is crucial to reducing adverse outcomes such as maternal mortality, stillbirth, preterm birth, and NICU admission, according to a recent March of Dimes report.
According to Edwin Park, a professor at Georgetown’s McCourt School of Public Policy, there are proposed cuts to Medicaid spending of at least $625 billion in the budget bill that was reported out of the House Energy and Commerce Committee on a party line vote.
Preliminary estimates from the Congressional Budget Office indicate that Medicaid enrollment would fall by 10 million people, and 7.6 million people would become uninsured, Park said.
The Medicaid provisions in the budget bill include a mandatory work requirement, extended to the age of 64, in all states.
“You would have to satisfy the work requirement upon application, with states given the flexibility to look back multiple months and potentially a year or more to see if you could satisfy that work requirement or qualify for an exemption,” Park said.
There’s also a proposal requiring states to conduct redetermination of Medicaid eligibility every six months, rather than once a year, and a provision that would prevent states from implementing new provider taxes or increasing existing taxes.
“These are taxes to raise revenues to finance the state’s share of the cost of the Medicaid program,” Park said. “So no new taxes and no increases in taxes would limit the ability of states to identify sufficient revenues to not only make improvements to Medicaid over time, but also sustain existing Medicaid over the long run.”
And there’s a proposal to limit retroactive coverage, which is important for people who have sudden longterm care needs, Park said.
Kozhimannil said the impact cuts to Medicaid will have on care for pregnant women and babies and access to facilities with labor and delivery services “cannot be overstated.”
“Every person is affected by the loss of birth in that community,” she said. “It changes how a community sees itself.”
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