OPINION — Congress allocated $50 billion through the One Big Beautiful Bill to improve rural healthcare. Many states have identified maternal and infant health as a priority for this funding, and for good reason: most rural hospitals no longer deliver babies.
Whether these dollars improve maternity care will depend less on Washington than on state reform. As the Centers for Medicare & Medicaid Services rolls out the Rural Health Transformation Program, states should use this opportunity to expand access to certified nurse-midwives and licensed birth centers to address the maternity-care shortage in rural America and to move low-risk pregnancies into lower-cost, high-value settings.
America’s maternity-care system is expensive, hospital-centered and increasingly inaccessible, especially for low-income families. Medicaid finances 41% of all U.S. births, including nearly half of rural births, making it the dominant payer for maternity care. Nearly all Medicaid births occur in hospitals, the most expensive setting for delivery.
