In the already perilous landscape of Black maternal health, there’s an invisible threat lurking beyond labor and delivery: insurance. For thousands of Black women, the care they need is technically available—but financially or bureaucratically out of reach. And when continuity of care is disrupted due to insurance complications, it can be deadly.

The issue isn’t new, but its consequences are becoming increasingly clear. According to the Kaiser Family Foundation, Black women are more likely than white women to be uninsured, underinsured, or reliant on Medicaid. Even when insured, many face barriers like narrow provider networks, high out-of-pocket costs, and last-minute coverage changes that can make it nearly impossible to maintain a consistent relationship with a trusted provider.

That lack of consistency isn’t just inconvenient—it’s dangerous.

A study published in Health Affairs found that a lack of continuous care throughout pregnancy increases the risk of complications like preterm birth and low birth weight. And when you add in the racial disparities in healthcare, it’s no surprise that Black women are more likely to experience gaps in care and worse outcomes as a result.

The Hidden Costs of Network Gaps

One of the most infuriating aspects of this crisis is how preventable it is. Many Black women enter prenatal care with one provider only to discover midway through pregnancy that their doctor is no longer in-network. Some find out after their baby is born, stuck with unexpected bills or denied postpartum services. Others are forced to switch hospitals altogether, losing not just a doctor but a carefully planned birth strategy and a provider who knows their medical history.

The reality is that insurance networks change often, and providers are dropped for reasons patients rarely understand. Some hospitals won’t accept certain Medicaid plans. Some OB-GYNs are part of hospital systems that don’t contract with specific insurers. And in states that have not expanded Medicaid under the Affordable Care Act, the gap is even wider.

Black Women and Medicaid: A Lifeline With Limits

According to the National Partnership for Women & Families, nearly 65% of Black births are covered by Medicaid. This makes Medicaid policy critical in the fight to improve maternal health outcomes. Yet the quality and consistency of care can vary drastically by state.

In states like Mississippi and Texas, where Medicaid expansion has been rejected or delayed, Black mothers often find themselves in a healthcare desert—insured in theory but struggling to find providers who accept their coverage or offer culturally competent care. And even in states with expansion, Medicaid often cuts off 60 days postpartum, long before many complications or mental health issues emerge.

The American Rescue Plan Act allowed states to extend postpartum Medicaid coverage for up to 12 months, and as of 2024, more than 30 states have opted in. But that still leaves millions without protection—and many of those women are Black.

Culturally Competent Care Gets Lost in the Shuffle

Another less discussed impact of insurance gaps is the loss of culturally competent care. Black women are more likely to experience bias in clinical settings, to have their pain dismissed, or to feel unsafe advocating for themselves. When they find a provider they trust, that relationship becomes a vital part of their care.

But when insurance changes force them to start over with a new doctor—or worse, a rotating team of strangers—the impact can be more than clinical. It can be psychological. It can be traumatic.

Policy Solutions and Community Workarounds

Advocates are calling for a number of policy solutions to close the insurance gap. These include:

• Expanding Medicaid in all 50 states
• Mandating 12-month postpartum coverage nationwide
• Increasing reimbursement rates for OB-GYNs and midwives in underserved areas
• Incentivizing insurers to include more diverse providers and community-based care
• Ensuring transparency in provider network changes

Some organizations are stepping in to bridge the gap. The Black Mamas Matter Alliance is not only advocating for policy change but also helping connect women to culturally aligned care. Meanwhile, community clinics and midwifery collectives are providing low-cost or sliding-scale services to those who’ve been dropped or denied by insurance.

Still, these patchwork solutions can only do so much. The truth is, insurance access should not determine whether a woman lives or dies during childbirth.

When we talk about the Black maternal health crisis, we can’t ignore the gatekeeping role that insurance companies play. Behind every denial, dropped provider, or bureaucratic delay is a woman whose life could hang in the balance.

It’s time to dismantle the structures that make it harder for Black women to receive consistent, quality care. Because the cost of doing nothing isn’t measured in dollars, it’s measured in lives.

Khalilah Archie is a D.C.-based journalist and maternal health advocate who juggles three kids, a husband, and Real Housewives of Potamac viewing.