Fredericksburg Parent

16 Fredericksburg Parent and Family • June 2025 Cuts to Medicaid would further destabilize the already precarious health- care system for pregnant women and babies in rural areas and small towns, including those in the Fredericksburg area. According to a new report on Medicaid's role in maternal and infant health in rural communities, almost a quarter—24.5%—of Virginia women of child- bearing age living in such communities have Medicaid as their sole source of healthcare coverage. That's greater than the national average of 23.3%. Virginia is also one of nine states with the biggest differentials in Medicaid coverage between women in rural and metropolitan areas. The report, from the Center for Children and Families at Georgetown University's McCourt School of Public Policy, defines small towns/rural areas as "non-metropolitan counties with central urban areas of fewer than 50,000 people," using the U.S. Census Bureau designation. Locally, that definition applies to Fredericksburg City and Caroline and King George counties. "Women in rural areas already have difficulty accessing care because of the loss of labor delivery units and obstetrical capacity," said Joan Alker, one of the lead authors on the report, in a webinar hosted Thursday by the Center for Children and Families. "This is a real challenge for rural communities and particularly in the face of very large cuts to Medicaid that Congress is con- templating right now." Since 2010, the percent of rural hospitals that do not offer obstetric care has been increasing, said Katy Kozhimannil, co-director of the Rural Health Research Center at the University of Minnesota, who participated in Thursday's webinar. "Between 2010 and 2022 there were 537 hospitals that lost their obstetrics programs," Kozhimannil said. "Our research shows that by 2022, 52.4% of rural hospitals did not offer obstetric care," up from 43% in 2010. Rural Moms and Babies in the Wake of Medicaid Reductions WRITTEN BY ADELE UPHAUS AT RISK: According to a March article in Cardinal News, Virginia lost five labor and delivery units between 2018 to 2024, "due to the financial strain of maintaining these services." Obstetric care has high fixed costs, "requiring dedicated space, equipment, and trained staff" who must be con- stantly on-call, Kozhimannil said. "Revenues are variable and depend on the volume of births, which disadvan- tages lower birth-volume hospitals." Medicaid pays for almost half of all births in rural areas and 40% of those in urban areas, she continued, and it reimburses at a lower rate than private health care plans, which disadvantages facilities in rural areas. When a facility closes, the effects are felt by every- one, not just those with Medicaid, said Ryan Cross, vice president of government affairs and advocacy for Franciscan Missionaries of Our Lady Health System, dur- ing Thursday's webinar. "It all comes back to the Medicaid dollar," Cross said. "Every dollar is critical, not for market share, but to meet community need and save lives. When Medicaid is cut, everyone is affected. That commercially insured patient will also have to drive further if a hospital is closed." Access to maternity care is crucial to reducing adverse Cuts to Medicaid would make it even more difficult for facilities to stay open in these areas. Nearly 1 in 4 childbearing-age women in rural Virginia rely solely on medicaid for health care

• Cover