by Rolonda Donelson, Maia Eng, and Marla Guerra
President Trump signed into law over $1 Trillion in Medicaid cuts in the One Big Beautiful Bill Act (OBBA) that will have a devastating impact on rural hospitals and patients, particularly on pregnant women with low incomes and their children. Medicaid is the single-largest payer of maternity care in the United States, and plays an even bigger role in rural areas – covering over 40 percent of births nationwide and nearly half of all births in rural communities. The odds of experiencing maternal morbidity or mortality are greater for pregnant women in rural areas compared to urban areas; therefore, rural labor and delivery units are crucial to combating the maternal health crisis.
Medicaid helps keep hospital labor and delivery units running, including services for high-risk pregnancy management, neonatal intensive care units (NICUs), and postpartum and lactation support. Since 2020, over 100 rural hospitals have closed their labor and delivery units or announced plans to close before 2026. When labor and delivery units close, pregnant patients must travel further for care, creating a barrier to timely care and causing some pregnant people to delay or avoid medical care that could result in early recognition and treatment of urgent maternal health warning signs. Under these conditions, pregnant women face an increased risk of adverse birth outcomes, exacerbating maternal health disparities for rural women and women of color.
The new law puts even more labor and delivery units in rural areas at risk. Provisions in the law, such as freezing provider taxes, which most states use to help finance their Medicaid costs, could lead to hospitals reducing the maternity care services they offer, cutting staff or closing altogether. Other provisions, such as enforcing Medicaid work reporting requirements and other burdensome requirements, even with exemptions for pregnant women, put mothers and millions of others at risk of losing health coverage. This will result in more uncompensated care for rural hospitals that are already in a financial crisis. While the proposed cuts to Medicaid will be disastrous for all hospitals, those in Medicaid expansion states, such as Kentucky, West Virginia and North Carolina, are at greater risk due to several provisions in the law that penalize states that have expanded Medicaid.
New National Partnership for Women & Families analysis finds that 131 rural hospitals across the country with labor and delivery units are at risk of closure or severe service cutbacks under President Trump’s cuts to Medicaid. These hospitals across the country include fourteen hospitals in Kentucky, nine hospitals in Louisiana, three hospitals in Alaska and two hospitals in Maine, among others.
While our analysis shows all but 10 states plus the District of Columbia may be impacted, it does not paint the complete picture. States without labor and delivery units at risk may already face severe maternity care shortages. For example, in Arkansas, where our analysis found no labor and delivery units currently at risk, 45.3 percent of counties are already considered maternal health deserts, defined as an area with limited or non-existent access to maternal health services. Therefore, states with few or no at-risk hospitals could reflect states that already have very limited access to maternal health care.
The severe and historic cuts to Medicaid will affect everyone in rural communities – not just people with Medicaid coverage. Hospital employees and those with jobs in the broader community, whose primary customers are workers from the local hospital (e.g., restaurants, shops, and other small businesses), would also be impacted. National Partnership analysis finds that more than 80 percent of people working in hospitals in non-metro areas are women. This disastrous law will threaten the health of pregnant women and infants and the economic security of rural communities.
➤ Download the full list of rural hospitals.
Methods Note: This analysis uses a list of 338 hospitals featured in a letter to Congressional Republican leadership about the impacts of the House Reconciliation Bill on Rural Hospitals. The data was provided by Cecil G. Sheps Center for Health Services Research at the University of North Carolina and analyzes the financial vulnerability of rural hospitals and the impact on these hospitals based on potential Medicaid cuts. The Sheps Center identified hospitals as at-risk of closing, conversion or severe service cuts due to potential Medicaid cuts in the reconciliation bill based on whether the hospital has been unprofitable for the last three years; whether the hospital is at risk of financial distress relative to peer hospitals; and whether the hospital serves a disproportionately high share of Medicaid patients. To analyze whether these hospitals had a Labor and Delivery unit, we referenced hospital websites and followed up with phone calls as needed. The analysis of hospital workers includes people working in general medical and surgical hospitals, and specialty hospitals (except psychiatric and substance abuse) in non-metropolitan areas using American Community Survey 2023 one-year data via IPUMS.
The following people contributed to this fact sheet: Amani Echols, Katherine Gallagher Robbins, Kiera Peoples, Lorena Bonet Velazquez, and Sarah Coombs.
Correction
September 2025
A previous version of this fact sheet identified 144 rural hospitals across the country with labor and delivery units are at risk of closure or severe service cutbacks but additional information on hospital services led to a revision.
