HELENA, Mont. -- Maternity health specialists are getting together to overcome the daunting size of Big Sky Country and its impact on their profession.

The Montana Obstetrics and Maternal Support or MOMS program at the Billings Clinic is connecting providers in urban and rural areas to tackle a troubling trend: the state has the sixth-highest maternal mortality rate in the country.

Tersh McCracken, medical director the MOMS program and a practicing OB-GYN said Montana's remoteness is a hazard for some expecting mothers.

"I have patients who are pregnant who drive from more than two hours away to get their obstetrical care," McCracken explained. "So our biggest challenge is distance."

Fifty-two of Montana's 56 counties have at least one medically-underserved area, and the U.S. is one of the only countries in the world where maternal mortality is rising.

MOMS is funded by the federal Health Resources and Services Administration and is finishing its first year of a five-year program.

MOMS also is facilitating Project ECHO, a bimonthly teleconference session connecting doctors, nurses and health care administrators across the state.

Started in June, the hour-long meetings include lectures and case reviews.

Stephanie Fitch, MOMS grant coordinator at the Billings Clinic, said 25 to 35 specialists regularly attend the meetings.

She added many maternal deaths are preventable and distance is doctors' first concern.

"Lack of access to mental health and substance abuse treatment were the next highest issues that were identified by rural providers," Fitch observed.

MOMS also partners with the Rural Institute, and the Center for Children Families and Workforce Development at the University of Montana.

Annie Glover, research director at the University of Montana, evaluates the MOMS grant and said in urban areas, doctors might have colleagues down the hall they can speak to about a case.

"But in a place like Montana, there might be one or two providers and then not another colleague for 100 or 200 miles," Glover described. "And so through Project ECHO, these providers are getting together and creating that community so they have that support and that co-management of these complex patients."

McCracken added Project ECHO is eliminating the isolation some maternal health professionals feel.

"We're a big state but we're a small community and there's no reason that we shouldn't all work together," McCracken concluded.

Groups fighting for immigrants' rights and health care access asked lawmakers in Sacramento on Tuesday to reject proposed cuts to Medi-Cal for undocumented adults.

In his updated May budget, Gov. Gavin Newsom proposed freezing enrollment, charging people $100 a month for coverage and dropping dental, in-home care and long-term care benefits.

Maribel Cruz, associate director of the Long Beach-based nonprofit Órale, said the consequences could be dire.

"People are going to die because of this because they're not getting primary care," Cruz contended. "So many diseases are preventable if they are detected early enough. And how are you going to detect a disease when you can't even access a doctor? Most folks are going to end up in emergency rooms. This is people's lives, and this is real."

Gov. Newsom said the cuts are needed to balance the state budget, which faces a shortfall that he blames on tariffs and on higher-than-expected enrollment in Medi-Cal. Republicans in Congress are considering major cuts to Medicaid and a huge drop in funding to states offering health care to undocumented immigrants.

Rachel Linn Gish, communications director for the advocacy group Health Access California, thinks the state should not pull back on its goal of universal health coverage or balance the budget on the backs of the most vulnerable families.

"These are people that are scraping down the last penny to afford rent, to afford groceries, to make sure they have gas in their car, to get their kids to school or get themselves to work," Gish emphasized. "Asking them to spend another $100 a month to access the health care that they currently receive is cruel."

Masih Fouladi, executive director of the California Immigrant Policy Center, said it is unjust to deny or charge people more for health care because of their immigration status.

"We don't see that as fair or equitable or aligned with California values," Fouladi stressed. "Especially given the impact that immigrants have, and what they do to make California the fourth-largest economy in the world."

Fouladi added he believes the proposed budget would take California backward and compromise the health of families and communities.

A new report found women of childbearing age in rural areas rely more on Medicaid for health care coverage than their urban counterparts and cuts to Medicaid could threaten services.

The report by the Georgetown University Center for Children and Families found nearly a quarter of Virginia women in small towns and rural areas get health care through Medicaid. Republicans lawmakers are now considering a $625 billion cut to Medicaid, which many believe will eliminate health care for thousands in the Commonwealth. Virginia expanded Medicaid coverage in 2019 but any decrease in Medicaid funds automatically triggers the expansion to end.

Joan Alker, executive director of the center, said cuts would threaten rural communities.

"Rural communities tend to have lower income than metro areas," Alker pointed out. "Medicaid, as important as it is for moms and babies nationwide, is even more important in rural areas and small towns."

Republican lawmakers have proposed the Medicaid cuts to redirect $4.5 trillion to other programs and tax cuts. Rep. Mike Johnson, R-La., the Speaker of the House said Congress is addressing government waste and abuse.

Cuts to Medicaid could affect rural women not on Medicaid, too. One study showed rural hospitals are at least 60% more likely to remain open in states that have expanded Medicaid. In Virginia, only eight rural hospitals have labor and delivery units.

Victoria Richardson, staff attorney for the Virginia Poverty Law Center, said rural hospitals depend on Medicaid coverage to keep their doors open.

"It's important to keep those hospitals open, not just for women covered under Medicaid but also for pregnant women in general," Richardson contended. "If a hospital closes, that affects everybody in the community, no matter what source of coverage you have."

A poll by The Associated Press and NORC Center for Public Affairs Research found 55% of U.S. adults believe the government is spending too little on Medicaid, compared to 15% who believe it is spending too much.

Lipscomb University's College of Pharmacy is poised to launch Tennessee's first Certified Anesthesiologist Assistant master's degree program pending Gov. Bill Lee's signature.

House Bill 979 would address the shortage of anesthesiologists in Tennessee by allowing hospitals in counties with fewer than 105,000 residents to directly employ physician anesthesiologists.

Tom Campbell, dean of the College of Pharmacy at Lipscomb University in Nashville, said Certified Anesthesiologist Assistants play a key role alongside anesthesiologists in patient care during surgery. He stressed the school's 24-month curriculum is designed to prepare students for the high standards of the profession.

"They are fully trained in how to manage the airways, how to manage emergency situations that would require cardiac life support, whether that be in an adult or a pediatric or neonatal patient," Campbell outlined.

With more than 500 health care firms in Nashville, Lipscomb's new degree fills a gap. Campbell added the school's program is one of 14 national institutions overseeing 24 independent campuses. Campbell is optimistic about legislation allowing certified assistants to work in Tennessee. If signed, the law would take effect January 2026 and classes would start in the summer, pending accreditation approval.

Josie Turk, a second-year pharmacy student, grew up in a small town with limited medical resources, which fueled a passion for health care. She is interested in the master's program and said it would coincide with her current field of study in pharmacy.

"Why would you not want to be a part of that team, that anesthesiology team?" Turk asked. "The overall goal is for patients' experience and having the ability to give good health care to patients and make sure their safety is the number one thing that we look at. And I think that's what drew me to it."

She noted the program would replace other requirements and add two years of additional study after she completes the pharmacy program.

Campbell added Lipscomb has connected with several existing programs offering guidance on launching the curriculum.

"We will work alongside anesthesiologists to make sure that this program addresses exactly what they want from the anesthesiologist assistant and the care of the patients," Campbell emphasized. "It's going to be designed in such a way that the anesthesiologist assistant and the anesthesiologist are on the same wavelength."

Campbell added many anesthesiologist assistants employers will help repay debt the students incurred while earning their degree.