Advocacy Day Focuses on Weak Implementation of Affordable Care Act in California

February 13, 2023

When the Affordable Care Act (ACA) passed in 2010, maternal-child health advocates celebrated. The women’s preventive health provision required non-grandfathered health insurance plans and Medi-Cal Managed Care plans to provide breastfeeding and lactation help at no cost to the subscriber.

Help promised in the ACA includes lactation support, counseling and equipment for the duration of breastfeeding (with no cost sharing) before and after birth.

And yet, here it is 2023 and California continues to fail families with substandard implementation of the law. 

“It is really disappointing to see the lack of attention to the lactation benefits families are entitled to by our state agencies,” said California Breastfeeding Coalition (CBC) Founding Executive Director Robbie Gonzalez-Dow. “They’ve had 13 years to figure this out. It’s time for us to get organized and lead the efforts for the changes that need to be made.”

Plans are required to cover the cost of breast pumps, rented or owned, but families aren’t experiencing these benefits in reality. Health plans have been allowed to create guidelines on whether covered pumps can be manual or electric, how long they’ll cover rental costs and whether a birthing parent can get their pump before or after birth.

Lactation advocates throughout the state brought this issue to the attention of legislators on Jan. 26 during the California Breastfeeding Coalition’s virtual Advocacy Day. Hosted as part of the California Breastfeeding Summit, Advocacy Day gave legislators the opportunity to learn the real-life experiences and impact of incomplete and inconsistent implementation of ACA mandates in their districts. 

Advocates asked legislators to do the following related:

  1. Direct the Department of Health Care Services to:
    1. Convene a Lactation Services stakeholder workgroup to define the specifications of “breastfeeding support, counseling, and equipment for the duration of breastfeeding – with no cost-sharing in the State of California;
    2. Create a Provider Manual for Lactation Services; and
    3. Update MMCD Policy Letter 98-10 and distribute an All-Plan Letter regarding lactation services.
  2. Review and increase the reimbursement for breast pumps, and establish specifications for breast pumps provided by Medi-Cal.

Separate from the issues with ACA implementation, CBC representatives requested support of a concurrent resolution to proclaim August each year as Breastfeeding Awareness Month in California. Additionally, advocates asked legislators to consider increasing the reimbursement rate for Pasteurized Donor Human Milk (PDHM) covered by Medi-Cal to the national average.

“Advocacy Day was a great vehicle for lactation advocates throughout the state to share our issues with Legislative offices,” Gonzalez-Dow said. “Legislative aides were very interested in the issues we shared and many of them could relate based on their own experiences when having a baby.” 

To participate in advocacy efforts for these issues, join the Lactation Action Network.