Hi Allyson,

I am chair of the USLCA Licensure and reimbursement Committee. I am responding to your Lactnet post on Medicaid reimbursement for IBCLC services. 

Federal regulations prohibit Medicaid to pay unlicensed providers and some private insurers also have similar rules they must follow. There is no way around that rule which applies to fee-for-service Medicaid plans.

However, Managed Care Organizations that are contracted for Medicaid services do have the option to reimburse unlicensed providers since the regulation does not apply to them. Alternatively, as you mention it is possible for a state Medicaid agency to submit a state plan amendment to allow them to reimburse IBCLCs. However using this rule requires that a physician refer the mother for the service. This particular method is likely to delay care, at the least, since mom has to go to a physician first. Also, many physicians don’t have enough training in lactation to recognize that breastfeeding support is needed. So while it is a possible means to reimbursement, it is not ideal.

USLCA just exhibited at a Medicaid Director’s Conference in Washington DC in November, see the article in the eNews. We continually work to educate the 50+ state agencies on the need for IBCLC services and methods to achieve it. IBCLCs can help by joining USLCA so that we can use our funds to have a presence at these conferences and pay for other ways to gain audience with the stakeholders. We also have a licensure committee in Ohio and a USLCA Chapter that may have this on their agenda. 

It will take efforts of IBCLCs in each state to advocate for system changes to make IBCLC services available to mothers and babies. Relying on grant funding is not a sustainable way to provide essential lactation services, but inclusion of lactation services as the standard of care for families through third party reimbursement is sustainable and right.

Thanks for bringing this up. 

Judith L. Gutowski, BA, IBCLC, RLC


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