By Kathleen Shannon - Producer, Contact - News
Big Sky Connection - Amid a maternal health crisis in the United States, Congress has proposed cuts to Medicaid funding. A new report shows rural women across the country and many in Montana are more likely to rely on Medicaid for obstetric services. Comments from Katy Backes Kozhimannil [BOCK-uhs KAZ-ee-mon-uhl], professor, Division of Health Policy and Management, University of Minnesota, and co-director, Rural Health Research Center; and Joan Alker, executive director, Center for Children and Families, and research professor, McCourt School of Public Policy, Georgetown University.
Click on the image above for the audio. Medicaid covers more births in rural areas than metro ones, at 47% and 40% respectively, according to a new report from the Georgetown University Center for Children and Families. (Oleg Breslavtsev/Adobe Stock)
Kathleen Shannon
May 22, 2025 - Montana mothers and could-be moms rely more on Medicaid than in other states, and would be harder hit by proposed cuts to the program.
More than 30% of Montana women of childbearing age are covered by Medicaid. It's the seventh-highest rate in the nation and about 7% higher than the national average. That's according to a new report from Georgetown University's Center for Children and Families, which also shows Montana is home to three of the nation's 20 most Medicaid-dependent counties: Glacier, Prairie and Big Horn.
Joan Alker, the Georgetown center's executive director, notes all 20 counties are in states that adopted Medicaid expansion.
"Rural communities tend to have lower income than metro areas," Alker said. "So Medicaid, as important as it is for moms and babies nationwide, is even more important in rural areas and small towns."
House Republicans have proposed cutting more than $600 billion in Medicaid funding to pay for Trump administration priorities, including mass deportations and tax cuts. The Congressional Budget Office estimates the proposed cuts would drop more than 8 million Americans from Medicaid benefits.
Obstetric care has high fixed costs for hospitals, including dedicated space and equipment and 24/7 staff availability. Katy Backes Kozhimannil, a professor in the Division of Health Policy and Management at the University of Minnesota, and co-director of the university's Rural Health Research Center, said covering costs can be more challenging for rural hospitals.
"The revenues to cover these fixed costs are variable and depend on the volume of births at each hospital, which disadvantages lower birth volume facilities," she continued. "And the reimbursement rate for each birth is another factor that leads into revenues."
Kozhimannil said in 2022, more than half of hospitals in rural America did not offer obstetric care, following the closure of nearly 550 obstetric units since 2010.
