Rural vs. urban hospitals providing Medicaid maternity care, by state

Rural hospitals account for more than one-third of U.S. hospitals providing inpatient maternity care to Medicaid enrollees, though states vary widely in how much they rely on rural facilities for that care, according to an Aug. 26 KFF analysis.

In Vermont, 91% of hospitals providing inpatient maternity care to Medicaid enrollees were in rural areas in 2023, the highest share among states. Wyoming followed at 89% and South Dakota at 84%. At the other end, rural hospitals accounted for 2% of such facilities in New Jersey, 4% in Florida and 10% in Massachusetts.

The typical rural hospital providing inpatient maternity care to Medicaid enrollees was a 43-minute drive from the nearest in-state hospital providing the same care, compared with 13 minutes for urban hospitals. For 1 in 4 rural hospitals, the nearest alternative was at least an hour away, and in 14 states, the typical drive from a rural hospital to the nearest in-state alternative was an hour or more, according to KFF.

The findings come as rural hospitals continue to eliminate labor and delivery services. Since the end of 2020, 146 rural hospitals have stopped delivering babies or announced plans to do so by the end of 2026, according to a July report from the Center for Healthcare Quality and Payment Reform. Only 40% of rural hospitals still offer labor and delivery services.

KFF’s analysis used 2023 Medicaid claims data, the most recent available at the time of the analysis. Hospitals were classified as providing inpatient maternity care if they were general acute care hospitals with at least 10 live births to Medicaid enrollees during the year. KFF used the Department of Agriculture’s Rural-Urban Commuting Area codes to determine rurality. Georgia and Rhode Island were excluded because of data-quality concerns.

Nationwide, 2,439 hospitals provided inpatient maternity care to Medicaid enrollees in 2023. Of those, 1,496 were urban and 943 were rural, meaning rural hospitals accounted for 39% of the total.

Below is a state-by-state breakdown, including the District of Columbia, of hospitals providing inpatient maternity care to Medicaid enrollees in 2023, according to KFF:

State	Urban hospitals	Rural hospitals	Rural share
Alaska	5	9	64%
Alabama	26	18	41%
Arkansas	15	21	58%
Arizona	30	12	29%
California	174	26	13%
Colorado	32	19	37%
Connecticut	20	3	13%
District of Columbia	5	0	0%
Delaware	4	3	43%
Florida	81	3	4%
Hawaii	5	6	55%
Iowa	17	35	67%
Idaho	12	14	54%
Illinois	69	22	24%
Indiana	48	31	39%
Kansas	13	35	73%
Kentucky	15	29	66%
Louisiana	27	14	34%
Massachusetts	36	4	10%
Maryland	26	6	19%
Maine	6	16	73%
Michigan	46	31	40%
Minnesota	27	47	64%
Missouri	33	27	45%
Mississippi	14	22	61%
Montana	7	19	73%
North Carolina	39	36	48%
North Dakota	6	5	45%
Nebraska	8	31	79%
New Hampshire	6	9	60%
New Jersey	43	1	2%
New Mexico	8	18	69%
Nevada	13	4	24%
New York	80	24	23%
Ohio	50	36	42%
Oklahoma	21	23	52%
Oregon	22	26	54%
Pennsylvania	59	21	26%
South Carolina	28	10	26%
South Dakota	3	16	84%
Tennessee	31	23	43%
Texas	137	66	33%
Utah	22	16	42%
Virginia	40	10	20%
Vermont	1	10	91%
Washington	35	18	34%
Wisconsin	39	42	52%
West Virginia	10	10	50%
Wyoming	2	16	89%

Note: Georgia and Rhode Island were excluded because of data-quality concerns.

At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.