Lawmakers hear evidence on maternity care deserts, FQHC roles, telehealth and mobile clinics
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Summary
State health officials, researchers and providers outlined causes of maternity care deserts — declining births, low delivery volume, workforce and financial pressures — and discussed a range of responses including telehealth, mobile units, doula coverage, residency training and targeted Medicaid payments.
The Joint Labor, Health & Social Services Committee heard multiple briefings Oct. 16 on maternity care deserts across Wyoming, including which counties have never had maternity services, which recently lost labor-and-delivery units and which are showing warning signs.
Franz Fuchs, deputy director of the Wyoming Department of Health, presented the department’s mapping of "maternity deserts," categorizing counties as long-standing deserts (for example, Crook, Weston, Niobrara, Bighorn and Sublette) and newer deserts where hospitals have discontinued labor-and-delivery services, including Riverton (stopped in 2018), parts of Carbon County (2020–2022), and Platte County (most recently). Fuchs said declines in birth volume and shifting patient patterns contributed. "Labor and delivery is not a, it's kind of a loss leader," Fuchs told the committee, saying hospitals face fixed costs and low volume that can make maintaining obstetric units financially unsustainable.
A range of state and third-party presenters described potential policy tools.
- Andrew Corbine, a graduate student working with the Wyoming Primary Care Association, summarized research on federally qualified health centers (FQHCs) and rural maternal access. He said 11 of Wyoming's 23 counties had no practicing OB-GYN provider as of 2024 and described strategies other states use — mobile maternal clinics, staffed telehealth-supported mobile units, digital wraparound services, and ECHO-style continuing education for low-volume sites. - Clayton Caldwell (LSO) highlighted three policy levers for states: covering doulas under Medicaid; broadening telehealth reimbursement beyond video; and integrating midwives into state systems. He noted Wyoming limits Medicaid telehealth coverage to video-only at present. - Jesse Springer (Medicaid) provided payment context: Medicaid pays delivery-related professional services today at 100% of Medicare in Wyoming and said the agency carved out a payment group for critical access hospitals that deliver babies. "We're covering 72% of cost at critical access hospitals that deliver babies," Springer told the committee.
Providers and health system representatives described local conditions and possible interventions. The Wyoming Hospital Association said 9 critical access hospitals currently provide deliveries and that sustaining call schedules and staffing is expensive; one hospital contact reported on-call costs for coverage that exceed a quarter-million dollars per physician. OBGYNs and residency leaders said expanding training capacity and supporting family medicine OB tracks could improve local capacity.
Arguments and evidence raised
- Volume and fixed costs: multiple speakers emphasized that labor-and-delivery care requires 24/7 availability and that low birth volumes reduce hospitals' ability to amortize fixed costs and maintain staff proficiency. - Workforce and liability: speakers said malpractice premiums and the difficulty of recruiting providers (and locum tenens reliance) affect local capacity. LSO and providers noted state malpractice rules and minimum insurance thresholds but also that premiums vary widely by state and county. - Alternatives and mitigation: presenters described telehealth and mobile clinic pilots from other states, doula Medicaid coverage (12 states cover doulas under Medicaid), midwife integration and continuing education (ECHO programs) as evidence-based or pilot-tested approaches.
What the committee recorded
Officials said the Department of Health is preparing a CMS rural health transformation application due Nov. 5 and had consolidated public input into a prioritized list of 33 themes and about 1,300 survey responses. Committee members asked for more quantitative cost and utilization breakdowns; LSO and the department agreed to provide additional budget detail and historical spending lines for prenatal, delivery and postpartum services.
Ending
Committee members and witnesses framed the problem as complex and multi-faceted. Several witnesses urged a combination of training/residency expansion, targeted payments, malpractice/ liability solutions, and community-based service models (mobile units, telehealth and doula integration) rather than a single policy change.
