Medicaid Cuts Could Increase Maternal Mortality and Jeopardize Women’s Health

Twenty-four million women rely on Medicaid for everything from maternal health and contraception to vaccinations and cancer screenings. Using data from the Commonwealth Fund’s 2024 State Scorecard on Women’s Health and Reproductive Care, we looked at the role Medicaid plays in women’s lives and explored how cuts to Medicaid could significantly worsen women’s health and put their lives at risk.

How Does Medicaid Support Maternal Health?

Medicaid is the primary source of coverage and the largest single payer for pregnant women’s health care nationwide. The program covered more than 1.47 million births in 2023. This ranged from one of three, or 3,853 births, in Montana to nearly half, or 185,348 births, in Texas. Given its outsized role, Medicaid is an essential tool for improving maternal health in the United States, which continues to face the highest rates of maternal mortality of any high-income nation. Deaths are especially high among rural, Black, and American Indian/Alaska Native women. Most of these deaths are preventable.

Medicaid coverage is associated with increased use of essential care. This covers the preconception stage and continues through the postpartum period, when the majority of deaths occur. Medicaid beneficiaries use prenatal care during pregnancy more than their uninsured counterparts do and have better health outcomes. Compared with private insurance, Medicaid is also associated with lower rates of cesarean-section births for low-risk pregnancies, which leads to lower levels of maternal morbidity and mortality, shorter recovery, fewer adverse outcomes in subsequent births, and fewer negative impacts on infant health. These positive health outcomes also have the added benefit of being more cost-effective for the nation. In addition to being the gold standard of care for women with low-risk pregnancies, vaginal births cost 30 percent less than cesarean births.

Medicaid offers ongoing access to mental health services before, during, and after birth. Mental health issues, including suicide and substance use disorders, are the leading cause of pregnancy-related deaths. Having access to mental health services under Medicaid safeguards against these deaths. Forty-eight states and D.C. have extended postpartum Medicaid coverage to 12 months to ensure women’s access to mental health and other services during this critical period. Forty states and D.C. have also adopted Medicaid expansion under the Affordable Care Act, thus making continuity of mental health services — including before a woman conceives and again after the postpartum period — possible.

Medicaid expansion also benefits newborns. Medicaid expansion is associated with smaller racial and ethnic disparities in maternal and infant health outcomes, in addition to lower rates of maternal mortality.

How Does Medicaid Expansion Support Women of All Ages?

Medicaid has expanded access to health coverage for women of all ages. Historically, low-income women lacked access to health insurance through their employers and to Medicaid coverage outside of pregnancy, leaving many uninsured. As states have adopted Medicaid expansion, these gaps have narrowed, all-cause mortality has decreased, and women’s health outcomes have improved. In nonexpansion states like Georgia, Mississippi, and Tennessee, women are more likely to be uninsured and to report skipping needed care due to cost. Women enrolled in Medicaid receive preventive health services, such as well-women visits and cancer screenings, at higher rates than women who are uninsured. This improved access to screenings and timely follow-up treatment has increased women’s survival rates from breast and cervical cancer.

What Role Does Medicaid Play in Women’s Health in Rural Communities?

Medicaid helps sustain access in rural areas and protects against health care shortages. Medicaid funding plays a critical role in the financial viability of rural hospitals, community clinics, and other health care systems, and pays most of the bills. Medicaid expansion is associated with improved hospital financial performance and substantially lower likelihood that hospitals will close, particularly in areas that had large numbers of uninsured adults before Medicaid expansion. The scorecard shows where women in the U.S. have adequate access to care vs. areas where women experience shortages. In 2023, 36 percent of U.S. counties were maternity care deserts. These are areas in which women do not have access to hospitals, birthing centers, or obstetric providers. Cuts to the Medicaid program would exacerbate these challenges, reduce access to essential services, increase the risk of rural hospital closures, and result in the loss of key employers in rural communities. Medicaid funding allows rural health systems to keep their doors open, not just for Medicaid clients but for the entire community.

What Policies Is Congress Considering and How Would They Impact Women’s Health?

Congress is considering policies that would dramatically decrease federal resources for Medicaid. The policy proposals shown in the table have gathered support among Congressional Republicans.

Outlook

With the highest rates of maternal mortality and morbidity of any wealthy nation, the U.S. should be investing in proven strategies to eliminate preventable deaths and improve women’s health. Budget proposals that limit Medicaid eligibility, reduce funding, or increase barriers to access do the opposite. Cuts to Medicaid would roll back progress, widen health disparities, devastate the health care system, and put undue additional burden on the lives of women and mothers in the United States.