State reminds providers that Medicaid covers donated breast milk for premature babies

Premature little baby in an incubator at the neonatal section of the maternity

State officials are reminding health care providers that Florida’s Medicaid program will pick up the costs of human donor milk for some of the state’s sickest hospitalized infants.

Medicaid officials on Monday sent out a bulletin informing providers that the benefit is available to infants who are medically or physically unable to receive maternal breast milk or able to breastfeed. It’s also available to those infants whose mother is medically or physically unable to lactate. The benefit was made available after the Legislature this spring passed SB 1770.

To qualify, the neonates must have weighed 1,800 grams or less at birth, or a little less than 4 pounds. They must also suffer from a congenital or acquired condition that is likely to cause an infection, feeding intolerance, or necrotizing enterocolitis, a condition that affects premature infants and causes their intestinal tissue to die.

The benefit only is provided while the premature newborn is in the hospital. It ends when the infant is discharged.

Laene Keith, communications coordinator for Mothers’ Milk Bank of Florida, said 95% of the human donor milk that is dispersed in Florida today is for premature infants in hospitals. 

The Orlando-based organization has 58 partnerships across the state that assist in getting the milk to the medically fragile newborn as well as providing support services to the mother so she can pursue a successful nursing relationship with her baby.

“That’s where we prioritize our resources,” Keith told Florida Politics, referring to hospital settings and neonatal intensive care units where the babies can often live for weeks. 

Tampa General Hospital is one of the 58 entities that work with the Mothers’ Milk Bank of Florida. A hospital spokesperson said Tuesday the facility spent nearly $63,000 last year purchasing 4,843 bottles of milk for low birth weight babies.

Human Milk Banking Association of North America Executive Director Lindsay Groff said the costs of the milk ranges anywhere from $4 to $5.50 an ounce, depending on the costs of interviewing and vetting the women who donate breast milk, testing the product, processing the milk and delivering the milk to those in need.

“There is a cost, but obviously it’s worth it,” she said, adding that some premature babies can only ingest up to one ounce of breast milk when first born.

But not every hospital has a program. The Human Milk Banking Association of North America is hosting a webinar on Oct. 18 for health care facilities or other organizations that are interested in starting a donor milk program

The Centers for Disease Control and Prevention has called breast milk the best source of nutrition for most infants. But sometimes, mothers of premature infants cannot produce milk because their bodies aren’t ready, they’re affected by stress, they are taking medication or they are too sick to breastfeed.

Florida Medicaid covers prescription commercial formulas when medically necessary. Commercial formulas would be considered medically necessary for infants diagnosed with conditions such as metabolic disorders or for those who are unable to accept nutrition orally. 

In addition, if an infant needs commercial formula during an inpatient hospital stay, it would be covered as part of the all-inclusive payment to the hospital, just as needed food or medicine would be covered for a patient of any age.

According to the Oct. 10 Medicaid advisory, coverage for human donor milk also is part of the all-inclusive payment to the hospital. Given that, the advisory notes that the state won’t have to change any of its reimbursement manuals for the benefit to take effect.

As initially filed, the legislation would have authorized reimbursement for inpatient and home use. While more generous than what ultimately passed, the initial bill would have required the infant to weigh 1,500 grams, or about 3.3 pounds, to qualify.

The initial bill also would have required the donor human milk to be procured from a nonprofit milk bank certified by the Human Milk Banking Association of North America (HMBANA), which is the Mothers’ Milk Bank of Florida. Additionally, the initial bill would have mandated reimbursement to cover the reasonable cost of the milk procured plus reasonable processing and handling fees.

But that language was stripped from the bill by sponsor Sen. Lauren Book as it moved through the process.

According to the Journal of Perinatology, California, Connecticut, Illinois, Kansas, Kentucky, Louisiana, Missouri, New Jersey, New York, Ohio, Oregon, Pennsylvania, Texas and Utah mandate coverage for Medicaid and or commercial health plans. The District of Columbia also provides coverage for human donor breast milk under their state Medicaid programs.

While the Medicaid coverage for the newborns is limited to hospitalized babies, the Legislature also included $75,000 in the Fiscal Year 2022-23 budget for the Mothers’ Milk Bank of Florida.

Keith said that money will be used for its “Babies at Home” program, which can help with an infant’s nutritional needs at home. That program could assist an infant whose mother has had a mastectomy, for instance.

Regardless of whether the baby is at home or in a hospital or whether Medicaid reimburses the expenses, the real success for the program lies in the lactating women who donate their milk and the partners that distribute the milk to the premature and critically ill infants.

Keith said that nationwide one in 500 breastfeeding women donate their milk. There are 24 locations across Florida where women can drop off their donations.

Keith said there is a three- to four-week screening process, and that the women are interviewed, screened and tested. Keith said they are looking for women who after feeding their own children have an excess supply of milk.

Once approved to participate in the program, the Mothers’ Milk Bank of Florida requests that women donate 100 ounces of milk. The donation can be made all at once or over time, she said.