Federal Policy Changes Endanger Medicaid's Critical Role in Perinatal Care and Health Equity

Medicaid is the nation's largest public health insurer and the primary payer of perinatal care; it covers more than 70 million low-income residents and 41% of births. The One Big Beautiful Bill Act (OBBBA), which was signed into law on July 4, 2025, introduced the largest Medicaid funding reductions in the program's history-an estimated $1.1 trillion over 10 years. In this article, we describe the major OBBBA provisions related to eligibility and Medicaid financing and the anticipated effects of these provisions on the delivery of perinatal care services and related outcomes. Although pregnant women are exempt from some of these provisions, systemwide coverage losses and structural changes in Medicaid financing are expected to increase the numbers of uninsured individuals; increase administrative burdens for states, providers, and families; increase financial strain on health care organizations; and reduce access to care. These effects will vary across states and compound longstanding challenges in perinatal health, including persistent racial and geographic inequities, widespread closure of obstetric units, and lagging maternal and infant outcomes. Collectively, these policy shifts threaten to worsen maternal and infant morbidity and mortality, particularly in underserved communities. We conclude with recommendations for practice and policy to safeguard perinatal health amid deep structural reductions in Medicaid support. The purpose of this series is to critically examine emerging federal and state health policy changes and their implications for the health and well-being of women, childbearing families, and young children and to provide evidence-based analyses that inform the nurses who care for these populations. The author solicitation and preparation of each article are overseen by series coordinators Mindy B. Tinkle, PhD, RN, WHNP-BC, CNE, FAAN, associate professor, and Nick Edwardson, PhD, MS, associate professor, College of Nursing, University of New Mexico, Albuquerque, NM.