Attorney General Ellison announces Strengthening Rural Maternal Healthcare in Minnesota project

More than 700K people in Greater Minnesota live in counties without labor and delivery wards, more than 20 percent of Minnesota hospitals have discontinued obstetric services in the last 15 years low rural hospital birth volumes and long drives to deliver babies correlated with complications during delivery

Problem likely to grow dramatically next year when $1 trillion in federal cuts to Medicaid come into effect thanks to ‘Big Beautiful Bill’

AG Ellison’s office to facilitate new Strengthening Rural Maternal Healthcare project: will survey existing rural maternal healthcare services, map them against standards for safe access, propose collaborative solutions with wide range of partners

Strengthening Rural Maternal Healthcare is first focus area of Rural Healthcare Stability Initiative, announced in August 2026 in conjunction with AG’s oversight agreement with Sanford Health and North Memorial Health and anchored with $15 million commitment from Sanford

October 28, 2026 (SAINT PAUL) — Minnesota Attorney General Keith Ellison today announced a new project called “Strengthening Rural Maternal Healthcare in Minnesota,” which is designed to propose solutions to the increasing problem of lack of nearby access to maternal healthcare, especially labor and delivery services for people in Greater Minnesota. The project is the first focus area of the Rural Healthcare Stability Initiative, which was announced in August 2026 in conjunction with the oversight agreement between the Attorney General’s Office, Sanford Health, and North Memorial Health. The Rural Healthcare Stability Initiative is anchored with a $15 million commitment from Sanford Health.

"We're facing a growing crisis across rural Minnesota as hospital labor and delivery wards close. This is a national problem, but rural Minnesota is feeling it more than most — and it will be compounded when $1 trillion in federal cuts to Medicaid become effective next year, since many rural Minnesotans rely on Medicaid for their healthcare,” Attorney General Ellison said. “The immediate impact of the growing distance between where rural Minnesotans live and where they can deliver their babies is on felt by families across Greater Minnesota, and over time it has impacts across the state. I’m standing up the Strengthening Rural Maternal Healthcare in Minnesota project because we need collaboration between health care systems, stakeholders and communities to implement new ways to support maternal health in rural Minnesota. It’s no exaggeration to say that lives are at stake."

"We are grateful to Attorney General Ellison for his solutions-focused leadership and commitment to strengthening rural health care across Minnesota," said Bill Gassen, President and CEO of Sanford Health. "We're incredibly optimistic about what we can accomplish together through this initiative and proud to make an anchor commitment. What we do will not change: caring for the patients and communities who place their trust in us. But how we do our work must continue to evolve to meet the changing needs of our communities. By bringing organizations across the sector together, building on what's working, learning from one another and embracing innovative approaches, we can advance sustainable solutions that improve access, quality and affordability for patients and families across Minnesota."

“As an independent, community-owned organization based wholly in rural Minnesota we are proud to join this partnership,” said Kent Mattson, President and CEO of Lake Region Healthcare. “We will bring firsthand experience with the challenges facing rural patients, providers, and communities, and in creating long-standing, strong regional partnerships that keep care close to home, while connecting patients to specialized services when needed.  We look forward to partnering to build on what is already working, strengthen what is needed, and create a more durable healthcare system for all Minnesotans.

Scope of the problem

Research shows that maternal healthcare  is a complex challenge. Currently, more than 700,000 Minnesotans live in a county without labor and delivery services. More than 67,000 Minnesota women of childbearing age live more than a 30-minute drive from a labor and delivery ward — and 13,000 live over an hour from a labor and delivery ward. These travel times are easily compounded by bad weather.

Ample research has shown a direct correlation between the distance an expectant parent has to cover to get to a labor and delivery center and the occurrence of complications or morbidities, such as needing a blood transfusion or emergency surgery. At the same time, studies show that rural hospitals with very low birth volumes also present higher risks of severe maternal morbidity.

These findings underscore the complexity of sustaining rural maternity services. Ensuring safe, high-quality care requires balancing proximity to services with adequate clinical capacity and experience, while strengthening regional networks that connect patients to the appropriate level of care.

Rural birth centers are closing across the country for a variety of reasons, but Minnesota is feeling the impact more than most other states: since 2010, Minnesota is one of only seven states to lose more than 20 percent of hospital-based obstetric services. 

It is good news that more than half of Minnesota counties still have at least one hospital with obstetrics services, and that the numbers of maternal health patients are growing at some rural hospitals in Minnesota. However, as the impacts of $1 trillion in federal Medicaid cuts that many rural Minnesotans rely on for their healthcare begin to be felt across Greater Minnesota next year — thanks to the so-called “Big Beautiful Bill” championed by President Trump and the Republican majorities in Congress — financial pressures on many rural hospitals will become more acute than they already are and more labor and delivery wards may come under pressure.

Addressing these challenges requires more than keeping individual labor and delivery units open. It calls for a coordinated approach that strengthens women's health care before, during and after pregnancy; supports rural clinicians; and ensures patients have access to safe, appropriate care when and where they need it.

Framework of the project

Attorney General Ellison has asked his Office’s strategic facilitator, Lois Quam, to facilitate the Strengthening Rural Maternal Health project. Ms. Quam and Attorney General Ellison will invite healthcare organizations and individuals with expertise — especially those living or working in rural areas — to participate. Ms. Quam, who grew up in Marshall,  will convene an initial meeting before the end of 2026 with the purpose of defining the scope, timeline, and goals of the project. One or more public townhall meetings are anticipated as part of the project. The Strengthening Rural Maternal Healthcare project will issue a report with its recommendations in 2027.

The Project will map existing rural maternal health care services in Minnesota, and projected services after the federal cuts take effect, against available standards for safe access to labor and delivery services, pre-natal and post-natal care and propose collaborative solutions.

The Rural Healthcare Stability Initiative charitable fund will be administered by the Minneapolis Foundation, a community foundation with 110 years of experience in getting resources into communities in Minnesota and beyond.