New York State Medicaid Coverage of Breast Pumps

Coverage:

Medicaid requires that breast pumps meet minimum specifications to be reimbursable through the NYS Medicaid program. Health care providers and DME vendors must review the specifications and determine if the pumps they prescribe/issue to postpartum women qualify to be reimbursed. The Minimum Breast Pump Specifications for Medicaid Reimbursement document is available at www.health.ny.gov/community/pregnancy/breastfeeding/medicaid_coverage/minimum_breast_pump_specifications.htm.

Background:

Promoting exclusive and sustained breastfeeding are important public health objectives in New York. The minimum breast pump specifications were established to increase the availability of high quality breast pumps to women who need a pump to continue feeding breast milk to their infants. These standards are expected to result in more women being prescribed, filing and using breast pumps, leading to more women continuing to feed breast milk to their infants. This will result in longer duration of breastfeeding, improved maternal and child health outcomes, and reduced health care costs.

Breastfeeding or feeding expressed human milk provides optimal growth and ensures the best neurodevelopmental and psychosocial outcomes for the infant. The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of life and continued breastfeeding as complementary foods are introduced until at least 12 months of age and beyond for as long as mutually desired by the mother and child.

Exclusively breastfed infants get sick less often due to the immunological properties of breast milk, and require fewer sick visits which decrease parental employee absenteeism. Thus, breastfeeding lowers health care costs - $475 per infant lower during the first year of life - compared to infants not breastfed during the first 6 months of life. In addition, breastfed infants have a reduced risk of obesity and other chronic health conditions, and their mothers, a reduced risk of breast or cervical cancer.

In 2011, there were 215,660 live births in NYS hospitals. Eighty-two percent of mothers breast fed their infant during the birth hospitalization, and almost half (39.7%) of those mothers exclusively breast fed their infants during the birth hospitalization (first 2-5 days of life). However, by 3 and 6 months of life, only 33% and 15%, respectively, of mothers continued to exclusively breastfeed their infants.

More than half of all postpartum women return to work or school within the first year of their infant's life; many at 12 weeks, when the Family Medical Leave benefit ends. One of the most common reasons given by lactating women for discontinuing breastfeeding is that they need to return to work. For working women to exclusively feed their infant breast milk for the first 6 months of life (as recommended by expert groups such as World Health Organization, the Centers for Disease Control and Prevention, American Academy of Pediatrics), they must pump breast milk.

Pumps should be prescribed in coordination with lactation services to determine which type of pump is best for the mother.

  • Manual pumps (single-user) are appropriate for daily milk expression or occasional use, depending on the mother's life schedule such as working part-time.
  • Personal use (single-user) double electric pumps are intended for mothers who are returning to work or school, have an established milk supply, and are anticipating long-term use.
  • Personal use (single-user) single electric pumps are not recommended since they are not effective in maintaining a long-term milk supply or when pumping during short time periods such as work breaks.
  • Hospital grade, multi-user pumps (with a single-user, double pumping kit) are designed for short and long-term use based on the mother's and infant's health situation, and appropriate for women who need to establish their milk supply.

Reimbursement:

NYS Medicaid will provide reimbursement for three types of breast pumps based on whether they meet the minimum breast pump specifications. For details regarding minimum pump specifications and reimbursement for breast pumps, go to: www.emedny.org/ProviderManuals/DME/communications.aspx.