As the One Big Beautiful Bill (OBBB) advanced through Congress, the health care industry raised serious concerns about its proposed Medicaid cuts. Experts warned that millions of Americans in vulnerable communities could lose coverage, with direct and potentially devastating consequences for the hospitals that serve them. Since Medicaid finances more than 41% of U.S. births, any reduction in Medicaid support could have a significant impact on maternal health.
Now that the bill has been signed into law—with some amendments—the question remains: what will it actually mean for health care access, particularly for mothers and families?
Medicaid Eligibility Changes and Exemptions
Among the most consequential provisions in the bill are new requirements for Medicaid eligibility. According to the Congressional Budget Office, work requirements, more frequent eligibility checks, the elimination of auto-enrollment, and increased cost-sharing will account for the largest portion of federal Medicaid savings—and lead to the largest increase in the number of uninsured individuals.
However, several vulnerable populations are explicitly exempt from these requirements. This includes pregnant individuals, those entitled to postpartum medical assistance, and adults with dependents under the age of 13.
On paper, this codifies strong protections for individuals during pregnancy and postpartum. Yet in practice, implementation may prove more complicated. With a short timeline for these changes to take effect (by December 31, 2026), states must quickly develop the systems and infrastructure needed to apply these exemptions consistently. Without robust planning and oversight, even eligible individuals may fall through the cracks and lose coverage.
The Role of Medicaid Expansion in Early Maternal Health
While coverage during pregnancy and postpartum is essential, data shows that the period before conception and the earliest weeks of pregnancy are equally essential to long-term health outcomes for both mothers and infants. That’s why early and continuous access to coverage is critical.
Pregnant women eligible for Medicaid often don’t enroll in coverage until later in pregnancy—missing key opportunities for preventive care and chronic disease management. Medicaid expansion has allowed women to enroll earlier, leading to increased use of prenatal services and improved birth outcomes, including reduced rates of low birthweight and preterm birth.
The OBBB, however, significantly reduces federal support for Medicaid expansion. It weakens financial incentives for states and increases administrative complexity, potentially discouraging adoption or maintenance of expansion programs. These changes may place timely maternal care—and associated health outcomes—at risk in presently underserved areas.
Ripple Effects for Rural and Underserved Communities
Even if coverage for mothers is preserved, other provisions in the bill may still affect the care they receive and their ability to access it—especially in rural and underserved communities. Across the country, hospitals in these areas have closed maternity wards and labor and delivery units due to financial strain. Maternity care is often a financial loss for hospitals, and when budgets tighten, it is frequently one of the first services to be cut.
The hospitals most vulnerable to closure are those serving economically disadvantaged patients—especially the uninsured and those enrolled in Medicaid. With the OBBB projected to increase the number of uninsured individuals, financial pressure on these hospitals will likely intensify.
Compounding the challenge, the bill prohibits states from creating new provider taxes or increasing existing ones. These taxes have long been a tool used by states to subsidize hospitals that serve a high volume of Medicaid patients. Removing this option limits states’ ability to offset new financial burdens on their healthcare systems.
Rural Health Transformation Program: A Counterbalance
To address some of these risks, the final version of the bill includes a new $50 billion Rural Health Transformation Program, which will be implemented from fiscal years 2026 to 2030. These funds will be distributed to states to support rural health care providers, with 50% allocated equally among states with approved applications and the remaining funds distributed based on demonstrated need.
This program represents an important investment in stabilizing and modernizing rural healthcare infrastructure—and may help mitigate some of the anticipated disruptions caused by other provisions in the bill.
A Promising Carve-Out for Digital Health
One of the most forward-looking components of the Rural Health Transformation Program is its explicit support for digital health innovation. The law directs funding toward “data- and technology-driven solutions that help rural hospitals and other rural health care providers furnish high-quality health care services as close to a patient’s home as possible.”
Permitted uses include “training and technical assistance for the development and adoption of technology-enabled solutions that improve care delivery in rural hospitals, including remote monitoring, robotics, artificial intelligence, and other advanced technologies.”
This carve-out for digital health is notable. It affirms digital tools as a core part of the healthcare infrastructure, not just temporary workarounds. It also establishes a clear funding pathway for hospitals and providers to invest in technologies that can extend care to underserved populations without requiring costly brick-and-mortar expansion. By supporting both innovation and implementation, the program helps ensure that rural systems can sustainably integrate these tools into long-term care delivery models.
The effectiveness and efficiency of this legislation will depend on how states apply for and implement these funds, and whether digital health is prioritized consistently across regions and use cases.
Cautious Optimism, Careful Monitoring
The future impact of this legislation will largely depend on how states respond: how they interpret exemptions, manage eligibility transitions, support rural systems, and leverage new federal funding streams. For digital maternal health in particular, the bill offers both risk and promise.
In this moment of transition, continued monitoring, stakeholder engagement, and flexibility will be critical. As implementation unfolds, the health policy community must remain focused on ensuring that reforms improve access and outcomes—especially for mothers and families who need it most.
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