There are many decisions to make when you’re expecting. One of those decisions is if you’re going to breastfeed. If you do decide to breastfeed, you may find yourself in need of a breast pump. These pumps and the supplies can be expensive. Thankfully, Medicaid covers many women’s health-related needs, including pregnancy and postpartum care. But is the cost of breast pumps included in coverage? This article explores Medicaid coverage of breast pumps.
Federal regulations do not mandate Medicaid coverage of breast pumps.
Many states provide coverage of breast pumps through their Medicaid programs, but they may require a prescription and preauthorization.
The type of breast pump covered will vary based on state regulations.
If your state’s Medicaid program does not cover breast pumps, you may be able to obtain one through their WIC program.
Does Medicaid cover breast pumps?
Because individual states govern Medicaid, coverage for breast pumps depends on where you live. Most states provide coverage for breast pumps through their Medicaid programs. However, there may be rules and stipulations associated with coverage. Colorado covers lactation services, including supplies and equipment. Double electric breast pumps free of charge are available to all Colorado Medicaid enrollees.
These are available starting at 28 weeks' gestation and during the postpartum period without any prior authorization. Some states that don't cover breast pumps in their Medicaid programs do cover them in their Women, Infants, and Children (WIC) programs. South Carolina is one of those states.
What breast pumps does Medicaid cover?
Medicaid covers both manual and electric breast pumps. Pumps will either be owned by the user or rented and later returned. The pumps covered may or may not be hospital-grade. The specific guidelines of your Medicaid plan will determine if you receive the pump before you give birth or after.
Coverage depends on your medical provider’s recommendation and your Medicaid plan may require preauthorization. States providing breast pump coverage through Medicaid require a prescription. Each state offers different coverage and has a different process for obtaining a breast pump.
Will Medicaid cover free breast pumps?
Yes, most states provide coverage for breast pumps through their Medicaid programs. The type of pump (manual, electric, rented, or owned) will depend on state-specific guidelines. The Affordable Care Act preventive services require coverage of breast pumps and consultation services for states who participate in Medicaid expansion. At the time of this article, this includes 38 states and the District of Columbia.
There is no federal mandate for coverage of breast pumps or lactation services for states that do not participate in the Medicaid expansion program.
How to get a free breast pump from Medicaid
To get a free breast pump from Medicaid, ensure that you are enrolled in Medicaid. Once enrollment is confirmed, contact your medical and Medicaid providers. Ask what documentation your Medicaid provider requires as if it will vary from state to state. Reach out as soon as possible, as your Medicaid provider may require pre-authorization, and this can take some time.
You may also be required to have a face-to-face appointment with your medical provider to be approved for a free breast pump. If you have been assigned a case manager, they will be the best point of contact for you during the process.
What else does Medicaid cover?
Each state manages their rules of qualifying for coverage under Medicaid services as well as what is covered. They do have to abide by federal regulations which require Medicaid programs to provide coverage for family planning services, nurse midwife services, and freestanding birth centers.
Individual states offer additional coverage for other pregnancy-related needs. Pregnancy-related needs potentially covered include:
- Prenatal care
- Childbirth services
- Dental services
- Blood pressure monitors and scales
- Gestational diabetes supplies and nutritional counseling
- Delivery and postpartum care
- Fertility services
- Genetic screening
- Counseling services
Breastmilk is the healthiest form of food for babies. Many moms who decide to give their babies breastmilk will find themselves in need of lactation support, including equipment such as a breast pump. If you find yourself in this situation and have Medicaid, you may be able to get a breast pump for free. Many states provide coverage for breast pumps, and other lactation support services, with their Medicaid programs.
What is the best pump to get from Medicaid?
The best pump from Medicaid will depend on individual needs. Their medical provider will assess their need and prescribe the best pump. The pump may be electric or manual. It may be owned and kept by the user, or it will be rented and need to be returned when it is no longer needed.
Can I get a free breast pump from Medicaid?
It is possible to get a free breast pump from Medicaid. Each state has different rules regarding breast pump coverage. If you need a breast pump, reach out to your medical and Medicaid provider to discuss your options and eligibility.
How to know if Medicaid covers breast pumps in my state?
The best way to know if Medicaid covers breast pumps in your state is to reach out to your Medicaid provider. Every state has different rules, and they may change from year to year. If your state does not cover breast pumps, reach out to your local WIC program to see if they can assist you in obtaining one.
- WIC Breastfeeding Support. Finding a Breast Pump.
- Colorado Children's Campaign. Double electric breast pumps now covered under Colorado Medicaid.
- Kaiser Family Foundation. Medicaid Coverage of Pregnancy-Related Services: Findings from a 2021 State Survey.
- Medicaid.gov. Mandatory & Optional Medicaid Benefits.