President Donald Trump signed the Full-Year Continuing Appropriations and Extensions Act (referred to as the CR) into law over the weekend, after it was passed by both the House of Representatives and the Senate. This act extends government funding through September 30, 2025, and prevents a shutdown, but it is crucial not to overlook the long-term budget resolution passed by the House on February 25, 2025, which could gravely affect the health and well-being of mothers and infants across the nation.
The CR addresses short-term funding, but the long-term budget remains the primary objective of the House majority, with a goal of reducing federal spending by $1.5 trillion over the next decade. The most concerning aspect of this resolution is its directive to the House Energy and Commerce Committee to identify $880 billion in savings, making significant Medicaid funding reductions highly likely. Although the resolution does not explicitly outline these cuts, the substantial savings target strongly suggests that Medicaid is a primary focus.
Medicaid is a cornerstone of maternal health care, providing coverage for nearly two-thirds of women of reproductive age and financing 42% of all births in the United States. If federal Medicaid funding is reduced, states will be forced to either raise revenue or cut Medicaid programs. This could result in reduced coverage for pregnant and postpartum women, limited benefits, and lower provider payments, all while states contend with slowing revenue growth and the challenge of maintaining balanced budgets. These cuts come at a time when reproductive rights are being restricted, forcing more women to carry pregnancies to term while simultaneously weakening the health care infrastructure essential for safe childbirth and postpartum care.
A brief history of Medicaid and maternal health care
When Medicaid was established in 1965, it was not originally designed to cover pregnant women. The program primarily served children, seniors, and people with disabilities, leaving millions of low-income adults, including women of reproductive age, without access to affordable health care. It wasn’t until the 1980s and 1990s that Medicaid began expanding eligibility for pregnant women in response to growing concerns about maternal and infant mortality. By 1990, all states were required to cover pregnant women up to at least 133% of the federal poverty level.
"If federal Medicaid funding is reduced, states will be forced to either raise revenue or cut Medicaid programs."
However, a major gap remained — many women lost Medicaid coverage just 60 days after giving birth, leaving them uninsured at a time when postpartum complications, mental health conditions, and medical needs are most urgent. The Affordable Care Act (ACA) in 2010 helped address these issues by expanding Medicaid eligibility, allowing more low-income women to qualify for continuous coverage before, during, and after pregnancy. Yet, even then, postpartum Medicaid coverage still ended at 60 days for many women who no longer met Medicaid’s strict income thresholds.
Recognizing the disparities in maternal health outcomes, the American Rescue Plan Act of 2021 (ARP) introduced a 12-month postpartum coverage extension for Medicaid and CHIP beneficiaries, allowing states to enhance maternal health care beyond the previously mandated 60-day postpartum period. This extension aimed to reduce pregnancy-related deaths — 50% of which occur in the postpartum period — and improve the management of chronic conditions such as hypertension, diabetes, substance use disorders, and depression. Studies indicate that states expanding postpartum Medicaid coverage have reported increased postpartum care visits, greater continuity of coverage, and improved engagement in health care services .
However, if Medicaid funding is cut, many states may be forced to reduce or eliminate this extended coverage, returning to the previous 60-day postpartum limit. This would leave millions of women uninsured at a critical time when they are vulnerable to postpartum depression, infections, hypertension, and other life-threatening complications. There are also concerns about how states will cover pregnant women as a whole if Medicaid is significantly reduced.
Medicaid expansion has reduced maternal mortality
Multiple studies have confirmed that Medicaid expansion under the ACA has led to a significant reduction in maternal mortality rates. States that adopted Medicaid expansion saw 7.01 fewer maternal deaths per 100,000 live births compared to non-expansion states, with even greater reductions among non-Hispanic Black women.
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Overall, Medicaid expansion has been linked to earlier prenatal care, higher postpartum visit rates, and better continuity of care, which are critical in reducing complications that contribute to maternal deaths. Lack of Medicaid funding could reverse these life-saving gains, putting more mothers at risk of preventable pregnancy-related deaths.
The Crisis of Rural Hospital Closures
Since 2010, over 500 rural hospitals have shut down their labor and delivery units, leaving more than 52% of U.S. rural hospitals without obstetric services. In ten states, fewer than one-third of rural hospitals offer maternity care, leading to the emergence of maternity care deserts — regions where women must travel long distances for prenatal, delivery, and postpartum care.
The closure of these facilities exacerbates maternal health disparities by forcing pregnant women to travel further, increasing the risk of preterm births, low birth weights, and maternal mortality. Studies have shown that the loss of local obstetric services is linked to an increase in out-of-hospital births and poorer birth outcomes. With proposed Medicaid cuts, these closures may accelerate, making it even harder for women to access safe maternity care.
A looming crisis: Perinatal mood and anxiety disorders
One in five women experiences perinatal mood and anxiety disorders, also commonly known as postpartum depression, and Medicaid is the primary payer for postpartum mental health care.
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The crisis will only deepen, according to Paige Bellenbaum, LCSW, an adjunct professor at the Silberman School of Social Work and former member of the NYC Maternal Mortality and Morbidity Review Committee, as more mothers are forced to give birth without access to comprehensive reproductive health care — both mental and physical. Bellenbaum warns that without adequate postpartum care, the country will likely see a surge in maternal suicides and long-term health complications for both mothers and children. She further emphasizes that these challenges will persist across generations, compounding economic instability and widening health disparities.
Widespread and preventable harm
There is already a need for improved and more expansive reproductive health services for women around the country. If 40% of pregnant women rely on Medicaid for reproductive health care, where will they give birth and receive postpartum care if they lose coverage and rural hospitals continue to close? If states force women to carry pregnancies to term while slashing Medicaid, they are actively creating a greater maternal health crisis that will lead to more maternal and infant deaths.
Cutting Medicaid would reverse years of progress in maternal and postpartum health care, leading to higher mortality rates, worsening mental health, increased hospital costs, and deepening economic hardship for families across the country. There will be no cost savings — only long-term harm to every aspect of our society, as families struggle, health disparities widen, and economic instability grows.
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