Can Investment in Rural Health Offset Proposed Medicaid Cuts and Improve Care for Rural Women?

With the increasing trend of closure of rural hospitals and maternal units, many women are left without access to adequate prenatal care. The federal government has stepped in to address such gaps in care by introducing a $50 billion Rural Health Transformation (RHT) program that will bolster rural health systems. Interestingly, the same piece of legislation, HR 1, also included nearly $1 trillion in cuts to Medicaid and CHIP (Children’s Health Insurance Program). This begs the question: can investment in rural healthcare delivery offset the reductions in insurance coverage?

Well, it depends on how important Medicaid is for rural communities. Medicaid and CHIP insure over 40% of rural children. Medicaid further covers almost half of births in rural areas. Medicaid also does more than just insure patients. It helps fund hospitals, labor and delivery units, and prenatal and postnatal care. Cuts in Medicaid funding risks hospital closures, reduction in services,  and loss of providers. Overall, Medicaid is central to rural maternal and child healthcare. 

The RHT program offers a new way to think about rural healthcare delivery:

1. Reduce geographic barriers by connecting smaller clinics to hospitals in “hub and spoke” networks and expand telehealth and remote monitoring capabilities

2. Address staffing shortages by expanding the list of providers that can provide medical care beyond obstetricians and to include midwives, doulas, and community health workers

3. Provide alternate sites of care in the face of rural hospital closures. With loss of labor and delivery units women require more options for giving birth, and some proposals explore providing such services through ERs and birthing centers.  

4. Provide greater investment in community-based care. Through mobile health clinics, home visiting programs and behavioral health services, mothers can be supported before, during, and after delivery and children supported during their early years.  

However the RHT has limitations. Only 15% of its funds can go directly to providers, and funding must be earmarked for specific programs and is time-limited. Medicaid, on the other hand, provides ongoing and flexible coverage. So while RHT can improve specific services and quality of care, it is Medicaid that provides the access to these services. And here is the dilemma: the same policy that aims to improve rural health delivery is also cutting health care coverage for rural families. So while the RHT program is certainly a step in the right direction, it must be coupled with increasing insurance coverage, and future policies that support both goals will be most effective in transforming rural healthcare.