Rural hospitals are placing their bids for maternal health grants that some rural obstetric providers have been able to parlay into permanent funding.
Rural hospitals that operate maternity wards rely on a patchwork of federal grants, including the Health Resources and Services Administration's Rural Maternity and Obstetrics Management Strategies Program. The four-year grant offers up to $1 million a year to providers that set up collaborative maternal health networks. HRSA plans to roll out the next round of funding in September, following an April 22 application deadline, despite a crackdown on federal grants by President Donald Trump and his administration.
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The rural maternity program known as RMOMS has laid the foundation for new services and legislation that will bolster rural obstetric care for years, hospital executives said. Hospitals and federally qualified health centers have used RMOMS grants as a bridge to source sustainable funding for services tailored to often-overlooked rural communities, they said.
"We wouldn't have been able to establish the services we did, get funding from nonprofit foundations or get support for billing reforms without RMOMs," said Colleen Durocher, director of rural obstetric access and maternal services executive director at Holy Cross Medical Center in Taos, New Mexico.
Rural maternity wards are difficult to maintain because of high physician recruitment costs, a payer mix that skews heavily toward Medicaid, the threat of legal liability and the declining birth rate.
More than 290 rural hospitals — nearly a quarter of all rural hospital obstetric units — stopped offering obstetric services between 2011 and 2023, according to the latest data from the Chartis Center for Rural Health. As a result, roughly a third of counties throughout the country are in maternity care deserts, threatening healthcare outcomes as women travel farther for prenatal, labor and delivery, and postpartum care.
RMOMS grants have kept more maternity care, and corresponding revenue, in local community hospitals. Providers have used the funding to set up telehealth services, hire community health workers and care coordinators, and launch marketing campaigns that highlight the importance of prenatal care, grant recipients said.
Holy Cross Medical Center, Raton Miners Colfax Medical Center and Union County General Hospital were some of the first awardees in 2019. The grant funding, about $3 million through 2023, helped the northeast New Mexico hospitals hire staff and purchase equipment to coordinate telehealth maternal-fetal medicine services. Even though grant funding ended, those programs are continuing through support from a handful of nonprofits, Durocher said.
Specialists from Pinon Perinatal Maternal Fetal Medicine physician practice in Albuquerque sit in on video calls to help diagnose, monitor and treat high-risk pregnancies at community hospitals. The telehealth service saved patients at Union County General close to 5,000 hours of driving in 2024.
Before introducing the virtual care option, 41% of pregnant women did not get a prenatal exam at Raton Miners in their first trimester. That share has since fallen to 25%, Durocher said.
New Mexico hospitals used RMOMS-linked data to inform a state law enacted last year that boosts Medicaid payments for rural obstetric units, she said.
“That extra bump is a game-changer that is going to help stop rural health hospitals from closing and OB deserts from expanding,” Durocher said.
Missouri Highlands Health Care, an FQHC based in Poplar Bluff, also used the funding to implement tele-obstetric services and show state lawmakers its programs are a worthwhile investment.
The FQHC used its 2021 grant funding to form a partnership with St. Louis-based SSM Health that allows SSM specialists to virtually sit in on ultrasounds and other prenatal appointments for high-risk pregnancies at Missouri Highlands, said Molly Black, project director of the RMOMS program at Missouri Highlands. Missouri Highlands is in talks with SSM to continue that partnership, she said.
The FQHC also used grant funding to hire community health workers to help patients overcome transportation, nutrition and other social barriers. These programs helped establish a closer relationship between Missouri Highlands and state policymakers, who passed a 2023 state law that extended Medicaid postpartum coverage from 60 days to a year, Black said.
“Access would be a big problem without RMOMS funding,” she said. “This grant helped fund locum positions when our OB-GYNs left to form an independent practice, which could’ve forced us to shut down the clinic.”
Other RMOMs grant recipients, Avera Health in Sioux Falls, South Dakota, and Dartmouth Health in Lebanon, New Hampshire, used the funding to hire care coordinators to try to keep more care in community hospitals and clinics.
Care coordinators identify remote monitoring strategies for patients with gestational diabetes, preeclampsia, preterm labor and other high-risk conditions. They also work with community organizations to help patients set up home visits, apply for Medicaid, find substance use disorder treatment and other services close to patients’ homes.
“The RMOMS grant allows us to get more specific in finding out what makes sense in our population,” said Dr. Kimberlee McKay, medical officer and research director at the Avera Research Institute.
Grants like the RMOMS program could play an even bigger role as the Trump administration and Congress look to slash other federal funding sources tied to public health, research and Medicaid.
Congress is considering significant Medicaid cuts as Republicans aim to reduce federal spending, potentially squeezing low-margin rural providers, experts said.
“Medicaid cuts would savage the entire rural health safety net, not just the obstetric providers,” said Michael Topchik, executive director of Chartis.
Rural hospital operators are hoping for a more permanent, nationwide solution to ease financial pressure, such as the Rural Obstetrics Readiness Act. The bipartisan bill, reintroduced in February, would provide federal grants for rural health providers, fund obstetric emergency training and create a pilot program for rural tele-obstetric networks.
Without additional funding, low-volume hospitals are not going to deliver enough babies to keep obstetric units open, said Daisy Goodman, a midwife at Dartmouth who oversees its RMOMS grant.
“We need a multimodal [state and federal] approach to supporting these obstetric practices, she said. “Otherwise, we are just going to lose them.”
