Improving Access to Medical Lactation Support and Counseling: Building the Case for Medicaid Reimbursement.

Objective While the Affordable Care Act improves access to lactation services for many women across the US, low-income mothers in states without Medicaid expansion lack coverage for lactation support. As these states consider individual Medicaid reimbursement policies, the availability, effectiveness, and cost-benefit of lactation services must be evaluated. We conducted such an analysis for low-income mothers in North Carolina (NC), providing a model for other states. Methods First, we analyzed the distribution of NC International Board Certified Lactation Consultants (IBCLCs) and county-level breastfeeding rates among low-income infants. Logistic regression was used to examine the association between IBCLC density and 6-week breastfeeding duration. Finally, state advocates collaborated on a cost-benefit analysis of Medicaid coverage of IBCLCs. Results Maps of the NC breastfeeding support landscape indicate that IBCLCs are available to provide services to low-income women across the state. Compared to counties with no IBCLCs, those with high IBCLC density were found to have a 6-week breastfeeding prevalence ratio of 1.20 (95 % CI 1.12, 1.28). Medicaid reimbursement of IBCLCs showed an estimated annual cost savings of $2.33 million. Conclusions for Practice In one state without Medicaid expansion, we found that breastfeeding support resources are available across the state, high density IBCLC support is associated with increased breastfeeding by low-income mothers, and services are cost-effective. Our model for Medicaid reimbursement in NC provides a framework for states to improve equity in access to optimal lactation support.