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Expanding Medicaid Payment for Pasteurized Donor Human Milk in High-Risk Neonates
Shetal Shah1, Emily Miller2, Allison Rose3
1Division of Neonatology, Department of Pediatrics, Maria Fareri Children's Hospital, New York Medical College, Valhalla, New York.
Insights
Advocacy efforts expanded Medicaid coverage for pasteurized donor human milk (PDHM), improving access for very low birth weight (VLBW) infants. This initiative reduced disparities by increasing PDHM availability in neonatal intensive care units.
Area of Science:
- Neonatal Medicine
- Health Policy
- Public Health
Background:
- Pasteurized donor human milk (PDHM) reduces necrotizing enterocolitis in very low birth weight (VLBW) infants.
- Lack of insurance coverage for PDHM creates healthcare disparities based on socioeconomic status and state of residence.
- Limited state policies for PDHM coverage affected less than 30% of VLBW infants before 2017.
Purpose of the Study:
- To outline a successful advocacy strategy for expanding Medicaid coverage of PDHM.
- To demonstrate how partnerships can facilitate policy change for neonatal nutrition.
- To provide a replicable model for pediatric subspecialty advocacy.
Main Methods:
- Collaboration between local American Academy of Pediatrics (AAP) chapters and the national AAP Section on Neonatal-Perinatal Medicine.
- Development and utilization of a PDHM Advocacy Toolkit.
- Neonatologist-led advocacy, supported by AAP funding, over a 5-year period.
Main Results:
- Five additional states implemented Medicaid payment for PDHM, increasing national coverage to over 55% of VLBW infants.
- Key factors for success included state AAP chapter partnerships, pilot funding, advocacy coaching, and toolkit customization.
- The advocacy model demonstrated effective state-level policy advancement.
Conclusions:
- Targeted, collaborative advocacy can successfully expand insurance coverage for essential neonatal nutrition.
- The developed toolkit and partnership model offer a template for other pediatric subspecialties.
- Addressing policy barriers is crucial for equitable access to PDHM for VLBW infants.
Abstract:
Pasteurized donor human milk (PDHM) is associated with a reduced incidence of necrotizing enterocolitis in very low birth weight (VLBW) infants. Absence of Medicaid and private insurance payment for PDHM use in neonatal intensive care units contributes to disparities based on state of birth and socioeconomic level. Before 2017, 5 states had policies for PDHM coverage, incorporating less than 30% of VLBW infants born nationally. In this case study, we outline the partnership of local American Academy of Pediatrics (AAP) chapters with the national AAP Section on Neonatal-Perinatal Medicine to create a PDHM Advocacy Toolkit to facilitate Medicaid PDHM coverage. Over 5 years, neonatologist-led advocacy, incentivized via AAP funds, contributed to 5 additional states providing Medicaid payment for PDHM, resulting in over 55% of VLBW infants born nationally in states with funded coverage. Partnerships with state AAP chapters, pilot grant funding with deliverables, emphasis on advocacy coaching, and modification of the generalized toolkit to suit local needs were essential in engineering Medicaid PDHM payment. Together these actions provide a template for other pediatric subspecialists to help advance niche-focused advocacy issues at the state level.
