One Big Beautiful Bill complicates maternal care in Kansas City and beyond | Opinion

Now that the One Big Beautiful Bill has been signed into law, one question is of particular importance to Kansas City families: What will it mean for health care access, particularly for new and expecting mothers?

For one, the bill introduces 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 a very large increase in the number of uninsured people.

However, several vulnerable populations are explicitly exempt from these requirements. This includes pregnant women, those entitled to postpartum medical assistance and adults with dependents younger than 13.

On paper, this codifies strong protections for individuals during pregnancy and postpartum. In practice, implementation may prove more complicated. With a short timeline for these changes to take effect (by Dec. 31, 2026), Missouri must quickly develop the systems and infrastructure needed to apply these exemptions consistently. Without robust planning and oversight, even people who are eligible might fall through the cracks and lose coverage.

While coverage during pregnancy and postpartum is essential, data shows that the period before conception and during 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 birth weight and preterm birth.

The One Big Beautiful Bill, 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 areas that are presently underserved.

Research Medical Center closed maternity programs

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. Hospitals in these areas (such as Research Medical Center in Kansas City, which closed its neonatal intensive care unit and obstetrics program this summer) have shut down maternity wards and labor and delivery units because of 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 One Big Beautiful Bill projected to increase the number of uninsured Americans, 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 health care systems.

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 health care infrastructure — and might help mitigate some of the anticipated disruptions caused by other provisions in the bill.

The future impact of this legislation will largely depend on how Missouri responds: how it interprets exemptions, manages eligibility transitions, supports rural systems and leverages new federal funding streams.

For digital maternal health in particular, the bill offers both risk and promise. 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.”

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.

Anish Sebastian is co-founder and CEO of Babyscripts, a virtual maternity care program.