Coverage for donor breast milk increasing nationwide in 2020

March 15, 2020

Nicu baby breast milk

States across the country are pushing for legislation to require either private insurance companies or state Medicaid to cover donor breast milk for at-risk babies.

When a baby is born prematurely, has a formula intolerance, or other life-threatening medical condition, it can be vital to get the nutrients only breast milk can provide.

In these situations, doctors may prescribe donor milk which could cost thousands of dollars a month. Parents would typically have to pay but, in some states, insurance could cover the costs.

Just last month, a new law went into effect in Illinois, mandating private insurance coverage for donor breast milk if prescribed by a patient’s heath care provider.

In 2019, New Jersey passed a similar law and Massachusetts is currently considering the same legislation. The Massachusetts House and Senate bills, H995 and S633, currently sit in the Joint Committee for Financial Services, which held a hearing in October.  

For low-income families, more states are also allowing Medicaid coverage of donor milk.

California became the first state to cover breast milk for low-income babies in 1998, followed by Texas in 2008, Missouri and the District of Columbia in 2014, Kansas and Utah in 2015 and New York in 2017. Connecticut was the last to join the list in 2019.

In the past, states like Montana, Pennsylvania, Nebraska and South Carolina have allowed Medicaid coverage in specific circumstances but only in a few cases.

In 2019, Nevada State Sen. Scott Hammond, introduced a similar bill but no action was taken.

“Really, if you can get mother’s milk into a baby earlier then you’re talking about shortening the time they’re in the hospital and you’re improving the health of the baby over their childhood which then reduces the cost as well,” Hammond said. “So we’re looking to put a little bit of money in the front end and save money on the back end for everybody, the taxpayers included,” Hammond told the Nevada Independent last year.

Currently, Florida state legislatures are considering a bill to allow Medicaid coverage and if passed would go into effect July 1, 2020.

“With those two things in mind, I think that something like this makes smart policy,” the bill’s sponsor, Rep. Nick Duran, told the Orlando Sentinel.  

Though Medicaid coverage isn’t available in all states yet, some, like Ohio, have programs in place that can help low income families obtain coverage for prescribed breast milk. Also, many hospitals have their own similar programs, or their own milk bank, that could assist in providing and paying for breast milk.

Even without state mandates, some insurance companies such as Tricare, the health care program for uniformed service members and retirees, are now offering coverage as well.

For more information, check with your insurance company, hospital and state for coverage options for you and your newborn.

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