Bill would require Medicaid breast milk coverage

The Health and Human Services Committee heard testimony Feb. 8 on a bill intended to increase access to donor breast milk for Nebraska families covered by Medicaid.

LB13, sponsored by Bellevue Sen. Carol Blood, would include human breast milk as a required Medicaid-covered service for eligible recipients with a prescription. An infant would be eligible if breast milk is medically necessary and the mother’s milk is medically contraindicated or the mother is physically unable to produce sufficient quantities of breast milk to meet the infant’s need.

Additional requirements would depend on the age of the recipient. An eligible infant younger than six months must have one of the following conditions to apply:
• sepsis;
• birth weight at or below 1,500 grams;
• has or will have an organ transplant;
• infant hypoglycemia; or
• congenital heart disease.

An eligible infant between six and 12 months of age must have one of the following conditions to apply:
• spinal muscular atrophy;
• has or will have an organ transplant; or
• low birth weight coupled with long-term feeding or gastrointestinal complications related to prematurity.

An eligible child 12 months or older must have spinal muscular atrophy to apply.

Under the bill, donor breast milk would be required to come from a donor bank that meets quality guidelines established by the Human Milk Banking Association of North America or is licensed by the state Department of Health and Human Services.

Blood said the bill is in the best long-term interests of infants and families on Medicaid. Many families in need of donated breast milk cannot afford the cost, she said, which can run between $3 and $5 per ounce — and babies consume between 32 and 48 ounces of milk per day.

“[My] intent with LB13 is to address the ongoing issues with prescribed breast milk for at-risk infants covered by Medicaid,” she said. “Barriers to donor milk disproportionately affect mothers insured by Medicaid as well as Black infants and Native American or Alaska Native infants due to their higher pre-term birth rates.”

Because of the expense, Blood said, families without insurance coverage sometimes buy unregulated breast milk online or receive donated milk from friends or family — which runs the risk of contamination.

Julie Wagner, a clinical dietician in an Omaha neonatal intensive care unit, testified in support of LB13, provided that some revisions be made. The bill should be amended to include coverage of FDA-regulated, shelf-stable donor milk, she said, which Nebraska NICUs already use.

In addition, Wagner said, while breast milk is important for infants to thrive, donor milk is inferior to a mother’s own milk — primarily due to the extensive processing necessary to ensure its safety. Long-term use of donor milk without close medical management could put infants at risk for vitamin deficiencies and growth failure, she said.

“I suggest that the language of LB13 be revised to exclude donor milk coverage for infants over six months of age,” Wagner said. “A gestational age or weight-based coverage limit also could be considered to prevent excessive and unnecessary donor milk use.”

Representing the Nebraska Perinatal Quality Improvement Collaborative, medical director Ann Anderson Berry also testified in support of the bill. Donor milk frequently is used as a bridge to mother’s own milk in the hospital, she said, because it is not an ideal source of sole nutrition for a newborn in the NICU.

Anderson Berry also suggested excluding infants over age six months from the bill’s provisions, saying there is no medical evidence they would benefit from donor milk and that donor milk use within that population carries a significant risk of malnutrition.

“Breast milk is the best source of nutrition for newborns, especially for those who are ill or premature,” Anderson Berry said. “It provides all the necessary nutrients for growth and development and contains antibodies and other immune boosting factors that can protect against infection.”

No one testified in opposition to LB13 and the committee took no immediate action on the bill.