Provides medical assistance coverage for the cost of donor breast milk which is medically necessary for certain prematurely born infants

2 Co-sponsors

• Brad Hoylman-Sigal
• Liz Krueger

Title of bill

An act to amend the social services law, in relation to requiring medical assistance coverage for the cost of donor breast milk in certain circumstances

Purpose or general idea of bill

To provide one of the most effective measures for preventing death of high risk babies that are born prematurely

Summary of specific provisions

Amends Subdivision 2 of section 365-a of the social services law to provide for the coverage of donor breast milk, ordered by a licensed medical practitioner for an infant who is unable to receive breast milk or a mother is unable to provide. Coverage shall be for a reasonable cost of such milk procured from a certified milk bank, plus a reasonable handling fee.

Justification

Premature infants, particularly those less than 1,500 grams or less, are at high risk of developing necrotizing enterocolitis (NEC), a sudden onset intestinal disease which affects approximately 6% of these infants. Mortality from the disease is extremely high, ranging from 10-50%. Even among survivors, the disease causes increased risk of infection, may impart lifelong intestinal problems and has been associated with an increased risk of mental retardation.

It has long been known that the greatest preventive measure for this condition is for the infant to be fed breast milk. The mother's own breast milk is the optimal nutrition for her baby. Donor breast milk which is processed and pasteurized currently has the next best nutritional profile, especially in the digestibility of the proteins. Both are nutritionally superior to current standard preterm formulas. In a 2012 policy statement, the American Academy of Pediatrics recommended feeding preterm infants donated human milk when maternal breast milk is not available. Several other organizations, including the Academy of Breast-feeding Medicine, the European Society for Pediatric Gastroenterology, Hepatology and Nutrition and its North American counterpart, all agree providing this "medicine" for high-risk infants can be lifesaving, including reducing the rate of NEC by a factor of two or more. Unfortunately, not all mothers of premature babies are able or well enough to lactate, and must rely on pasteurized, donated mother's milk to provide this preventative measure for their high-risk newborn. Presently, donated mother's milk is not covered by insurance companies or Medicaid and is expensive, costing approximately five dollars per ounce from a Human-Milk-Bank-Association-of-North-America certified outlet.

Medicaid coverage of pasteurized human donor breast milk would provide substantial costs savings within the Medicaid program. While the number of infants in New York State who would be eligible for coverage of donor breast milk is only 1.5%, these critically-ill, very low birthweight, premature infants constitute the majority of the total Medicaid budget for neonatal care. Given that use of pasteurized donor milk is expected to reduce the risk of NEC by roughly 2.5 times, it is clear Medicaid coverage of donor breast milk would be COST-SAVING to the Medicaid program, and ultimately the New York State taxpayer. Of note, these estimates do not begin to factor in out-patient costs such as increased physician visits, repeat hospitalizations, and the significant physical and occupational therapy costs these patients incur upon hospital discharge. This bill is dedicated to Elizabeth Nostrand, a strong and caring woman who worked diligently to ensure that this become law.

Prior legislative history

New bill.

Fiscal implications

In the aggregate, this measure would provide a cost-savings to New York State.

Effective date

This act shall take effect on the first of January next succeeding the date on which it shall have become law.