HD28 - The Feasibility of Revising the State Plan for Medical Assistance Services to Include Lactation and Supplies for Medicaid Recipients


Executive Summary:
Recognition of the benefits of breastfeeding and concerns about the low rate of breastfeeding among women in Virginia, especially among women of lower socioeconomic status, prompted the General Assembly to pass House Joint Resolution No. 248 directing the Department of Medical Assistance Services (DMAS) to study the feasibility of revising the Medicaid State Plan to include reimbursement for lactation education and breastfeeding supplies for Medicaid recipients. The Department of Medical Assistance Services, Division of Policy and Research prepared this study with the assistance and expertise of the Virginia Department of Health, Division of Public Health Nutrition. The benefits and costs of covering these supplies and services were calculated using Medicaid claims data and breastfeeding rates for Medicaid recipients. The cost-benefit analysis proved to be essentially cost neutral. Given this and the overwhelming scientific evidence regarding the benefits of breastfeeding, this report concludes that the Medicaid State Plan should cover certain breastfeeding supplies and lactation education services for Medicaid recipients.

The benefits of breastfeeding are well established. Not only does breastfeeding prevent infection and allergies, but it also promotes closeness between a mother and her child. Research shows that the maximum benefits of breastfeeding are seen in infants who breastfeed at least until four to six months of age. (*1) Benefits for a breastfed infant compared to a formula fed infant include lower rates of otitis media (middle ear infections), serious respiratory disease, diarrheal illness, atopic skin disorders (*2), meningitis, diabetes, childhood leukemia and other cancers, allergies, obesity, and developmental delays. Despite these benefits, many women who initially attempt to breastfeed quit soon after delivery for reasons such as lack of knowledge or support. The provision of breastfeeding supplies and lactation education are intended to address the mother's needs, prolong breastfeeding, and thereby preventing illness in the child. For the purposes of this study, the benefits of breastfeeding are measured by the costs of the services and drugs avoided from preventing episodes of illness such as otitis media, intestinal infection/diarrheal illness, and pneumonia by increasing the duration of breastfeeding among Medicaid recipients.

Costs of breastfeeding are measured by the costs of providing breastfeeding supplies and lactation education services to assist mothers in prolonging breastfeeding. This study only considers the costs of supplies and services deemed appropriate for Medicaid coverage. Certain supplies and services were not included because they are either already being paid for or are the responsibility of the Supplemental Feeding Program for Women, Infants, and Children (WIC).

The benefits (cost avoided, $364,000) and the costs of covering breastfeeding supplies and lactation education services ($359,348) for a one-year period were compared to arrive at the recommendation of covering the following services under the Medicaid State Plan:

1. Breast shells during the prenatal period for women with flat or inverted nipples who intend to breastfeed; breast shells during the postpartum period for women with sore nipples.

2. A hand-held manual breast pump for women attempting to breastfeed.

3. Rental of electric breast pumps and purchase of the associated kit in cases where a mother and infant are separated due to hospitalizations, or return to work or school.

4. Postpartum lactation education on an outpatient basis provided by a certified lactation education consultant for problems that are beyond the scope of a peer counselor.
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(*1) Saarinen, UM. "Prolonged Breast Feeding As Prophylaxis for Recurrent Otitis Media." Acta Paediatrica Scandinavia. 1982; Vol. 71, pp. 567-571.
(*2) Walker, M. "A Fresh Look at the Risks of Artificial Infant Feeding." Journal of
Human Lactation. 1993, Vol. (2), pp. 97-106.