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Affordable Care Act Adds Breastfeeding Benefits

Breastfeeding benefits through the Affordable Care Act became available August 1, 2012. The Act provides comprehensive benefits for pregnant and post-partum women including free or fully reimbursed breastfeeding equipment, as well as counseling from trained lactation consultants. A lactation consultant is a healthcare professional with specialized training and mentoring in lactation and breastfeeding. International Board-Certified Lactation Consultants have the initials IBCLC following their name, similar to MD for a medical doctor.

While federal policy extends these benefits to every county in Washington State, the reality is that insurance networks and medical service providers are still working on the structure to make these benefits available, particularly in rural areas.

“We are still trying to figure it out,” says Tracy Corey, IBCLC, a lactation consultant who runs the Seattle company Nurturing Expressions. “We don’t know how the insurance companies are going to interpret the Act or what they are going to reimburse.” For example, Corey questions whether insurance companies will opt to reimburse for the lower expense of a manual breast pump as opposed to a more costly electric pump. She says, “My company handles a lot of pump reimbursements through insurance, and the right equipment makes a difference.”

Corey also wonders how insurance companies will reimburse clients for lactation consultations. As a registered nurse, Corey can submit medical claims for her clients. One insurance company has invited lactation consultants to join their network, but Corey has observed that they intend to reimburse consultants at a lower than customary rate, placing these services in the category of a class session rather than an individual appointment with a skilled healthcare professional. “You have to be able to assess the situation in a consultation,” says Corey. “There can be problems like failure to thrive, or even a physical limitation like a tongue tie in an infant, which can interfere with nursing.”

Given the additional challenge that few lactation consultants are based in rural areas, Corey anticipates that hospitals and community clinics may need to organize breastfeeding support groups led by a credentialed consultant. Corey says, “A group setting is a good way for moms to get help. In a group, I can at least assess problems and get a mom follow-up help. There will still be the issue of reimbursements because the rural health care institutions can’t absorb the full cost of these services.”

Resources

ACA Breasfeeding Fact Sheet
International Board of Lactation Consultant Examiners

Plan Objectives Addressed

Target Audience

Current or prospective parents

Region

Statewide

For More Information:
  • Tracy Corey, IBCLC, Nurturing Expressions, 206-763-2733