Why It Matters
A large national survey released this month reveals persistent gaps in maternity care quality for Medicaid-covered patients across the United States, with Louisiana and other states facing the added pressure of hospital maternity unit closures and ongoing cuts to Medicaid funding at both state and federal levels.
The findings arrive as policymakers debate the future of Medicaid financing, making the data particularly relevant for the roughly one-in-five American births covered by the program.
What Happened
The National Partnership for Women and Families, a nonpartisan nonprofit, published results from its fourth maternity care survey since 2002, drawing on responses from more than 3,800 people who gave birth in U.S. hospitals in 2023 and 2024. Respondents were age 18 or older, delivered a single baby, and lived with the child — a group the survey estimates represents about 90 percent of the broader childbearing population.
Medicaid patients consistently reported worse outcomes compared to those carrying private insurance, including higher rates of high blood pressure, gestational diabetes, depression, and substance use disorders during and after pregnancy.
“While preventing catastrophic outcomes rightly commands attention, surviving childbirth is the floor and not the ceiling,” the survey stated.
By the Numbers
Prenatal access showed clear room for improvement across all coverage types. Sixty-one percent of respondents received their first prenatal visit by eight weeks of gestation, while 19 percent did not see a provider until between nine and eleven weeks. Twenty-one percent waited until after the first trimester had ended, and 1 percent received no prenatal care at all.
One in four respondents — 25 percent — said they were unable to access prenatal care as early as they wanted. Of that group, roughly one-third were enrolled in Medicaid. Barriers included a lack of available early appointments, providers who preferred later-gestation visits, difficulty locating clinics accepting new patients or Medicaid coverage, and delays tied to the Medicaid enrollment process itself.
The quality-of-care numbers were equally striking. Forty-three percent of respondents said they received less than optimal care because their knowledge and lived experiences were not taken seriously by providers. Forty-two percent reported that providers failed to respond in a timely manner to requests for help, and 40 percent said they felt unheard during their care. Six percent cited discrimination as a factor, with race-based bias most frequently mentioned. American Indian and Alaska Native respondents were most likely to report that providers showed a lack of respect for their cultural background.
Zoom Out
The survey results land at a fraught moment for maternity care infrastructure nationwide. Hospital maternity units have been closing across multiple states, reducing geographic access to care particularly in rural communities. Meanwhile, deep cuts to Medicaid are under consideration at both the state and federal levels, which advocates and health systems warn could further shrink provider networks for low-income patients.
On the positive side, postpartum Medicaid coverage has been extended in nearly every state — from the previous 60-day standard to a full 12 months following delivery. All but one state has adopted the longer coverage window, a policy shift aimed at reducing maternal mortality and addressing mental health and chronic disease management in the months after birth. Congressional scrutiny of federal health spending has nonetheless raised questions about the durability of recent Medicaid expansions. Lawmakers have separately been examining large-scale federal fund redirections, as seen in recent congressional pressure on the Interior Department over $90 million in diverted National Park fees.
What’s Next
The National Partnership for Women and Families is expected to use the survey data to inform advocacy efforts around maternity care policy at both the state and federal levels. With Medicaid financing under active debate in Congress, the findings are likely to factor into arguments over what baseline coverage standards should look like for pregnant and postpartum patients.
State legislatures, including those in Louisiana where rural hospital closures have drawn sustained attention, will face continued pressure to address provider shortages and access barriers identified in the data. The survey’s release also comes as the FTC and several states pursue legal action against a transgender healthcare nonprofit over allegations of deception, reflecting broader federal and state scrutiny of healthcare organizations and their accountability to patients.