title: Medicaid IBCLC Service Coverage following the Affordable Care Act and the Center for Medicare and Medicaid Services Update.
abstract: BACKGROUND
  International Board Certified Lactation Consultants (IBCLCs) are associated with increased rates and duration of breastfeeding. Recent US legislation offers opportunities for private and public insurers to include IBCLC services as a covered benefit.
  
  
  OBJECTIVE
  To explore US states' Medicaid coverage of IBCLC services following January 2014 legislative expansions of coverage for preventive health services.
  
  
  METHODS
  To assess IBCLC reimbursement practices, 20 states, stratified by Medicaid expansion (yes/no) and 3-month exclusive breastfeeding rates, were selected to participate. An electronic survey was sent to Medicaid and Maternal Health Directors, breastfeeding coordinators, and Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) coordinators between July and December 2014. Email follow-ups clarified missing or ambiguous responses.
  
  
  RESULTS
  Of the 15 states responding, 9 had Medicaid expansion. None of the states permitted IBCLCs to bill for services autonomously. In 9 states, IBCLC services were covered with some type of stipulation, for example, billing under a physician. Of the 9 states with IBCLC coverage, 7 had accepted Medicaid expansion. States with higher rates of exclusive breastfeeding were also more likely to provide IBCLC coverage.
  
  
  CONCLUSIONS
  Recent legislative changes to public and private insurance that could expand coverage of IBCLCs have not yielded appreciable changes, particularly in states without Medicaid expansion. There is a need for research on the effects of adopting expanded coverage for IBCLCs and advocacy to do so.
authors: Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA.
authors: Rachel A
authors: RA
authors: Herold
authors: Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA karen.bonuck@einstein.yu.edu.
authors: Karen
authors: K
authors: Bonuck
mesh_terms: D001942:Breast Feeding / Q000706:statistics & numerical data; D003253:Consultants; D005260:Female; D019538:Health Care Surveys; D006291:Health Policy; D006801:Humans; D019458:Insurance Coverage / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D007774:Lactation; D008484:Medicaid / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D006278:Medicare / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D058991:Patient Protection and Affordable Care Act; D014481:United States
keywords: Affordable Health Care Act; breastfeeding; lactation consultants