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Senate of Pennsylvania
Session of 2023 - 2024 Regular Session


Posted: February 24, 2023 04:56 PM
From: Senator Michele Brooks and Sen. Judith L. Schwank
To: All Senate members
Subject: Medicaid Coverage for Pasteurized Donor Human Milk
In the near future, we plan to reintroduce legislation that would require Medical Assistance coverage for medically prescribed pasteurized donor human milk (PDHM) in inpatient and outpatient settings for medically fragile infants under the age of 12 months. To qualify for coverage, the child's mother must be medically or physically unable to produce maternal breast milk in an amount needed to meet the child's needs. The donor milk must also be obtained from a milk bank licensed in Pennsylvania or through a hospital licensure process in accordance with the Keystone Mother's Milk Bank Act (Act 7) of 2020.

In very low birth-weight babies and other medically compromised infants, donor milk provides powerful, unparalleled protection against serious health complications that can lead to longer hospital stays, multiple medical and surgical procedures, readmissions, life-long disability, or even death, while also increasing rates of exclusive maternal breastfeeding. Donor milk is also medically prescribed for children with heart problems and certain serious health care issues, including neonatal abstinence syndrome (NAS), which occurs when infants are exposed to opioids or other substances of abuse in utero. As a result, the use of PDHM for necessary supplementation is a proven, cost-effective way to improve health outcomes and lower health care costs.

This legislation will ensure that evidence-based coverage for PDHM is provided to that small subset of infants who are unable to thrive on commercially available specialty formulas or who have medical conditions that require donor human milk.

Finally, the statutory coverage of PDHM under Medical Assistance will further address equity issues associated with disparities in access to donor milk, thereby yielding significant health benefits for all of our most medically fragile and vulnerable infants in Pennsylvania.

Similar legislation was introduced last session as Senate Bill 1202. Due to significant feedback on the bill, this legislation will address coverage solely for Pennsylvania’s Medical Assistance program and not for private insurance. Prior sponsors of SB 1202 included Senators Costa, J. Ward, Stefano, Collett, Pittman, and Haywood.

Please join us in co-sponsoring this life-saving legislation.

Introduced as SB500