State Budget Request – Medi-Cal Reimbursement for Breastpumps

Update

Unfortunately, the proposal to increase breast pump rates in Medi-Cal did not make it into the final State Budget deal with the Legislative Leaders and the Governor. However, we will be well positioned for next year to continue this budget request, as it often takes more than one year to achieve victory. Thanks for all of your support. We will continue to push issues that are important to breastfeeding families!

Background

Progress has been made in California over the last two decades with improved maternity care practices, state and federal laws and cultural acceptance of breastfeeding. Breastfeeding rates, including for low income women, while still very low, have increased for initiation and duration.

Despite this, there are still challenges, one being the low reimbursement rates for quality breast pumps and supplies that imposes a barrier to access for low-income women in California.

Why Is More Funding Needed?

A huge barrier to obtaining quality breast pumps and supplies under Medi-Cal for low-income women is the inadequate reimbursement rates for breast pumps and supplies. The current Medi-Cal rates were set 30 years ago! These low rates are untenable for durable medical equipment suppliers and manufacturers to provide breast pumps, that are effective. As a result it has gotten more difficult to acquire an effective breast pump through a Medi-Cal plan.

A recent actuarial analysis, Breastfeeding Support in the Medi-Cal Population: A Large Return on a Small Investment, reported that for total breastfeeding support, counseling and breast pump supplies, the per-member per year costs would be only $1.16! Medi-Cal could realize a savings of $405,000-$940,000 per 100,000 births, by providing breastfeeding support and supplies!

Access to Quality Breast Pumps and Supplies:

To continue to breastfeed, especially with a majority of mothers returning to work and school, most mothers need effective and quality breast pumps. Some mothers need a breast pump to overcome initial challenges. Medi-Cal was always supposed to be the first level of support for breastfeeding needs, including pumps. In reality though, mothers have not gotten the support they need through their health plan and medical provider, especially for a time-sensitive medical need such as breastfeeding, and have turned to WIC or stopped breastfeeding. WIC has for nearly 30 years, provided low-income women with support and counseling for how to breastfeed and address challenges. One component of support has been the provision of high quality breast pumps, when appropriate for initial problems, and when available for return to work or school.

It was assumed the Affordable Care Act would re-balance the support provided through health plans. For most plans, especially the Medi-Cal plans, that has not been the case. Administrative barriers still exist for acquiring breast pumps and denials are not uncommon. Low reimbursement rates are unacceptable.

Print Friendly, PDF & Email