New York State Medicaid Coverage of Lactation Counseling Services
Coverage:
NYS Medicaid provides reimbursement for evidence-based breastfeeding education and lactation counseling consistent with the United States Preventive Services Task Force (USPSTF) recommendation.
Background:
The USPSTF recommends coordinated interventions during pregnancy and after birth to promote and support breastfeeding. Additionally, the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American Congress of Obstetricians and Gynecologists (ACOG) support exclusive breastfeeding for the first six months of life, followed by breastfeeding in combination with the introduction of complementary foods until at least 12 months of age and thereafter for as long as mutually desired by mother and baby. Practitioners are strongly encouraged to prepare women for the hospital experience by providing a good foundation in breastfeeding basics. Then, in the hospital, the focus can be on the operational aspects of breastfeeding such as latch-on techniques and the establishment of the breastfeeding relationship. Women are significantly more likely to achieve their breastfeeding goals if they are supported prenatally, in the maternity care facility, and then after discharge. A small investment in lactation care and services early in a child's life reaps a long-term positive return on investment.
The implementation of Medicaid coverage for lactation counseling services is expected to result in an increase in breastfeeding initiation, exclusivity and duration consistent with the recommendations of expert groups and the USPSTF. Besides the short- and long-term health benefits to mothers and infants from breastfeeding, there will be health care cost savings to New York State as well.
Reimbursement:
Qualified practitioners of Medicaid reimbursable lactation counseling services are the following New York State licensed, registered, or certified health care professionals who are International Board Certified Lactation Consultants (IBCLCs) credentialed by the International Board of Lactation Consultant Examiners (IBLCE):
- physician
- nurse practitioner (NP)
- midwife (MW)
- physician assistant (PA)
- registered nurse (RN)
IBCLCs are specifically educated in human lactation and breastfeeding, have clinical practice in breastfeeding care, and are trained to deliver lactation services. They have been working in the health care field for 25 years in the U.S. and worldwide in 81 countries. An IBCLC is skilled to encourage informed decision-making about infant feeding, develop/implement care plans, minimize the potential for breastfeeding problems or complications, facilitate referrals, and communicate with other health care professionals as appropriate.
IBCLCs are expected to practice within the scope of practice that is appropriate to their respective discipline, i.e. registered nurse, etc. as defined by the Office of the Professions, New York State Education Department.
For details, refer to the March 2013 Medicaid Update article on Fee-For-Service Medicaid: Breastfeeding Support Payment for Specially Trained Lactation Counselors at: www.health.ny.gov/health_care/medicaid/program/update/2013/march13_mu.pdf.
Other Services:
Mothers enrolled in Medicaid can also be enrolled the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) or not. The WIC program provides lactation services and support to women. Each local agency has a breastfeeding coordinator trained in lactation counseling. Many of the breastfeeding coordinators hold the IBCLC credential and some staff may also hold the professional license/registration required to receive reimbursement. While practicing in the WIC clinic, Medicaid cannot be billed for these in-kind services.
If during lactation counseling, a WIC staff, credentialed or not, feels the woman needs further evaluation or services beyond the level provided in WIC, a referral will be made to an IBCLC, who may be able to bill Medicaid for these services.
