Question of the Month: What guidelines and regulations exist regarding human donor milk for infants whose mothers cannot provide breast milk?

Breast milk contains important nutrients, immune-system antibodies and growth factors that all contribute to a baby’s health, particularly babies who are vulnerable because they are premature or underweight. But a number of circumstances — including maternal illness, death, surgery, use of drugs or medications, and certain chronic conditions — can prevent a mother from being able to breastfeed.

One potential alternative for some babies, then, is the use of human donor milk. Indiana, Iowa, Michigan and Ohio are among the states with nonprofit human-milk banks that have been certified by the Human Milk Banking Association of North America. (The association’s certification standards were established with input from the federal government and the blood and tissue industries.)

In four states (California, New York, Maryland and Texas), laws have been passed defining and/or regulating human milk banks. New York, for example, requires that donors be periodically screened and regulates collection and storage at milk banks. In Maryland, milk banks must acquire permits and meet certain inspection and testing standards.

According to the U.S. Center for Medicaid and CHIP Services, some states provide Medicaid coverage for infants to use donor milk. For example, in Texas, Medicaid covers the cost for donor milk for a limited period of time, when its use is deemed medically necessary. And a new policy in the District of Columbia includes coverage for Medicaid-eligible infants through age 11 months, when certain “medically necessary” conditions are met.

Health plan coverage under the Affordable Care Act requires plans to cover certain women’s preventive services including “breastfeeding support, supplies and counseling.” But apart from requiring coverage for the cost of a breast pump, there are few federal guidelines on what qualifies as “support, supplies and counseling” — or who may provide or be paid for lactation care. 

To help fill that gap, the National Breastfeeding Center and the U.S. Breastfeeding Committee have developed a model policy on insurance coverage for breastfeeding. That proposed policy includes as a covered benefit pasteurized milk from a human donor — provided that the donor has been screened and that the milk comes from a certified milk bank. A prescription from a licensed provider would also be required and have to be renewed every three months.

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Article written by Laura Kliewer, CSG Midwest senior policy analyst. Question of the Month highlights an inquiry received by CSG Midwest through its Information Help Line.