Bridging the gap in lactation support through state Medicaid coverage and policy reform.

BACKGROUND

Access to comprehensive lactation support services is essential for promoting successful breastfeeding practices, which have significant health benefits for both mothers and infants. Despite these benefits, disparities in lactation support persist, particularly among low-income populations reliant on Medicaid. Currently, many state Medicaid programs do not reimburse outpatient visits with International Board-Certified Lactation Consultants (IBCLCs) or other healthcare providers for breastfeeding support. This lack of coverage creates a critical gap in access for marginalized and low-income communities, which often intersect with communities of color.

OBJECTIVE

To understand the current landscape of state-level Medicaid policies on outpatient lactation consultation and other breastfeeding services, and to provide recommendations for expanding coverage in states without such provisions.

METHODS

A comprehensive search of Medicaid state plan amendments (SPAs) was conducted to identify state-level policies on Medicaid coverage for outpatient lactation consultants and other breastfeeding services. This search resulted in a total of nineteen SPAs from January 2012 to December 2024, which were included for further analysis.

RESULTS

Fourteen states have amended their state Medicaid plans to include provisions for lactation coverage and/or reimbursement (CO, CT, DE, GA, IL, NE, NH, NJ, NM, NY, OH, OR, TN, and VT), with 19 approved amendment proposals, some of which apply to the same states (NH, NY, and OH). Eight SPAs explicitly recognize IBCLCs as billable provider types (CO, DE, IL, NH, NJ, OR, TN, and VT), while seven SPAs extend this designation to other lactation support providers (CO, DE, GA, IL, NH, NM, and TN). Five states have session limits for lactation support (DE, GA, NE, NJ, and OR), and two states restrict coverage to sessions conducted during the postpartum period, with exceptions allowed for medical necessity (NE and OR). Additionally, three states (CO, CT, and NH) provide reimbursement for hospital-grade breast pumps or other breastfeeding-related supplies.

CONCLUSION

Policy recommendations include: (i) Implementing separate reimbursement through Medicaid for IBCLC services, (ii) securing state funding to meet federal matching requirements, and (iii) developing and submitting a SPA through state Medicaid programs.