Non-Hispanic, Black women in the United States experience the highest maternal morbidity and pregnancy-associated mortality rates. These rates hold for Chicago as well. On April 12, 2021, Illinois became the first state to expand Medicaid coverage from 60 days postpartum to 12 months postpartum when its Illinois Continuity of Care & Administrative Simplification 1115 Waiver was approved by the Centers for Medicare and Medicaid Services. The waiver should lower the number of Black women dying from pregnancy-associated causes. However, the policy only addresses the issues of access related to the social determinants of health, and not the heavily embedded biases rooted in anti-Black, structural racism. This paper uses the idea of racial capitalism to examine Chicago’s high rates of Black morbidity and mortality rates surrounding pregnancy and the potential limitations of the state’s expansion of Medicaid coverage for postpartum care.