Medicaid coverage varies from state to state. Here in Massachusetts Medicaid
is very generous. They will cover the SNS, they will cover the pump when a
woman returns to work (as long as she has a dr's prescription and we usually
try to find a medical reason like formula intolerance ;) ), they definitely
cover all NICU babies and breastfeeding problems in the 1st month. I have
never tried to bill for lactation services as I am not IBCLC.
Here you do not need prior approval for a handpump, you can just bill for it
(you have to be registered as a supplier of Durable Medical Equipment with
them first - if you're not planning to do this yourself you need to find a
company like a medical supply company that does Medicaid rentals). You do
need prior approval for electric pumps, SNSs, etc.
To get prior approval you need a prescription from a dr. Then the DME
supplier sends script plus prior approval request to Medicaid. They will
tell you within 2 weeks if the item is approved. Clearly moms cannot usually
hang about for 2 weeks waiting for approval. Since I work with Medicaid a
lot I know when something will be approved (most of the time!) so I can give
out the pump before I recevie the approval. They cover the cost of the kit too.
If you are planning to do this yourself, you need to connect with the
Durable Medical Equipment Dept. If you are working for clinets, call around
the major medical equipment stores and locate a medicaid provider. Don't
take any notice of what the person who answers the phone tells you unless
you know you are in the right department. When I initially asked the woman
fell off her phone laughing. "Breastpumps?" she said. "They're not MEDICALLY
necessary. Ha ha ha."
"Depends if the baby's dying," I said (or something like that). She
connected me to the right department....

On the same subject, a Blue Cross customer service rep recently told me on
the phone "Of course we can't tell you our policies on when we approve
breast pumps. If we did all the physicians would just write those on the
forms every time..."
(she was wrong, incidentally, their policies are public information).

Anne Merewood