WASHINGTON, Sept. 2 — A new KFF analysis warns that in 14 states, the closure of the closest rural hospital or its obstetric unit would force many Medicaid patients to drive an hour or more to reach another hospital offering inpatient maternity care. Nationwide, the median drive time between such hospitals for rural Medicaid enrollees is 43 minutes, compared with just 13 minutes for urban patients, according to the health care research organization. The states with the longest potential driving times are Alaska, Nevada and North Dakota.
Arizona, Colorado, Florida, Hawaii, Massachusetts, Montana, New Hampshire, New Mexico, Vermont, Virginia and Wyoming also would see median trips of an hour or more. At the other end of the spectrum, New Jersey, Louisiana and Ohio have the shortest drive times.
A crisis already in motion
Rural obstetric services have been disappearing for years. From 2010 to 2022, 238 rural hospitals closed their obstetrics units while only 26 opened new ones. By 2023, almost half of rural counties lacked a hospital offering obstetrics services.
A 2022 Government Accountability Office report pointed to low Medicaid reimbursement rates and the difficulty of recruiting and retaining providers as major drivers. The KFF analysis suggests the trend could accelerate because of changes in the broad tax and spending measure signed by President Donald Trump last summer.
That law will reduce some payments to hospitals and cut Medicaid enrollment by introducing work requirements. Brittni Frederiksen, the lead KFF researcher and associate director specializing in women’s health policy, said rural hospitals are especially vulnerable. “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,” Frederiksen said in an interview.
The stakes for mothers and babies
Lack of access to maternity care can lead to increased maternal mortality, low birthweight and premature births. The United States already has one of the worst maternal mortality rates among higher-income countries, at 17.9 deaths per 100,000 live births in 2024, according to the federal Centers for Medicare and Medicaid Services. The Commonwealth Fund notes that rate is double or triple that of most other high-income nations.
Outcomes are worse for women on Medicaid. A recent survey of Medicaid patients who gave birth in 2023 and 2024 found they experienced more complications, such as high blood pressure and gestational diabetes, than women with private insurance.
“We already have a maternal health crisis in this country, and already have very poor outcomes when it comes to delivering babies safely in this country,” Frederiksen said. “And then in rural areas, in particular, people already have to travel long distances to deliver.
Anytime you increase the distance to delivery, you know the likelihood that it could result in poor outcomes increases.” The analysis arrives as stories like that of Sierra Edgio, who discussed her birth experience at the Alabama Birth Center in Huntsville, Ala., on Wednesday, April 15, 2026, underscore the real-world stakes for families navigating an increasingly strained system.
