The maternal mortality crisis in the United States is particularly acute for women of color. Black and indigenous women are two to three times more likely to experience worse maternal health outcomes than white women. Increasingly, structural racism, including in how maternity care is delivered and financed, has been recognized as a key driver of maternal health disparities. For this brief, part of a larger series on the pandemic and maternal health equity, we conducted literature reviews and in-depth interviews to describe the strengths and deficiencies of maternal health care financing in the United States and the ways current policies and practices contribute to inequitable maternal health outcomes. We also consider how the pandemic is exacerbating these long-standing issues while allowing policymakers, practitioners, and advocates to reevaluate how we approach and pay for maternal health care. Several strategies could reduce maternal mortality and eliminate racial disparities in maternal and infant health outcomes, including

• permanently expanding access to Medicaid via extended postpartum coverage,
• adopting the Affordable Care Act Medicaid expansion in remaining states that have not done so,
• increasing funding for home visiting programs to continue providing vital services to families during the crisis, and
• providing additional federal financial assistance to state Medicaid programs.

To address the racial and ethnic inequities in maternal health outcomes predating the pandemic, recovery efforts will require additional changes to maternal care payment and delivery systems and investments in community-based social services.