Who Pays the Price? Medicaid Cuts and the Women Left Behind

A Preventable Crisis

More than 85% of maternal deaths in the United States are preventable, yet the country continues to lead all high-income nations in maternal mortality [1]. In 2023, the United States recorded 18.6 maternal deaths per 100,000 live births. This rate, despite modest improvement from prior years, remains more than 3 times higher than comparable nations such as Germany, Australia, and Japan [2].  The racial component of this crisis is also severe. In 2023, Black women 50.3 per 100,000 live births, more than three times the rate of white women at 14.5 [2]. Rather than mobilizing federal policy to close these gaps, the current administration has moved in the opposite direction–eliminating or defunding the very programs designed to keep mothers and infants alive. Analysts and advocates warn that these policies may worsen these existing inequalities, with the heaviest burdens falling on low-income women and those with limited access to support.

Barriers to Care 

Access to early, consistent prenatal care is one of the most effective tools available to reduce maternal mortality, yet that access has been declining for years especially among women of color. In 2024, only approximately 68% of Hispanic women and just over 65% of Black women received early prenatal care, compared to more than 82% of white women [1,3]. Geographic barriers also add to this problem. A 2023 March of Dimes article reported that more than one-third of all U.S. counties qualify as maternity care deserts–areas with no hospital offering obstetric care and no obstetric care and no obstetric providers–affecting 1 in 12 women across the country [4]. A 2024 update from March of Dimes found that more than 5.5 million women live in counties with no or limited access to maternity care, a figure that continues to worsen as hospital obstetric units close at alarming rates [4,5]. In 2024, more than a quarter of women of reproductive age with young children reported difficulty finding reliable maternity care, with rates even higher in states that have strict abortion restrictions [3]. These barriers are not new, but the federal policy response to them is moving in reverse.

Medicaid Under Threat

Medicaid is the foundation of maternity care financing in the United States, covering more than 40% of all births nationally, rising to nearly 50% in rural areas, more than 58% among Hispanic mothers, and 64% among Black mothers [3]. Over the past few years, nearly every state has extended postpartum Medicaid coverage from 60 days to 12 months in response to the maternal mortality crisis [6]. This gain is associated with a threefold increase in mental health service use and significant reductions in maternal mortality and morbidity. Those hard-won gains are now threatened.

The One Big Beautiful Act (H.R. 1) signed into law on July 4, 2025, cut federal Medicaid funding by approximately $1 trillion over ten years [7]. The nonpartisan Congressional Budget Office estimates that these cuts will result in more than 10 million people losing Medicaid coverage directly, with millions more losing marketplace insurance as enhanced premium tax credits expire [7]. Beginning in 2027, most Medicaid recipients will be required to meet work reporting requirements of 80 hours per month. While pregnant women and mothers with young children are formally exempt, the administrative burden of documenting and maintaining those exemptions is expected to push eligible women off the rolls–particularly those in low-wage, caregiving, or informal employment arrangements [8]. The Congressional Budget Office’s projections are grounded in precedent showing that similar state-level work requirement experiments cause widespread coverage loss, even among those who technically qualify [7].

Dismantling Title X

Simultaneous to the Medicaid rollback, the Trump Administration has escalated its campaign against Title X–the only federal program specifically designed to extend comprehensive family planning services to low-income individuals. Established by President Richard Nixon in 1970, Title X funds a network of approximately 4,000 service sites serving 2.8 million patients annually, providing not only contraception but cancer screenings, STI testing and treatment, infertility counseling, and early prenatal services [9]. Despite serving millions of patients each year, Title X funding has remained flat since 2015 at under $300 million [3]. The currency administration's proposed 2026 budget would eliminate Title X funding entirely and has already issued new guidance reorienting the program's mission from family planning to pronatalism [3]. The consequences of such a shift are documented as well. During Trump’s first term, regulatory changes such as a domestic gag rule prohibiting abortion counseling at federally funded clinics forced nearly 1000 services sites out of the Title X network. Between 2019 and 2020, as sites contracted, nearly 300,000 fewer women received breast cancer screenings through Title X clinics, a reduction HHS attributed primarily (63%) to policy changes rather than COVID-19 [3]. Targeting Title X does not improve maternal outcomes and harming  it only removes the safety net that makes those outcomes possible.

