Medicaid should cover donor breast milk for vulnerable infants

Each day, more than 1,000 babies are born prematurely in America. Born before 37 weeks and often weighing less than five pounds, these infants are at greater risk for a suite of serious health problems, including life-threatening infections, chronic lung disease, blindness, and death.

One of the leading causes of death is necrotizing enterocolitis. An inflammatory disease of the gut, necrotizing enterocolitis can kill up to 40% of the smallest — and most vulnerable — babies. Those who survive can face lifelong complications.

The best way to prevent this disease in babies born prematurely is giving them human breast milk. Feeding preterm infants exclusively human milk, rather than formula, reduces the odds of developing necrotizing enterocolitis by 77%. But a mother’s own milk supply often isn’t enough. This is when donor human milk becomes essential. Importantly, Medicaid pays for 42% of all births in the U.S. but covers access to donor milk in just 17 states.

As public health researchers at the University of Florida and members of the Florida Medical Schools Quality Network, we have shown that expanding Medicaid coverage of donor milk is one of the most effective ways to provide this treatment to more children. In response to our research, the Florida legislature passed a law in 2022 to mandate Medicaid coverage for donor milk.

It’s time for Congress to follow the example of Florida and 16 other states by expanding Medicaid coverage of donor milk nationally, particularly for preterm babies.

Although lawmakers are taking national access to donor milk more seriously than ever, but Medicaid coverage is not yet on the table. In response to the 2022 infant formula shortage, a bipartisan group of legislators in the House and Senate introduced the Access to Donor Milk Act of 2023 in September 2023. The bill would increase access to donor milk by allowing federal funds to support donations and providing emergency funding to nonprofit milk banks when there is an unexpected shortage. These funds would be used to raise awareness surrounding donor human milk and cover collection and processing fees. The legislation would also require the Food and Drug Administration to develop best practices and potential regulation for milk donation, processing, storage, and distribution, which could supersede today’s patchwork of state programs with unstandardized donation and collection systems.

The Access to Donor Milk Act is an essential step forward to protect vulnerable infants, and Congress should pass the bill quickly. But it doesn’t go far enough. Premature infants lack access to donor milk not because of problems with milk donation or banking, but because of cost. Under federal rules, donor milk is not a reimbursable expense for hospitals. Our research found that many hospitals forgo the cost and complexity of procuring, storing, and disbursing donor milk to infants in intensive care units, leaving large populations without access to this treatment.

If access to donor milk were expanded to all Medicaid recipients, we estimate that a total of 160,000 preterm infants in the United States would have access to this lifesaving treatment annually. And with guaranteed Medicaid reimbursement, more hospitals would likely participate in the complex but vital work of prescribing donor milk, which would increase access to it for those with private insurance as well.

Covering donor milk can also save taxpayers money. Our research network projected that the expansion of Medicaid coverage for donor milk in Florida will save $4 million in public money annually. Expanded nationally, broader access to donor milk could save more than $60 million a year. These savings stem from avoiding the complications of necrotizing enterocolitis, such as surgeries, which cost between $300,000 and $500,000 per affected preterm infant. The true savings are likely higher when considering hospital readmissions, long-term health problems associated with the condition, and other services needed by children with it.

With the Access to Donor Milk Act, Congress is starting to recognize that vulnerable infants deserve access to human milk, including donor milk. It’s time to lean into that commitment, cover donor milk nationally, and provide the chance for premature babies to thrive.

Sionika Thayagabalu is a third-year undergraduate student majoring in biology and women’s studies within the College of Liberal Arts and Sciences at the University of Florida in Gainesville, where Dominick Lemas, Ph.D., is an assistant professor in the Department of Health Outcomes & Biomedical Informatics.