Rural Hospitals Need Medicaid.
Rural hospitals across the U.S. count on Medicaid and Medicare funding to keep their doors open. Without Medicaid, these facilities could close.
Two recent studies, one from the Georgetown University McCourt School of Public Policy and another from the Center for Healthcare Quality and Payment Reform, are sounding the alarm about rural hospital closures in the United States, and proposed Medicaid cuts could play a big role. These cuts could cause a radical reduction in services, in some cases even forcing hospitals to drop inpatient care. One in three rural hospitals are at risk of closing altogether. This has big stakes for access to prenatal care as well as labor and delivery services for pregnant people in rural areas, and could endanger patients with high-risk pregnancies as well as medically complex children across the United States.
Rural hospitals serve 66 million Americans. These facilities don’t just provide critically-needed patient care: They are also huge economic drivers and can be major employers in their regions. Losing a hospital can hollow out a community.
Rural hospitals tend to run on extremely thin margins and can struggle to meet the needs of their patients, who are more likely to rely on Medicaid, especially if they are children. Medicaid expansion in the states that opted for it was a huge boon to rural hospitals, because Medicaid reimbursements are a significant source of operating funds; in states that opted out of the expansion, such as Wyoming, Kansas, Texas, and Florida, some rural hospitals are in a dire position already. Cuts to Medicaid could result in lower reimbursement rates and a rise in uninsured patients who need hospital care and can’t afford it. Both will make it even harder for rural hospitals across the country to stay open.
In very remote areas, there may be 20 miles or more between hospital facilities. A given hospital is often the only option for residents who need medical care, and there’s also a shortage in health care providers that can make it hard to get appointments, even urgent ones. Specialty care is typically even further away, with very limited services at many rural hospitals, although telehealth has allowed some facilities to expand their patient care. For families of medically complex children, this can require driving for hours to get to the doctor or visit a hospitalized child, a significant burden when children may be seeing numerous specialists every month.
Since 2005, the rate of rural hospital closures has accelerated rapidly. 111 rural hospitals have permanently closed, and 85 have converted their operations and are no longer offering inpatient care. In North Carolina, for example, 12 rural hospitals have closed or converted, leading to a loss of 404 beds, such as the 25 beds lost when Vidant Pungo Hospital closed in 2014, forcing some residents of Beaufort and Hyde Counties to travel more than 30 miles for care. In Missouri, seven hospitals have fully closed, including Twin Rivers Medical Center, which closed in 2018, leaving a county of 31,000 people scrambling for care after months of uncertainty about whether the hospital would be able to remain open.
In facilities that remain open, labor and delivery is a frequent target for service cuts, despite the fact that labor and delivery is the most common reason for a hospital stay nationwide — and already the subject of significant health care shortages in rural communities. Medicaid covers 47 percent of births in rural regions, in contrast with 40 percent in urban and suburban areas. In states such as West Virginia and Louisiana, one in three women of childbearing age are counting on Medicaid coverage for their health care needs, including potential prenatal and obstetrical care.
Without being able to access local prenatal care, rural pregnant people are at higher risk of having pregnancy complications and not catching potential issues earlier — and they’re already more likely to experience lower birthweights and other concerning pregnancy outcomes. This care shortage can increase the chances of pregnancy loss, and may mean that families are unprepared for premature birth or the birth of a medically complex child. In some cases, inadequate prenatal and obstetric care can be lethal: Missing a diagnosis in pregnancy or shortly after birth can be a life-or-death emergency and an under-resourced hospital may not be able to respond in time.
When labor and delivery wards or entire hospitals close, it forces patients further afield to give birth in a hospital setting, and in some cases means giving birth by the side of the road — as Danielle Redenbaugh did in Kansas in 2024 when she was unable to reach a medical center 30 miles away in time. It’s also dangerous for medically complex children like Megan Henry-Wilson’s son Olly, who had to be lifeflighted from rural Pennsylvania to a NICU when he experienced a medical emergency that the local hospital was unable to manage at less than a week old. As Olly grew up into a medically complex child, Henry-Wilson’s family experienced tremendous hardship as they fought to get Olly the care he needed, and was ultimately forced to uproot and move to Ohio so Olly could be closer to critical health care services.
Protecting Medicaid is imperative for parents and children in rural America. Under current conditions, many rural community hospitals are already struggling, especially in states that opted out of Medicaid expansion. These studies paint a grim future where even more of the facilities rural Americans count on for care could significantly cut back on services or close altogether, leaving residents stranded and endangering medically complex children who need access to specialty care to manage their long-term needs as well as the ability to quickly get treatment in an emergency.