Redirecting Dollars to Unregulated Centers

Even as evidence-based programs are being dismantled, public dollars are being redirected toward a different kind of institution: unregulated pregnancy centers, often called crisis pregnancy centers, which operate without medical licensure, are not bound by federal privacy law, and are not required to employ medically trained staff [3]. As of March 2024, more than 2,600 of these centers were operating in the United States–outnumbering abortion providers by more than three to one [3]. A States Newsroom analysis of tax records found that nearly $1.3 billion in government grants were awarded to 1,259 such centers between 2019 and 2024, largely through the Temporary Assistance for Needy Families (TANF) program–a federal block grant originally designed to provide direct cash assistance to low-income families [10]. The Government Accountability Office has repeatedly flagged weak oversight, poor transparency, and possible misuse of these funds, and issued new recommendations in April 2026 that HHS require more detailed state reporting [3]. Despite being positioned as a support system for pregnant women, unregulated pregnancy centers rarely provide prenatal care or refer patients to prenatal care, even though they deliberately target women who face the greatest barriers to accessing it [3]. The result is a resource shift with measurable human consequences: clinical providers lose capacity while centers that do not meet basic standards of care expand their reach. 

Art By Shea Davis

The Cost of Inaction 

The pattern emerging from these policy decisions is not ambiguous. When Medicaid contracts, women lose access to the prenatal visits, postpartum follow-up, and mental health services that prevent maternal death. When Title X sites close, low-income women lose cancer screenings and reproductive health services with nowhere else to turn. When public dollars are routed to unregulated centers rather than licensed providers, delayed prenatal care becomes more likely. This delay in care is extremely dangerous. Research consistently shows that women in maternity care deserts face a 13% higher risk of preterm birth, and that counties which have lost obstetric units experience higher rates of births occurring in emergency departments [5]. The administration’s budget reflects clear priorities, and by that measure it directs fewer resources toward the women most at risk of maternal mortality. Advancing maternal health in the United States will require reversing this trajectory by protecting Medicaid, fully funding Title X and Healthy Start, and directing public money only to providers that meet clinical standards for care. 

References

1. Psaki, S., Kass, D., & Tobin-Tyler, E. (2026, April 30). A Dangerous Shift in Maternal Health Policy. Time. https://time.com/article/2026/04/29/a-dangerous-shift-in-maternal-health-policy/

2. Hoyert, D. L. (2025). Maternal Mortality Rates in the United States, 2023. NCHS Health E-Stats. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/data/hestat/maternal-mortality/2023/maternal-mortality-rates-2023.htm

3. Psaki, S., Kass, D., & Tobin-Tyler, E. (2026, April 30). A Dangerous Shift in Maternal Health Policy. Time. [Primary source article; statistics drawn from HHS data and 2024 survey data cited therein.]

4. March of Dimes. (2023). Where You Live Matters: Maternity care deserts and the crisis of access and equity. https://www.marchofdimes.org/maternity-care-deserts-report-2023

5. March of Dimes. (2024). Nowhere to go: Maternity Care Deserts Across the US. https://www.marchofdimes.org/maternity-care-deserts-report

6. National Partnership for Women & Families. (2025). At Risk: Critical Medicaid Benefits for Moms. https://nationalpartnership.org/report/at-risk-critical-medicaid-benefits-for-moms/

7. Guttmacher Institute. (2025, November). New Federal Medicaid Cuts Will Devastate Coverage for Reproductive Health Care. https://www.guttmacher.org/2025/11/new-federal-medicaid-cuts-will-devastate-coverage-reproductive-health-care

8. Families in the USA. (2025, September). The Biggest Threats to Maternal Health Lurking in President Trump's Health Care Cuts. https://familiesusa.org/resources/the-biggest-threats-to-maternal-health-lurking-in-president-trumps-health-care-cuts/

9. Population Connection Action Fund. (2025). Title X and the Domestic Gag Rule. https://www.populationconnectionaction.org/policy-priorities/title-x/

10. Watford, A. (2026, April). Taxpayer Dollars Flood Pregnancy Centers. Oversight Hasn't followed. States Newsroom / Douglas Budget. https://www.newsfromthestates.com/article/taxpayer-dollars-flood-pregnancy-centers-oversight-hasnt-followedl