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Medicaid and Breast-feeding

 Medicaid and Breast-feeding


The Affordable Care Act (ACA) provides for breast-feeding by requiring health plans to cover breast-feeding support and supplies, including breast pumps. This aspect of the ACA went into effect as of August 1, 2012. Many enrollees in the ACA insurance plans qualify for Medicaid under expanded qualification criteria specific to their various states. However, each individual state permits its own Medicaid program to determine whether breast pumps will be covered in that state. ACA enrollees who participate in a commercial plan in their state are covered for breast pumps in their state.

It is important to note, patients enter a state’s Medicaid program in one of two ways: either they sign up directly for the Medicaid program themselves or they are designated to their state’s program when they sign up for coverage. Any new mother, who enrolled in a state Medicaid program through the ACA, is eligible to receive coverage for a breast-feeding pump and related equipment. However, if an enrollee joins a state Medicaid program directly, the state is not required to include breast pumps coverage.  In this instance, if the state’s existing program does not cover breast-feeding pumps or supplies, then the enrollee will not have coverage.

Those states that cover breast-feeding under their Medicaid program cover more than just the breast pump and supplies. They also cover lactation consultation, postpartum care and wellness exams of the mother and child.  

The Women, Infants and Children (WIC) Program is a Federal program administered by the USDA’s Food and Nutrition Service. Like Medicaid, WIC targets low-income and nutritionally at risk patients.  90 WIC State agencies administer Federal funds through approximately 47,000 authorized retailers. Nursing mothers participating in the WIC Program are often directed to their local county health agency to inquire as to the availability of loaner breast pumps. The availability of pumps is limited by budgetary issues and the number of nursing mothers already renting the available equipment.