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Reimbursement for Donor Human Milk for Preterm Infants
The Issue
Human breast milk is the ideal source of nutrition for infants. However, mothers of preterm infants face a number of barriers to providing sufficient milk volume to their babies, who are at risk for developing necrotizing enterocolitis (NEC). Donated milk, distributed through milk banks, is becoming a desirable alternative to formula feeding and is increasingly being considered for hospitalized preterm infants. Donor milk in North America is pasteurized (kept at 62.5 °C for 30 minutes) to remove possible infectious contaminants; however, a number of immune and bioactive components are either partially or entirely inactivated by this process.
Feeding donor milk has been shown to prevent NEC, reduce feeding intolerance, and improve long-term outcomes in premature infants. Common concerns, such as slow growth and loss of important biological components of donor milk because of storage and pasteurization, should not be reasons for denial of donor milk. Banked donor milk and human milk-based fortifiers should be promoted as a standard component of health care for premature infants.
Milk from a donor bank is safe. The Human Milk Banking Association of North America ensures quality control of donor human milk banking among member banks through adherence to mandatory guidelines and inspections.
Donor milk costs about $4.50 an ounce. Although more expensive than formula, the cost savings pale when compared with the cost of a prolonged hospital stay for NEC. For every dollar spent on banked donor milk, a state can save up to $11 in medical costs. The issue is Medicaid and insurance coverage for donor breast milk. Some states pay for donor breast milk from a regulated breast milk bank, but many do not. Maryland recently introduced legislation requiring state Medicaid programs to cover the cost of donor breast milk. Maryland's HR 180 Coverage of Donor Breast Milk: Infant Survival Act proposes that Maryland Medicaid cover the cost of banked human milk for critically ill premature infants whose mothers cannot provide their own breast milk.
The Opportunity
Nurses who support payment (by Medicaid and insurance companies) for donor breast milk have an advocacy opportunity. If you live in one of the states that has already introduced legislation, contact your state's elected officials--especially if they are members of the committee (such as the Health Committee) responsible for the bill--and ask them to vote for this legislation. If your state has not yet taken this step, write to your state elected officials and tell them of your concern about lack of access to donated human breast milk as a consequence of cost and inability to pay. Your experience in caring for very-low-birth-weight infants with NEC should be reflected in your message.
Key Resources
