The following article was originally published in the Ohio Capital Journal and published on News5Cleveland.com under a content-sharing agreement.
Rural hospitals in Ohio are looking down the barrel of significant losses when it comes to the federal budget reconciliation bill and its changes to Medicaid funding. On top of that general concern, the few hospitals in those areas that are still able to provide maternity care may see further challenges.
The more than $1 trillion in federal Medicaid cuts approved by Congress and signed into law by President Donald Trump in the “One Big Beautiful Bill Act” included adding work requirements to Medicaid eligibility, something the state had in its newest operating budget as well. The federal budget also included provisions regarding provider taxes, which states use to fund Medicaid agencies.
In a letter to President Donald Trump and congressional leaders in June, four Democratic U.S. Senators pushed back against the reconciliation package, particularly the provisions impacting rural health.
“Rural hospitals are often the largest employers in rural communities, and when a rural hospital closes or scales back its services, communities are not only forced to grapple with losing access to health care, but also with job loss and the resulting financial insecurity,” stated the letter, signed by U.S. Sens. Edward Markey, Ron Wyden, Jeffrey Merkley and Chuck Schumer.
The letter included a list of rural hospitals in the country considered at risk of “financial distress” because of the population of Medicaid patients they served and/or their consecutive years with a negative total profit margin.
Hospitals in Scioto, Darke, Columbiana, Tuscarawas, Harrison, Crawford, Jackson, Adams, and Fayette counties were included in the list, and only four of the 11 have maternity units or birthing centers.
Southern Ohio Medical Center in Portsmouth, Fayette County Regional Medical Center in Washington Court House, and Wayne HealthCare in Greenville all list maternity care as part of their services. Galion Community Hospital also has those services, and shares birthing facilities with Bucyrus Community Hospital, which was also listed as “at risk.”
Medicaid funding is used for 4 in 10 births nationwide, data from the Kaiser Family Foundation showed, and for almost half the births in rural communities specifically. In 2023, 39% of births in Ohio were covered by Medicaid, according to the foundation.
While a spokesperson from Wayne HealthCare said nothing has changed currently within their obstetrics services, a press release at the end of June released by the facility expressed concern about the congressional proposals to cut Medicaid funding that were eventually passed, saying the cuts “pose a serious threat to rural health care access.”
“As a health care provider serving thousands in west-central Ohio, we want to reassure our community that Wayne HealthCare is not at risk of closure or cutting services,” the release stated. “However, these proposed cuts could have devastating consequences, particularly for mothers, infants and low-income families.”
The health care facility said it remains “one of the few rural hospitals in the area providing comprehensive women’s health services, including labor and delivery care and employed obstetricians.”
According to the press release, about 45% of those services are funded through Medicaid.
“These proposed cuts jeopardize not just our ability to sustain these services, but the very health and safety of mothers, infants and families in our region,” Wayne HealthCare said in June.
Ohio is already considered low-ranking when it comes to infant mortality and maternal health rates, a struggle the state has dealt with for at least the last decade.
Southern Ohio Medical Center, Fayette County Regional Medical Center, Galion Community Hospital, and Bucyrus Community Hospital had not responded to multiple requests for comment as of Friday.
Maternity care units at risk
Hospitals in Ohio’s rural areas have an uphill battle economically already, with the National Rural Health Association showing three rural hospital closures in most recent data, and 18% of the 57 total rural hospitals considered “vulnerable” financially.
A spokesperson for the Ohio Hospital Association said his own research of hospital closures showed 25 hospitals in the state have “closed or consolidated maternity care” since 2018, with 10 of those serving rural areas.
Congress provided $50 billion in an attempt to stem objections from lawmakers on the impact of the $155 billion in Medicaid budget cuts on rural hospitals alone. The Ohio Hospital Association said it was “extremely grateful for the provisions in the Trump/Republican megabill that establish new financial resources for rural hospitals and extends Ohio’s Medicaid supplemental payment program through 2028.”
“We are grateful for the opportunity to discuss these critical issues with our congressional delegation and look forward to continued collaboration on future health care policies,” the association said in a statement.
But health care and Medicaid experts are unsure whether or not that new money will make a dent in the problem. According to the Kaiser Family Foundation, Ohio is one of 12 states where the cuts will have an outsized impact, due to the large rural population with Medicaid expansion groups.
The uncertainty extends to maternity services nationwide, as rural hospitals are struggling to maintain, if not eliminating all together, obstetric care due to the lack of help with finances from Medicaid reimbursements and other federal funding, and the rising costs of doing business.
The National Partnership for Women & Families said the federal budget bill could potentially mean the closure of more than 140 rural labor and delivery units across the country, where Medicaid “helps keep hospital labor and delivery units running, including services for high-risk pregnancy management, neonatal intensive care units and postpartum and lactation support.”
According to the partnership’s data, more than 100 rural hospitals have already closed their labor and deliver units since 2020 or announced plans to close before next year.
“We were already facing a dramatic maternity care crisis in the country, particularly in the South and in rural areas,” said Jennifer Driver, senior director of reproductive rights for the State Innovation Exchange, a national organization focused on state and national reproductive health policy.
Driver said with the new federal funding cuts, the country will see “even more backtracking,” especially in communities who were already struggling to make ends meet.
Losses of rural hospitals mean greater distances for pregnant individuals to travel, and that could mean more births happening costly emergency rooms, risks to healthy birth rates and the potential for sub-par prenatal care because of a lack of facilities from which to get that care.
A study by the Journal of the American Medical Association found that the percentage of women with “low prenatal care use” rose in rural counties where hospital-based obstetric services were lost, “which is consistent with prior studies showing that increased travel time is associated with fewer prenatal care visits.”
Driver said creating more barriers to health care for mothers who have to take care of children and for low-income households who might not have reliable transportation just creates more problems for states in maintaining the health of their residents.
“When all those things are impacted, that’s going to impact your every day existence,” Driver said. “You’re already seeing people start to wonder, what is going to happen to me?”
Ohio’s access to that care will be reduced in another way starting on Aug. 1, after the announcement of two Planned Parenthood clinics closing their doors in Hamilton and Springfield. The clinics cited Medicaid budget changes as reasoning for the closure of the clinics, which provided primary and preventive reproductive care.
