Medicaid IBCLC Service Coverage following the Affordable Care Act and the Center for Medicare and Medicaid Services Update

Rachel A. Herold, Karen A. Bonuck

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: International Board Certified Lactation Consultants (IBCLCs) are associated with increased rates and duration of breastfeeding. Recent US legislation offers opportunities for private and public insurers to include IBCLC services as a covered benefit. Objective: To explore US states' Medicaid coverage of IBCLC services following January 2014 legislative expansions of coverage for preventive health services. Methods: To assess IBCLC reimbursement practices, 20 states, stratified by Medicaid expansion (yes/no) and 3-month exclusive breastfeeding rates, were selected to participate. An electronic survey was sent to Medicaid and Maternal Health Directors, breastfeeding coordinators, and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) coordinators between July and December 2014. Email follow-ups clarified missing or ambiguous responses. Results: Of the 15 states responding, 9 had Medicaid expansion. None of the states permitted IBCLCs to bill for services autonomously. In 9 states, IBCLC services were covered with some type of stipulation, for example, billing under a physician. Of the 9 states with IBCLC coverage, 7 had accepted Medicaid expansion. States with higher rates of exclusive breastfeeding were also more likely to provide IBCLC coverage. Conclusion: Recent legislative changes to public and private insurance that could expand coverage of IBCLCs have not yielded appreciable changes, particularly in states without Medicaid expansion. There is a need for research on the effects of adopting expanded coverage for IBCLCs and advocacy to do so.

Original languageEnglish (US)
Pages (from-to)89-94
Number of pages6
JournalJournal of Human Lactation
Volume32
Issue number1
DOIs
StatePublished - Feb 1 2016

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Patient Protection and Affordable Care Act
Centers for Medicare and Medicaid Services (U.S.)
Medicaid
Consultants
Lactation
Breast Feeding
Food Assistance
Preventive Health Services
Insurance Carriers
Insurance
Legislation

Keywords

  • Affordable Health Care Act
  • breastfeeding
  • lactation consultants

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Medicaid IBCLC Service Coverage following the Affordable Care Act and the Center for Medicare and Medicaid Services Update. / Herold, Rachel A.; Bonuck, Karen A.

In: Journal of Human Lactation, Vol. 32, No. 1, 01.02.2016, p. 89-94.

Research output: Contribution to journalArticle

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