CMS Issue Brief: Improving Access to Maternal Health Care in Rural Communities

In an ideal maternal health system, all women would have access to comprehensive, seamless medical care with links to behavioral, economic, and social supports. Additionally, they would be engaged with this system before, during, and after pregnancy. Across the United States, many women are not receiving care in this ideal system, and women in rural communities face unique challenges that make it harder for them to reach this ideal or any care at all in some cases. Because maternal health care is a growing concern in rural America, rural maternal health care is an administration priority and the Centers for Medicare & Medicaid Services (CMS) has been focused on improving rural maternal health outcomes.  

As part of its Rethinking Rural Health Initiative, CMS released its first Rural Health Strategy in 2018. By applying a rural lens, CMS works to have new health policies and initiatives positively impact rural communities. As an example, the agency finalized improvements to the accuracy of Medicare payments to low wage hospitals so they can increase what they pay their workers, and help ensure patients including those living in rural areas, continue to have access to high-quality, affordable healthcare. Other CMS rural and maternal related activities have included, the recent release of the first Medicaid and CHIP Scorecard to evaluate state progress on health outcomes and determine return on investment. The Scorecard includes a measure related to postpartum care and may eventually include other maternal and infant health outcomes. Furthermore, CMS looks forward to implementing the newly enacted Improving Access to Maternity Care Act, which ensures that the National Health Service Corps sends OB-GYNs to areas of greatest need, as well as the Preventing Maternal Deaths Act, which authorizes the Centers for Disease Control and Prevention (CDC) to support state and tribal maternal mortality review committees (MMRCs). 

Since January 2010, more than 100 rural hospitals have closed, with a disproportionate share occurring in the South. These closures were the result of multiple factors including higher rates of uninsured residents, higher amounts of uncompensated care, financial distress, hospital size, and community poverty rates. Although many rural hospitals remain open, some have discontinued certain specialty service lines, including obstetric and gynecologic services. Between 2004 and 2014, 179 rural counties experienced closures/loss of hospital obstetric services (Figure 1).Also during this time, more than half of the rural counties in the US either had no hospital obstetric services or lost them (Appendix A).

Please see the attached report for more details. 

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