Medicaid expands breast pump coverage

Wisconsin Medicaid recently began covering breast pumps before birth.

Effective Oct. 1, the program expanded coverage of breast pumps, allowing providers to prescribe them any time after the start of a pregnant member’s third trimester. Previously, Medicaid covered pumps after delivery, said Elizabeth Goodsitt, Department of Health Services spokeswoman.

Goodsitt said breastfeeding provides health and economic benefits for parents and babies. By providing education and the pump before delivery, members may be able to plan before they face additional stressors and sleep deprivation after birth.

“There are many reasons — including trauma or personal choice — that may inhibit putting baby to breast, so facilitating greater and earlier access to breast pumps is a more health-supporting, member-centered approach,” Goodsitt said in an email.

During state fiscal year 2024, the number of pregnant people covered by BadgerCare Plus ranged from 17,299 to 28,094 monthly, according to state data. As of November, the program covered 15,696 pregnant people.

The Midwest Association for Medical Equipment Services and Supplies pushed for the change for years.

“We need the same access to care that other moms are getting, especially for this group of moms, because breastfeeding is so important in terms of cost savings,” said Angella Mattheis, senior manager at SSM Health at Home, a member of the association.

Mattheis said that most other insurance companies allow pregnant people to have breast pumps before birth, so expectant moms can learn to use them.

Providing a breast pump after birth can be “too much to learn” given everything else happening, she said.

Aeroflow Health, an Asheville, N.C.-based medical equipment supplier, advocated alongside the association. CEO Casey Hite said that expectant mothers often have “insecurity and fear” that they won’t be successful at breastfeeding.

“The more she can prepare, the more education that she has prior to having that baby, the more confident she’s going to be going into it, and the higher their success rate,” Hite said.

Rose Schafhauser, executive director for the Midwest Association for Medical Equipment Services and Supplies, said Wisconsin was an outlier compared to the seven other states in their organization, including Minnesota and Iowa, that covered breast pumps before delivery.

While DHS staff initially told them they couldn’t cover the pumps prior to delivery because their claims processing system wouldn’t allow it, department staff found a fix. In fact, DHS “pleasantly surprised” the association by allowing coverage at the third trimester, as the group had asked for coverage four weeks before birth, Schafhauser said.

“Everybody is just thrilled,” she said. “There shouldn’t be any more road bumps.”

The association previously pushed Medicaid to cover more than one breast pump per lifetime. The program now reimburses one breast pump per year of breastfeeding. After dispensing three pumps, prior authorization is required.

Schafhauser said the baby formula shortage in 2022 was an impetus for the changes too.

This article first appeared in the Wisconsin Health News daily email newsletter. Sign up for your free trial here.