Loss of labor and delivery services at rural hospitals raises risk for Arkansas moms

After learning of the impending closure of the maternity ward at a rural hospital in his state, U.S. Senate Finance Committee Chair Ron Wyden of Oregon introduced a bill last week that would fundamentally change and significantly enhance Medicaid hospital reimbursement for labor and delivery services.

The bill would provide states with additional funding to increase payment rates for labor and delivery services for rural hospitals and create “standby” payments for hospitals that deliver fewer than 300 babies a year. Though the bill does not yet have bipartisan support and is unlikely to pass, it is yet another sign that policymakers are recognizing that access to labor and delivery services in rural areas is dwindling and that hospitals’ ability to continue to provide these services is greatly dependent on Medicaid.

A report by consulting group Chartis released earlier this year documented 267 rural hospitals ceasing labor and delivery services between 2011 and 2021. Although Arkansas fared better than other states in the report — in part due to the state’s decision to expand Medicaid coverage under the Affordable Care Act — the loss of labor and delivery services at just a handful of rural hospitals can make a drastic difference to moms when their babies are on the way.

Aside from the anxiety of having to traipse across multiple counties or, in some cases, across the state border when in labor, recent evidence suggests that increased travel distance for delivering moms is associated with greater risk of adverse health outcomes for moms and babies. One study showed that more than 30 minutes of travel time from home to a delivery facility increases the risk of giving birth before arrival, which may increase the risk of mortality.

An analysis by the Arkansas Center for Health Improvement showed that 28% of Arkansas moms traveled 30 minutes or more to deliver in 2022, and 8% traveled 60 minutes or more. Depending on county of residence, the median travel time for Arkansas moms ranged from 2 minutes to 72 minutes in that year, according to the analysis.

For Phillips County moms, the median travel time to delivery facilities went from 6 minutes to 51 minutes after Helena Regional Medical Center ceased labor and delivery services in 2020. Travel times for Columbia County moms went from 11 minutes to 45 minutes after Magnolia Regional Medical Center ceased labor and delivery services in 2021.

Closing a maternity ward can be a tough decision for a hospital administrator. Communities greatly desire labor and delivery services as part of a hospital’s offerings, not only for the expectant mom to be closer to home for the delivery but also for family and friends to be able to share in the wonderful experience without having to travel so far. Maintaining those services in rural areas can be quite difficult, though. A maternity ward is a 24-hour, seven-day-a-week operation, frequently requiring multiple physicians to ensure that no one physician is constantly on call. It’s a fixed cost that must be staffed at a sufficient level to be prepared for whatever comes in, much like a fire department.

Increased staffing costs and a lower volume of deliveries — younger populations are migrating out of rural Arkansas counties, particularly in the Delta — mean that financially maintaining a maternity ward gets harder. This is especially true for areas with more low-income residents where many expectant moms rely on Medicaid, a healthcare coverage program which has historically paid for nearly half of all births annually in Arkansas.

As a major source of payment for labor and delivery services, Medicaid has a critical role to play in improving care and health outcomes for Arkansas moms and babies. Medicaid payment rates for these services, however, continue to lag, putting a strain on hospitals that want to maintain access to quality care for expectant mothers in their communities. Medicaid’s payment rates to physicians for obstetric care in Arkansas are 30% below what Medicare pays (notably, Medicare does not pay for many deliveries). An evaluation of the state’s Medicaid expansion program by the Arkansas Center for Health Improvement showed that Medicaid paid about half of what private insurers paid for obstetric/gynecological services.

Reducing these disparities in payment and working with Congress and federal agencies to create financing models to address low-volume challenges would go a long way in stemming the tide of maternity ward closures in rural areas. Recently announced federal funding opportunities to test new financing and care models over the next decade are welcome and should be pursued by the state, but more immediate and permanent adjustments are needed.

The birthing journey is already risky enough for Arkansas moms. Let’s invest in labor and delivery care and make sure that our rural communities can keep these services close to home.

Editor’s note: Craig Wilson, J.D., M.P.A., is the director of health policy for the Arkansas Center for Health Improvement, an independent, nonpartisan health policy center in Little Rock. The opinions expressed are those of the author.