Medicaid would be required to cover pasteurized donor breast milk for some premature babies under proposed legislation that supporters — including an Orlando milk bank — say would help save vulnerable newborns and health-care dollars because mother’s milk helps babies thrive and require fewer hospital visits.
“With those two things in mind, I think that something like this makes smart policy,” said the bill’s sponsor, Rep. Nick Duran, D-Miami, who filed HB 653 with Sen. Lauren Book, D-Plantation. “It’s a pragmatic policy that will reach both goals.”
The bill faces a tough road. It hasn’t be set for a committee hearing yet in either chamber, so it’s a race against time for Duran and his co-sponsors in House, including three from Orlando — Republican Rene Plasencia and Orlando Democrats Anna Eskamani and Amy Mercardo.
It’s the first time such bill has been introduced in the state.
If heard, lawmakers will consider whether Medicaid should cover the cost of donor milk when prescribed by a medical professional for babies born weighing less than 3.8 pounds, have certain intestinal conditions or require breast milk to thrive. Donor milk would have to come from a nonprofit milk bank certified by the Human Milk Banking Association of North America.
Medicaid covers about 60 percent of more than 220,000 births in Florida. Fewer than 1 percent of those babies are born very small and require special care at the neonatal intensive care units for weeks or months.
Seven other states, including New York and Texas, have passed similar laws.
“Arkansas just passed theirs,” said Kandis Natoli, executive director of Mothers’ Milk Bank of Florida, which opened in Orlando four years ago. “And then Connecticut, Florida and Pennsylvania are reviewing bills now.”
‘NOT A GOOD SITUATION’
The legislation could help parents such as Carly Evans, whose son, Palmer, was born last May at 31 weeks, weighing less than 4 pounds. To make matters worse, he was in septic shock. Evans too was septic.
“When he was born, he didn’t cry. Nothing. It was not a good situation,” said Evans, a nurse practitioner in Orlando.
As soon as she could, she started pumping breast milk so doctors could give it to her son via his feeding tube. But after a few weeks, she wasn’t able to produce enough milk.
The situation isn’t unique to Evans. Many times, mothers of preemies can’t produce milk, because their bodies aren’t ready, they too are sick, or they’re affected by the high stress of having a fragile preemie in intensive care.
Evans, a single mom, first tried mixing formula with the supply of her own milk, but Palmer wasn’t having it.
“He was immediately uncomfortable and his body weight wasn’t increasing,” Evans said.
So the doctor wrote a prescription for donor milk, which isn’t covered by Medicaid or most private insurances.
A ‘COST-EFFECTIVE’ SOLUTION
Pasteurized donor milk is recommended for preterm babies by the World Health Organization and the American Academy of Pediatrics.
Years of research has shown that breast milk helps premature babies have better short- and long-term health outcomes, as well as avoiding complications and infections, including necrotizing enterocolitis, or NEC. The intestinal infection affects about 12 percent of very premature babies. About 30 percent of babies with NEC don’t survive.
Babies who develop NEC stay in the newborn intensive care unit 22 days longer, which can add up to more than $70,000, and if the condition requires surgery, the cost can climb to more than $180,000, said Dr. Lakshmi Rajkumar, chair of the department of neonatology at Winnie Palmer Hospital for Women and Babies.
“When you have a good, simple, cost-effective solution like donor human milk, which decreases the incidence of NEC, that’s a right thing to do,” she said. “That’s why I think this legislation is very important because it will make human milk available to more babies.”
HELPING MORE BABIES
Mothers’ Milk Bank of Florida, the state’s main nonprofit milk bank, headquartered in Orlando, opened in 2015 and currently supplies donor milk to more than half of the 68 newborn intensive care units in Florida.
The milk bank sells its processed milk to hospitals to cover basic costs. Through fundraisers and donations, it provides grants to families like Evans to make donor milk more affordable.
Donor milk costs about $4 an ounce, which quickly can add up to more than $1,000 a month for families of premature babies.
But with a grant, Evans is paying $50 a week for the frozen milk that’s shipped to her house, instead of $800 a week.
“I wouldn’t be able to do it without the grant,” she said, comparing what she pays now to buying expensive formula.
“But for a lot of families, it’s expensive, and with Medicaid, they have (the federal nutrition program for Women, Infants and Children), and they have to go with what is provided by WIC. So without (donor milk) being covered by Medicaid, they’re not going to be able to do it,” Evans said.
Hospitals in Florida set certain criteria and absorb the cost of donor milk for very sick preemies, but only up to a certain point, and that’s due to limited supply and cost. After that, families can get a prescription for donor milk and purchase it from a milk bank.
Natoli said passage of the bill could encourage more hospitals, especially smaller hospitals in rural areas, to establish donor milk programs, because they’ll be reimbursed for it.
The reimbursement also would help the milk bank to grow and meet the needs across the state.
“We’re just a small nonprofit here and there’s a whole lot of babies,” Natoli said. “We do well meeting the needs of the babies in the (newborn intensive care units), but we could do better meeting the needs of the babies at home.”
Palmer, meanwhile, has caught up with the growth chart and has been weaned off of all his medications, Evans said.
“I really think if he didn’t have the donor milk, he would have had a lot more problems,” Evans said.
She’s planning to give him donor milk until her one-year grant with the milk bank runs out.