Keeping Obstetrics Local Act
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
The Keeping Obstetrics Local Act addresses the crisis of rural hospital obstetric unit closures by requiring states to conduct cost studies and mandating minimum Medicaid payment rates for maternity services at rural and low-volume hospitals. Starting in FY2027, eligible hospitals must receive at least 150% of Medicare rates for maternity services. For low-volume obstetric hospitals (<300 births/year), the bill creates 'anchor payments' with a standby capacity amount of $1.2M plus $10,000 per delivery to ensure financial viability.
Who Benefits and How
Rural and low-volume hospitals receive guaranteed minimum payment rates (150% of Medicare) with 100% federal match for the enhanced portion and enhanced FMAP for base payments. Low-volume obstetric hospitals receive annual anchor payments to cover standby capacity costs. States receive enhanced federal matching for all maternity-related payments at eligible hospitals. Critical access hospitals, IHS/Tribal hospitals, and hospitals serving underserved populations are explicitly included.
Who Bears the Burden and How
States must conduct cost studies every 5 years and submit Medicaid plan amendments. HHS must issue rules defining maternity services and establish per-delivery/standby amounts. States must administer anchor payment contracts requiring hospitals to maintain service levels for 3 years or repay funds.
Key Provisions
- Mandates minimum 150% of Medicare payment rates for maternity services at eligible hospitals (FY2027)
- Provides 100% federal match for enhanced maternity payments, enhanced FMAP for base payments
- Creates anchor payments for low-volume obstetric hospitals: $1.2M standby + $10,000/delivery
- Requires states to conduct cost studies every 5 years with federal grants for data collection
- Hospitals must maintain service levels for 3 years after anchor payment or repay funds
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers.
At a Glance
What This Bill Does
Improves access to obstetric and maternity care by increasing Medicaid payment rates for rural and low-volume hospitals, establishing minimum payment floors, creating anchor payments for low-volume obstetric hospitals, and providing enhanced federal matching funds.
Key Policy Areas
Healthcare, Medicaid, CHIP, Maternal Health, Rural Health
Primary Purpose
Improves access to obstetric and maternity care by increasing Medicaid payment rates for rural and low-volume hospitals, establishing minimum payment floors, creating anchor payments for low-volume obstetric hospitals, and providing enhanced federal matching funds.
Policy Domains
Title I - Medicaid Payment Improvements
Identified Gains
Contextual inference, no direct clause citation- Rural and low-volume hospitals providing obstetric care
- Critical access hospitals
- IHS and Tribal hospitals
- Pregnant individuals in rural areas
Contextual inference, no direct clause citation
Identified Costs
Contextual inference, no direct clause citation- States (cost studies, plan amendments, contract administration)
- HHS (rulemaking, oversight)
- CMS (implementation)
Contextual inference, no direct clause citation
Sponsors
Legislative Progress
In CommitteeMr. Wyden (for himself, Ms. Hassan, Ms. Cantwell, Mr. Bennet, …
Read twice and referred to the Committee on Finance.
Introduced in Senate
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Birthing centers and maternity group practices, Care coordination providers (FQHCs, birthing centers, midwives), Certified midwives
Positive-direction: Birthing centers and maternity group practices, Care coordination providers (FQHCs, birthing centers, midwives), Certified midwives, Certified nurse-midwives and certified midwives, Critical access hospitals, Doulas, FQHCs providing maternity care, Healthcare providers serving Medicaid postpartum patients, Healthcare providers serving uninsured pregnant patients, Hospitals providing CHIP-covered maternity services, Hospitals receiving both maternity and DSH payments, IHS and Tribal hospitals, Low-volume obstetric hospitals, Low-volume obstetric hospitals (<300 births/year), Mental health providers serving perinatal patients, Out-of-state maternity care providers, Rural and low-volume hospitals (data collection grants), Rural hospitals providing obstetric care
Negative-direction: Hospitals planning to close obstetric units, Hospitals providing labor and delivery services
State CHIP programs, State Medicaid programs, State health departments
Positive-direction: State health departments, States calculating supplemental payments, States implementing perinatal mental health screening, States opting to establish maternity health homes, States with Medicaid maternity programs
Negative-direction: State CHIP programs, State Medicaid programs, States (Medicaid agencies), States (Medicaid credentialing programs), States (Medicaid programs), States administering anchor payment contracts, States without presumptive eligibility for pregnant individuals
Federal government (increased spending), HHS Secretary, HHS Secretary (data collection)
HHS Secretary faces effects in multiple directions
Positive-direction: Public Health Service Commissioned Corps, U.S. Territories with Medicaid programs
Negative-direction: Federal government (increased spending), HHS Secretary (data collection)
Communities at risk of losing obstetric services, Communities facing obstetric workforce shortages, Rural communities at risk of losing obstetric services
Pregnant and postpartum individuals, Pregnant individuals seeking Medicaid coverage, Pregnant individuals with complex health needs
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_secretary"
- → Secretary of Health and Human Services
Key Definitions
Terms defined in this bill
Inpatient and outpatient hospital services related to maternity care or labor and delivery, identified by ICD and CPT codes specified by the Secretary
Rural hospitals, critical access hospitals, IHS/Tribal hospitals, or hospitals where at least 50% of births are Medicaid/CHIP/Medicare/uninsured
An eligible hospital with fewer than 300 births per year on average over the preceding 3 fiscal years
$10,000 for FY2028, indexed annually to medical care CPI, representing marginal cost of a birth or antenatal transfer
$1,200,000 for FY2028, indexed annually to medical care CPI, representing minimum expenditures for personnel/equipment/facilities
Annual payment to low-volume obstetric hospitals equal to Medicaid labor and delivery revenue floor minus actual Medicaid/CHIP payments received
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology