Waco, TX– As rural Texas continues to grapple with a shortage of maternity care services, health providers, advocates, and local leaders are calling for bold reforms to prevent the collapse of the state’s rural maternal health system. The Rural Texas Maternal Health Rescue Plan, a new set of proposals crafted by over 40 groups, seeks to address the growing challenges facing rural mothers and their access to care.
Nearly half of Texas counties lack any maternity care services, and more than a quarter of rural mothers live more than 30 minutes away from the nearest provider. The effects of these shortages are staggering—delayed prenatal care, increased pregnancy complications, higher rates of maternal and infant mortality, and worse delivery outcomes. In many cases, rural hospitals are closing their labor and delivery units, leaving expectant mothers with no choice but to travel long distances or give birth in under-equipped emergency rooms.
“We’re reaching a tipping point where people are frequently more than an hour from routine prenatal care, and more than an hour from a delivering hospital when their water breaks,” said John Henderson, president of the Texas Organization of Rural and Community Hospitals. “There’s no way we’re going to get the kind of quality or outcomes we want as a state when that’s the reality.”
The issue is compounded by the financial strain many rural hospitals face. Most that still offer maternity care lose money due to low Medicaid reimbursement rates and the small volume of births, which makes it difficult to cover the costs of around-the-clock staffing.
The Rural Texas Maternal Health Rescue Plan offers a comprehensive set of solutions, which health care leaders hope will gain traction in the upcoming legislative session. The plan outlines several key reforms aimed at improving access to care and stabilizing the rural maternity care system.
A major focus of the proposal is on Medicaid, the primary payer for maternal health services in Texas. Medicaid currently covers about half of all births statewide, but in rural areas, the proportion is even higher, ranging from 60% to 90%. The plan suggests significant changes to how Medicaid funds are allocated to rural hospitals.
One key recommendation is to reimburse hospitals based on the actual costs they incur to deliver babies, rather than a fixed rate. This would help make it financially viable for rural hospitals to maintain their maternity services. Additionally, the plan calls for fixed monthly per-patient payments to cover the costs of preventive, primary, and maternity care, which would make rural practice more financially appealing to doctors.
“The administrative burden of being in Medicaid is substantial,” said Diana Forester, director of health policy at Texans Care for Children. “I talked to one OB group outside of Sweetwater that said they’re the only birthing unit for hundreds of miles. And they couldn’t get enrolled in Medicaid, so they can’t treat Medicaid patients.”
The proposal also urges lawmakers to streamline the Medicaid enrollment process for both patients and healthcare providers, which could help ease access to essential maternity care services.
To counter the growing shortage of healthcare providers in rural Texas, the rescue plan calls for expanded loan repayment programs for OB-GYNs, family physicians, and other healthcare professionals who agree to practice in rural areas. It also recommends creating more opportunities for medical students and residents to train in rural settings, an initiative that could foster long-term sustainability in rural healthcare.
While these changes would take time, the groups behind the plan are focused on immediate action to stem the tide of rural hospital closures and prevent further deterioration of maternal health care services.
“We don’t expect to restore services at the 20 or 30 rural hospitals that have already closed their OB programs,” Henderson said. “But if we don’t act now, we’ll see more go the same way.”
Beyond maternity care, the plan also advocates for broader improvements in women’s health services. Texas remains one of 10 states that has not expanded Medicaid, leaving many women without affordable health insurance. As a result, the state has the highest uninsured rate in the country, with nearly one in five Texans lacking coverage.
The proposal calls for increasing funding for state-run programs such as Healthy Texas Women, the Family Planning Program, and the Breast and Cervical Cancer Treatment Program. These programs help provide care for uninsured and underinsured women, particularly in rural areas. Additionally, the plan suggests expanding access to mobile clinics and federally qualified health centers, which serve as a safety net for vulnerable populations.
With the state’s legislature preparing for a session dominated by hot-button issues like school choice, immigration, and property taxes, advocates hope that the Rural Texas Maternal Health Rescue Plan can unite lawmakers across party lines. By addressing a critical health issue that affects women and families in rural communities, the plan presents a cost-effective solution that could garner bipartisan support.
“All these other priorities are billion-dollar projects. What we’re talking about is maybe $100 million,” Henderson said. “It’s not a showstopper budgetary impact.”
Tom Banning, CEO of the Texas Academy of Family Physicians, echoed this sentiment, emphasizing that the proposals are not designed to be quick fixes, but rather sustainable, long-term solutions. “There’s not a silver bullet to this. We would have done it if there was. But we just want to bring forward ideas for them to think about as possible legislation or funding strategies,” he said.
As the 2025 legislative session approaches, advocates are hoping the proposals in the Rural Texas Maternal Health Rescue Plan will receive the attention they need. With rural communities at a breaking point, the hope is that lawmakers will take action to strengthen the state’s maternal health system before it’s too late.
“Rural communities have figured out that if they stand together, they can stretch a dollar a long way,” Banning said. “And in this case, it can be a force multiplier for other opportunities in those communities.”
The upcoming legislative session may offer one of the last chances to address the maternal health crisis in rural Texas and ensure that expectant mothers in these areas have access to the care they deserve.
