Does your state Medicaid program cover donor milk for preterm babies?

Have you heard that New York may soon join California, Missouri, Kansas, Texas, Utah, and Washington, D.C., in providing insurance coverage for pasteurized donor breastmilk for preterm and other medically needy infants?

A bill currently on Governor Andrew Cuomo's desk would require that the New York Medicaid program pay for donor milk from a certified milk bank for low birthweight infants, for those who have a congenital or acquired intestinal condition (such as necrotizing enterocolitis) or infection, or for those who otherwise require nourishment with breastmilk in the view of their physician.

This policy makes good sense for the health of babies, and for taxpayers as well. Here’s how:

For babies born preterm, the importance of breastfeeding and breastmilk really can’t be overstated. Premature babies who do not receive human milk are at a significantly higher risk of infections, sepsis, meningitis, digestive problems, and necrotizing enterocolitis (NEC) – all of which can be life-threatening to preterm infants. NEC is a particularly dangerous condition in which part of the baby’s intestine dies, and exclusively formula fed babies are 6 to 10 times more likely to contract it than babies who receive breastmilk.

When moms can't produce enough milk for their preterm babies, donor milk is a lifeline. Roughly one in ten preterm babies will contract a life-threatening case of NEC, and UNICEF estimates that “donor milk reduces the risk of NEC (described above) by about 79%. Donor milk also reduces the risk of late onset sepsis, another life-threatening condition. 

More and more hospitals are making the use of donor milk the standard of care for certain babies (often under 30 weeks gestation and weighing under 1500 grams). This means that babies at these hospitals have access to safe, life-saving human milk. 

But insurance coverage has been a significant barrier. At $4-5 an ounce, donor milk is out of the financial reach of just about all families whose insurance won't pay. Neonatologists who understand the value of donor milk may try valiantly to obtain insurance coverage for it, but they are often unsuccessful. This, despite the fact that a typical baby’s use of donor milk totals a few thousand dollars; while according to the American Academy of Pediatrics, NEC treatment costs can range from $275,000 to nearly $400,000.

That's why the recent trend toward insurance coverage of donor milk is so encouraging. It shows that states are recognizing that donor milk saves money and averts the highly expensive costs of treating NEC and other preventable diseases. 

As the justification for the New York legislation notes, “Medicaid coverage of pasteurized human donor breast milk would provide substantial costs savings within the Medicaid program. While the number of infants in New York State who would be eligible for coverage of donor breast milk is only 1.5%, these critically-ill, very low birthweight, premature infants constitute the majority of the total Medicaid budget for neonatal care… It is clear Medicaid coverage of donor breast milk would be COST-SAVING to the Medicaid program, and ultimately the New York State taxpayer.” The AAP estimates that “the roughly 3,500 infants who would be eligible for this treatment under the new legislation would save the state an estimated $10.5 million in direct hospitalization costs.”

And, of course, it would save lives.

We applaud this trend toward coverage for donor milk, and hope that the life-saving power of donor milk will soon be covered in every state!