“My main concern is having to give birth in a car.” Hofeldt, expecting her first child in South Dakota, said that when the birthing unit at Winner Regional Health shut down. Her nearest option is a hospital in Pierre, about 90 miles away.
Her worry is about to reach many more families. A KFF analysis found that in 14 states, if the closest rural hospital or its obstetric unit closed, many Medicaid patients would face a drive of an hour or more to another hospital with inpatient maternity care. Nationwide, the median drive between such hospitals is 43 minutes for rural Medicaid enrollees and 13 minutes for urban ones.
Where the drives are longest
Alaska, Nevada and North Dakota would see the longest trips. Median drives of an hour or more would also hit Arizona, Colorado, Florida, Hawaii, Massachusetts, Montana, New Hampshire, New Mexico, Vermont, Virginia and Wyoming. New Jersey, Louisiana and Ohio have the shortest.
Rural maternity care was already shrinking. From 2010 to 2022, 238 rural hospitals closed their obstetrics units and only 26 opened new ones. By 2023, almost half of rural counties had no hospital offering obstetrics. A 2022 Government Accountability Office report blamed low Medicaid payment rates and the difficulty of recruiting and keeping providers.
KFF says the trend could speed up. The broad tax and spending law President Donald Trump signed last summer will cut some hospital payments and reduce Medicaid enrollment through work requirements. Brittni Frederiksen, the lead KFF researcher, said rural hospitals already run on thin margins. “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,” she said.
What a closure looks like
KFF Health News followed families around Winner. Nanette Eagle Star had planned to deliver at the local hospital, five minutes from home, and then switched to Sioux Falls so her family could stay with relatives. Early labor arrived in a snowstorm, too dangerous for driving or a medical helicopter. She gave birth in the Winner emergency room, with no epidural because no anesthesiologist was available. The unit had closed three days earlier.
The hospital delivered 107 babies the previous year, down from 158 in 2021, CEO Brian Williams said. About 80% of its deliveries were covered by Medicaid, which typically pays about half what private insurers do for childbirth, according to the GAO. The hospital had been paying roughly $1.2 million a year for temporary physicians to keep deliveries going, and could no longer afford it.
The cost of distance
Lack of access to maternity care can lead to higher maternal mortality, low birthweight and premature births. The United States recorded 17.9 maternal deaths per 100,000 live births in 2024, according to the Centers for Medicare and Medicaid Services. The Commonwealth Fund says that is double or even triple the rate in most other high-income countries. A recent survey of Medicaid patients who gave birth in 2023 and 2024 found more complications, such as high blood pressure and gestational diabetes, than among privately insured women.
“Anytime you increase the distance to delivery, you know the likelihood that it could result in poor outcomes increases,” Frederiksen said.
Sources
- Staff Shortages and Medicaid Gaps Drive Rural OB Unit Closures | Physicians Weekly
- More rural hospital closures would mean long drives for pregnant women seeking obstetric care
