Under the Trump administration, Medicaid is set up to lose nearly $1 trillion in funding over the next decade, posing extreme threats to maternal healthcare nationwide.
Medicaid is a cornerstone of maternal healthcare, providing coverage for nearly two-thirds of women of reproductive age and financing 42 percent of all births in the United States, according to an analysis by KFF. That means almost half of all new parents—disproportionately low-income—depend on it for prenatal care, safe delivery and postpartum support.
Medicaid wasn’t originally designed to cover pregnant women. But in the 1980s and ’90s, rising maternal mortality prompted Congress to expand eligibility, eventually requiring all states to cover pregnancy-related care for people earning up to at least 133 percent of the poverty line. The Affordable Care Act and the American Rescue Plan went further, extending postpartum coverage and allowing more low-income people to maintain care before, during and after pregnancy. Today, Medicaid is the backbone of maternal health in the United States.
Unfortunately, pregnant and postpartum people are at the center of the crisis created by the “One Big Beautiful Bill”—recently passed by both the House and Senate and signed into law by Donald Trump—which guts Medicaid by nearly $1 trillion over the next decade. The Congressional Budget Office (CBO) estimates 11.8 million people will lose coverage by 2034. While pregnant and postpartum people are exempt from the bill’s harshest provision—the 80-hour monthly work requirement—they’re not exempt from the consequences.
The bill’s biggest threat comes from a cap on provider taxes, which states use to fund their share of Medicaid. Currently, they can collect up to 6 percent of a hospital or clinic’s revenue. The bill drops that to 3.5 percent by 2031. That dramatically cuts how much states can raise—and how much they receive in federal matching funds. Less state revenue means less federal support, and fewer dollars mean fewer services.
If clinics are shuttered, hospitals are closed and providers are stripped from Medicaid, what happens to people forced to carry pregnancies without care?
Medicaid Expansion
CDC data from 2019 to 2023 uncovered deep disparities in maternal mortality rates between states that expanded Medicaid under the Affordable Care Act and those that did not, recent analysis by Families USA found.
Over those five years, non-expansion states experienced maternal mortality rates 35 percent higher than expansion states.
For example, expansion states like California (maternal mortality rate: 10.2 per 100,000 live births) and Connecticut (9.4) consistently rank among the lowest in the country, while non-expansion states like Alabama (36.2), Tennessee (34.6), and Mississippi (30.2) report some of the highest rates, with highest mortality rates for women of color.
One threat to pregnant and postpartum people is the potential loss of Medicaid expansion itself, which provides full benefits to low-income adults before, during and after pregnancy. If federal matching funds decrease, some states may tighten income eligibility, potentially causing individuals to lose coverage entirely.
Estimates suggest that between 100,000 and 200,000 pregnant and postpartum people could lose full Medicaid coverage, based on projections that 3.5 to 7 percent of the 2.5 million people who rely on Medicaid during and after pregnancy may be affected. This estimate is grounded in prior CBO and KFF modeling of enrollment losses under similar funding restrictions.
PMADs and 12-Month Postpartum Coverage
Before 2021, most states terminated postpartum Medicaid coverage after 60 days. Now, 49 states, including D.C., have extended it to 12 months.
That fragile progress is now under threat. The “One Big Beautiful Bill” drastically alters how Medicaid is funded. By capping provider taxes and limiting federal matching funds—critical tools that states use to finance their Medicaid programs—the law weakens the financial underpinnings of maternal and postpartum care. These changes jeopardize the 12-month postpartum coverage extension.
Even those who remain technically covered may face steep reductions in care. Services such as lactation counseling, blood pressure monitoring, home visits and maternal mental healthcare could disappear.
This is especially dangerous given that perinatal mood and anxiety disorders (PMADs), including postpartum depression, are already among the most common complications of childbirth and a leading cause of maternal mortality. One in five people experiences a PMAD, and Medicaid is the largest single payer for postpartum mental health treatment. These conditions often peak after birth, when coverage is still vulnerable.
Studies show that women with unintended or unsupported pregnancies are significantly more likely to suffer from postpartum depression. PMADs are associated with higher rates of preeclampsia, C-sections, suicide and chronic disease. They also create lasting harm for families, increasing the risk of low birth weight, developmental delays and long-term health issues in children.
States already operating with strained maternal health systems will be least equipped to absorb these cuts. The Motherhood Center of New York, a day hospital treatment center for PMADs in New York City, estimates that one untreated PMAD can cost $1 to 2 million over the lifetime of the mother and child If abortion restrictions continue to increase birth rates in low-access states, the total economic burden could exceed $250 billion annually, driven entirely by preventable mental health outcomes.
Cutting Medicaid now will dismantle the only system proven to protect maternal mental health and reduce deaths. There is no cost savings—only widespread, generational harm. The price will be paid not only in dollars, but in lives.
Planned Parenthood, Gone. Hospitals, Closed.
These impacts fall hardest in the states that have banned or severely restricted abortion, where maternal care options were already disappearing.
The Supreme Court’s June 2025 ruling in Medina v. Planned Parenthood South Atlantic set a new precedent, allowing states to exclude reproductive health providers from their Medicaid programs, even if those providers meet all federal medical qualifications. In a 6-3 decision, the Court held that patients and providers cannot sue in federal court when states violate the federal provision allowing Medicaid recipients to choose their own provider.
Even though Medicaid funds cannot legally be used for abortions, Planned Parenthood provides only 3 to 4 percent abortion-related care. The vast majority of Medicaid reimbursements support essential services like cancer screenings, contraception, STI treatment, prenatal checkups and postpartum care. So when states cut off Medicaid to Planned Parenthood, it’s not abortion they’re defunding—it’s maternal healthcare.
When states cut off Medicaid to Planned Parenthood, it’s not abortion they’re defunding—it’s maternal healthcare.
At the same time, Medicaid cuts and provider tax caps will hit rural hospitals hardest. While the bill includes a $50 billion Rural Hospital Fund over five years, experts warn it’s nowhere near enough to counter the damage.
According to KFF, rural Medicaid programs stand to lose an estimated $119 to $155 billion over the next decade. That’s more than three times what the rural fund provides.
Over 35 percent of U.S. counties, home to 2.3 million women of reproductive age, are considered maternity care deserts, lacking access to hospitals, birth centers or obstetric providers. With Medicaid cuts outpacing rural investments, that number will grow, along with the distance pregnant people must travel to give birth. Pregnant people will be told to travel three hours to deliver a baby, or get turned away entirely. The pressure builds for those living in maternity care deserts, where the closure of hospitals or clinics leaves entire regions without safe labor and delivery options. These are not rare or hypothetical cases—they are the next wave of preventable trauma.
You Must Have Your Baby—But You’re On Your Own
Where will they go? If clinics are shuttered, hospitals are closed and providers are stripped from Medicaid, what happens to people forced to carry pregnancies without care? They will face unmanaged labor, untreated postpartum depression, and dangerous complications alone. In a nation that mandates childbirth but slashes access to care, the question isn’t whether outcomes will worsen. It’s how many will suffer—and how many won’t survive.
Because in this America, with the passage of this bill, birth is mandatory, but care is optional.
Great Job Allison Carmen & the Team @ Ms. Magazine Source link for sharing this story.
