What Breast Pumps Are Covered by Medicaid?

Understanding Medicaid Coverage for Breast Pumps

Medicaid, a joint federal and state program, covers breast pumps for new and expecting parents. This coverage stems from federal requirements mandating that health insurance plans, including Medicaid, provide benefits for breastfeeding support, supplies, and counseling. These provisions aim to support maternal and infant health outcomes.

While a federal directive for coverage exists, specific implementation details vary by state. Medicaid programs are administered at the state level, allowing flexibility in service delivery. However, the core requirement to cover breast pumps remains consistent across all state Medicaid programs. Coverage extends to the breast pump itself and includes related supplies.

Types of Breast Pumps and Supplies

Medicaid covers several types of breast pumps, depending on individual needs and medical necessity. Manual breast pumps, which operate without electricity, are covered for their simplicity and portability. Personal electric breast pumps, available in single or double electric models, are also covered, providing efficient milk expression for daily use.

Hospital-grade breast pumps may be covered for medical necessity, such as a premature infant or specific lactation challenges. These pumps are designed for heavy-duty use and are rented rather than purchased. Beyond the pump itself, coverage includes essential accessories and supplies, such as tubing, flanges (breast shields), milk collection bottles, and power adapters, necessary for the pump’s operation and hygiene.

Meeting Coverage Requirements

To ensure Medicaid covers a breast pump, individuals must be active beneficiaries of their state’s Medicaid program. This status confirms eligibility for healthcare services, including durable medical equipment like breast pumps. Obtaining a prescription or referral from a licensed healthcare provider, such as a doctor, nurse practitioner, or certified nurse midwife, is required.

The prescription needs to contain specific information to validate the pump’s medical necessity. This includes a relevant diagnosis code indicating pregnancy, postpartum status, or a medical condition requiring a pump. It should also specify the type of pump recommended, such as a manual, personal electric, or a hospital-grade pump. Confirm state-specific timing for obtaining the pump, such as during pregnancy or shortly after birth.

Steps to Obtain Your Breast Pump

Once eligibility is confirmed and the prescription secured, acquire the breast pump through a Medicaid-approved durable medical equipment (DME) supplier. These suppliers specialize in providing medical devices and are authorized to bill Medicaid for covered items. Find a list of approved DME suppliers through your state’s Medicaid website or by contacting a Medicaid representative.

After identifying a suitable supplier, submit your healthcare provider’s prescription directly to them. The supplier will then verify your Medicaid coverage and prescription details. Following verification, the breast pump can be obtained either through direct shipping to your home or by picking it up at the supplier’s location. The supplier will handle billing directly with Medicaid, ensuring you receive your covered equipment.