Rising Risks Threaten Maternal Health Amid U.S. Medicaid Cuts

Dr. Mimi Choate, a family physician specializing in care for pregnant women facing substance abuse challenges, practices at the Oasis Center of the Rogue Valley in southwestern Oregon. This clinic offers a comprehensive approach, combining mental health services, social support, addiction treatment, and prenatal and postpartum care. When asked to describe a typical first visit from a pregnant patient, Dr. Choate paints a stark picture.

“Many of the women I see are homeless,” she explains. “They might be staying temporarily on someone’s couch, moving between motels, or living outdoors. Often, they have no permanent address and lack access to a working cellphone.” Their addictions commonly involve fentanyl or methamphetamine, and most either lack insurance or rely on Medicaid coverage.

Operating in a semi-rural district heavily dependent on Medicaid, Dr. Choate highlights the vulnerabilities of her community, which also experiences some of the nation’s highest rates of drug abuse and overdose. She warns that the recent sweeping federal healthcare legislation, which includes over $1 trillion in Medicaid spending cuts over the next decade, could severely impact clinics like the Oasis Center and the patients they serve.

The extent of the impact will vary by state, as Medicaid program changes are implemented differently and will phase in over time. However, the magnitude of the cuts suggests that even pregnant women with private insurance could face challenges accessing adequate care.

Medicaid finances more than 40 percent of all births nationwide and an even larger share in rural communities. Analyses by nonprofit advocacy groups reveal that 144 rural hospitals with maternity units are at risk of shutting down or drastically reducing services due to Medicaid budget reductions. This threat compounds the closure of over 100 rural labor and delivery units since 2020.

Dr. Choate stresses the critical importance of immediate care access for her patients. “Getting a pregnant woman through the clinic door is a significant milestone,” she says. “It can be intimidating and unfamiliar, a place where many have felt judged or out of place before. Delays or barriers can cause them to reconsider seeking help altogether.”