Human Milk Banking Policy Proposal

INDUSTRY | POLICY & GOVERNMENT

Develop a policy proposal to recommend mandated insurance coverage of human milk for preterm infants through the Sunrise Review process in Washington state

In Washington, the Department of Health conducts "Sunrise Reviews" in which they provide recommendations to the legislature regarding the addition of new insurance mandates. This process is initiated at the request of the chairs of legislative committees. The requirements for mandated benefit reviews are outlined in chapter 48.47 RCW.

The challenge

Prematurity poses a significant risk to infants in the United States, affecting one in nine births. When mother's milk is not available or supply is inadequate, the use of banked human milk can significantly improve feeding tolerance and reduce serious infections and other life-threatening complications associated with prematurity, including long-term disability.

Despite the clear medical necessity of banked human milk for preterm infants, health insurance in Washington state does not cover its cost, leaving hospitals and families to shoulder the burden of this life-saving treatment. The economic benefits of providing adequate human milk feedings for this population would be substantial, reducing hospital stays and the likelihood of surgical intervention. In fact, it is estimated that for every $1 spent on donor milk, $11 can be saved in healthcare costs.

The solution

As a graduate student at Seattle University, I undertook a capstone project to tackle the critical issue of inadequate insurance coverage for banked human milk for preterm infants. Through extensive research and analysis, I developed a comprehensive policy proposal aimed at mandating insurance coverage for banked human milk in Washington state, specifically targeting preterm infants.

During the project, I had the privilege of meeting with Washington State Representative Eileen Cody, who went on to recommend my proposal for consideration as part of the ‘Sunrise Review’ legislative process.

The policy proposal advocated for the inclusion of pasteurized human milk from a non-profit milk bank, operating in accordance with evidence-based guidelines established by an accrediting organization and approved by the Department of Health, as an essential benefit for Medicaid plans, private insurance providers, and public employee health plans. The proposal emphasized the coverage of banked human milk for infants aged from birth to 11 months, when prescribed by a medical professional with the authority to prescribe medically necessary treatments or therapies.

This proposal was rooted in compelling evidence showcasing the remarkable health benefits of banked human milk for preterm infants, alongside its potential to generate substantial cost savings. By enhancing health outcomes for one of our most vulnerable populations, it has the power to save millions of dollars in healthcare expenditures.

The results

Although the Sunrise Review committee denied the recommendation to mandate insurance coverage of pasteurized human milk for preterm infants, I remain optimistic that the policy window will open and banked human milk will become an insured medical treatment for infants in need.

Here are the positive outcomes and results:

• Created a comprehensive policy proposal and submitted supplemental information to the Sunrise Review committee for review. The proposal and notice of a public hearing were then sent out to all interested parties.

• Received 27 letters of support to the Sunrise Review panel to mandate insurance coverage of banked human milk, including several prominent local hospitals, medical associations, breastfeeding organizations, and medical professionals.

• Worked closely with partners from NW Mothers Milk Bank and neonatologist Isabella Knox to prepare and deliver a persuasive case at the public hearing.

• Raised public awareness of the value of banked human milk in reducing risks of infection and death in preterm infants.

• The proposal remained on the DSHS website for more than years. Supporting documents can still be found online.

• Inspired and motivated other individuals in the healthcare field to pick up the baton and advocate for insurance coverage. I have been contacted by at least three individuals who expressed their plans to advocate for coverage, including a physician assistant student, a nurse practitioner student, and most recently, a neonatologist at Seattle Children's Hospital.