Pregnant Arkansas women living in rural areas will face even greater challenges obtaining obstetric care if Congress approves proposed cuts in Medicaid, according to health policy experts who discussed a new report Thursday.
Arkansas as a whole has the 10th highest share of women of childbearing age covered by Medicaid in rural areas, according to a Georgetown University Center for Children and Families study presented during a webinar Thursday.
The report also highlighted 20 U.S. counties where approximately half of their women of childbearing age are covered by Medicaid. One of those counties is in Arkansas, according to the study. Eastern Arkansas’ Lee County has about 8,100 residents and a nearly 39% poverty rate, according to the U.S. Census.
Medicaid is a significant source of health coverage for women of childbearing age, especially for those living in small towns and rural communities, the report found. The study defines these communities as non-metropolitan counties with urban areas of fewer than 50,000 residents.
“It’s absolutely critical for maternal and infant health that women have access to affordable, comprehensive healthcare before, during and after they get pregnant,” said Joan Alker, Georgetown University Center for Children and Families director and lead author of the report.
Women in rural areas face greater challenges to accessing care because of a shortage of providers, hospital closures and the loss of labor and delivery units and obstetrical capacity, Alker said.
Nationally, 23.3% of women of childbearing age (19 to 44 years old) in rural areas are covered by Medicaid, compared to 20.5% of women in metropolitan areas, according to the report. Louisiana and New Mexico have the highest share of Medicaid-covered women, with just over 40% each. Nearly 28% of women of childbearing age are covered by Medicaid in rural Arkansas.
For many Arkansas women, especially those living in rural areas with low-income families, Medicaid may be the only health insurance source to keep them healthy throughout pregnancy, Arkansas Advocates for Children and Families Health Policy Director Camille Richoux said in an interview.
“For me, it’s a great thing that we have Medicaid ensuring that women throughout the state have coverage options,” Richoux said. “It also means that we have more at stake whenever there are threats to Medicaid…this report really makes that case of how any kind of threats or cuts around Medicaid could have the potential to be devastating to a lot of women in the state and especially in a state that has so many challenges in maternal health.”
Arkansas has one of the highest maternal mortality rates in the nation and the third-highest infant mortality rate, according to the Arkansas Center for Health Improvement.
Access to Medicaid could change under proposed federal legislation. A U.S. House panel approved a plan Wednesday that would reduce federal spending on Medicaid by $625 billion over the next decade.
The proposal includes a provision for work requirements. Arkansas implemented a work-reporting requirement in 2018 that led to 18,000 people losing coverage, in part because enrollees were unaware or confused about how to report they were working. A federal judge later ruled the program was illegal. Arkansas officials submitted a request for a new work requirement earlier this year.
Rural communities have a lot at stake with the congressional Medicaid debate, Alker said, because the loss of Medicaid revenue would place “additional pressure on a very strained system.” Nearly half of all births in rural areas are covered by Medicaid, and less access to obstetrical care leads to worse outcomes to moms and their babies, she said.
According to one study, 293 rural hospitals stopped providing obstetric care between 2011 and 2023. Another study found that more than 52% of rural hospitals did not provide obstetric care by 2022.
Arkansas ranks sixth in terms of states with the highest percentage of maternity care deserts, according to the March of Dimes, which defines maternity care deserts as areas with no birthing facility or obstetric clinician. Nearly 51% of Arkansas is a maternity care desert, according to the organization’s 2024 report.
“If we see more hospital closures and loss of labor and delivery units, all women living in rural areas are at risk of losing out on the care they need, regardless of who is their insurer, if that care is just not available,” Alker said. “So these communities will not be able to grow and thrive without a robust system to support women and families.”
Beyond reducing healthcare access for all rural community residents, not just those insured through Medicaid, Richoux noted hospital closures can hurt an entire community, especially when it’s the area’s largest employer.
“Not everybody can just leave… to move out of an area is an easy thing to say, a lot harder to do,” she said. “And people shouldn’t have to be forced to leave their small, rural town because their hospital is unnecessarily closed.”
The full Georgetown University report is available here.
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