The Affordable Care Act BREASTFEEDING SUPPORT AND SUPPLIES New Benefits for Breastfeeding Families

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1 The Affordable Care Act BREASTFEEDING SUPPORT AND SUPPLIES New Benefits for Breastfeeding Families New Mexico Breastfeeding Taskforce

2 The Affordable Care Act The Patient Protection and Affordable Care Act was signed into law by President Obama in March Its major provisions went into effect in Jan. 1, The Affordable Care Act (ACA) requires that all new health plans must provide certain preventive services, including coverage for breastfeeding support and supplies.

3 What does this mean? All new health plans must cover breastfeeding equipment and supplies for the duration of breastfeeding without costsharing, which means, plans may not apply any co-payment, co-insurance, or deductible to these benefits. Breastfeeding equipment and supplies most commonly refers to a breast pump, and related accessories.

4 Frequently Asked Questions HOW DO I KNOW IF MY INSURANCE PLAN FOLLOWS THE HEALTH CARE LAW? The health reform law s breastfeeding coverage benefit applies to all health plans except for grandfathered plans. Grandfathered plans are those that were in existence on March 23, 2010 and have stayed basically the same. WILL MY PLAN EVER BECOME UN-GRANDFATHERED AND HAVE TO FOLLOW THE NEW RULE? Eventually all plans will lose their grandfathered status and distinctions between the two types of plans will disappear. At that point, all plans will cover these important preventive health services without cost sharing.

5 DOES IT APPLY TO THE MILITARY? Senator McCaskill and Representative Capps recently introduced the TRICARE Moms Improvement Act of This legislations requires the contracts entered into by the Secretary of Defense (DOD) for medical care for military dependents (e.g., TRICARE) to provide for breastfeeding support, supplies, and counseling as appropriate during pregnancy and the postpartum period. The provision has since been incorporated into both the House and Senate versions of the National Defense Authorization Act for Fiscal-Year 2015, requiring Tricare to cover the cost of lactation support, supplies and counseling.

6 How is the ACA supporting women in marginalized communities? Women of color, lesbian and bisexual women, and transgender people are disproportionately uninsured and subject to higher rates of health disparities. The ACA is making critical strides in providing vulnerable communities with quality health care through increased access to insurance coverage, increased funding for community health centers, promoting health literacy and cultural competency, prohibiting discrimination in the health insurance market, and improving data collection.

7 Who can apply for breastfeeding support and supplies? Each insurance company will decide who to contract with and be part of their network. The guidelines do not specify whether the provider needs to be a certified lactation consultant or can be a peer counselor, and they also don t weigh in on reimbursement. It s up to the insurance company. HOW DOES A HEALTH INSURANCE PLAN TO DELIVER BREASTFEEDING SUPPLIES TO A MEMBER? Each insurance plan independently determines their method of delivery of breastfeeding supplies. Your insurance plan provider is your primary resource for understanding the benefits of your policy and how to obtain your supplies.

8 Are there any time limits on coverage or care? Pregnant and postpartum women have access to comprehensive lactation support and counseling from trained providers, as well as breastfeeding equipment. Coverage extends for the duration of breastfeeding, meaning there is not a set time limit. Coverage is for comprehensive lactation support and counseling and costs of renting or purchasing breastfeeding equipment.

9 Does my Insurance Cover Breastfeeding Support & Supplies?

10 What questions do I ask insurance company? What breastpumps are covered? What type of pump can I get? Do I have brand options? (hospital-grade rental pump, double or single electric personal-use, battery or manual pump) How and when do I acquire my pump? When can I get my breastpump? Before giving birth? After the birth of my child(ren)? What sort of breastfeeding support is covered? Where can I receive lactation counseling services? Are there approved in-network providers? Can you provide me with a list of in-network providers? If there are no in-network providers can I see someone out of network? Can I get reimbursed if I use a lactation counselor out-ofnetwork? How long does it take to get reimbursed?

11 For Medical Professionals Breastfeeding support pays off in a healthier patient population. It is in your insurers best interests that you provide these services, and be reimbursed appropriately. For more detailed information about coding for breastfeeding management, please consult the AAP pamphlet Breastfeeding and Lactation: The Primary Care Pediatrician s Guide to Getting Paid at: coding.pdf.

12 What About Women on Medicaid and WIC? Centennial Care is the new name for New Mexico s Medicaid managed care program. You can apply for Medicaid and the Children s Health Insurance Program at any time, all year long there is no limited enrollment period for either program. If you qualify, you can enroll immediately.

13 Medicaid The new health care law expands the group of people who are eligible for Medicaid and requires that this new group of Medicaid enrollees have access to the preventive health services, including the full range of contraceptive coverage, and pregnancy support without cost sharing. The open enrollment period for 2015 is from November 15, 2014 to February 15, Breastfeeding education and Lactation consultation are covered only as a part of managed care (MCO). NM Medicaid also covers breastfeeding equipment rentals.

14 Women, Infants, and Children (WIC) WIC is the Special Supplemental Food Program for Women, Infants and Children (WIC). WIC mothers are encouraged to breastfeed their infants. Breastfeeding mothers are eligible to participate in WIC longer than non-breastfeeding mothers. Mothers who exclusively breastfeed their infants receive an enhanced food package. Breastfeeding mothers can receive breast pumps, breast shells or nursing supplementers to help support the initiation and continuation of breastfeeding.

15 Breastfeeding Peer Counselor Program Breastfeeding Peer Counselors are past or current WIC mothers who have successfully breastfed their own babies, and want to help other families benefit from breastfeeding. Peer Counselors coach and support WIC moms through their pregnancies and up to 6 months postpartum the time during which research shows a woman has the most questions and concerns about breastfeeding. They contact mothers monthly, and more often when problems arise, through telephone calls, home visits, hospital visits, and at the WIC clinic. A Peer Counselors goal is to support WIC moms to continue breastfeeding for at least their baby s first full year of life, and longer if they wish.

16 Indian Health Service Breastfeeding Promotion and Support For American Indians the ACA will help address health dispari5es by inves5ng in preven5on and wellness and increasing access to affordable health coverage. The ACA provides more choices; depending on eligibility and the coverage available, you can: Continue to use IHS, tribal, and/or urban Indian health programs, Enroll in a qualified health plan (QHP) through the Marketplace, and/or Access coverage through Medicare, Medicaid, and the Children's Health Insurance Program. If you choose to enroll in a QHP through the Health Insurance Marketplace plan, you may qualify for special benefits and protec5ons offered to American Indians and Alaska Na5ves. If I purchase a through the NM Health Exchange will my plan cover breastfeeding support and supplies? YES. All new plans purchased through the marketplace are required to cover breastfeeding support and supplies. h"p://

17 What if I don t have insurance? The New Mexico Health Insurance Exchange (NMHIX) was created to cover the uninsured, people who can t afford their employer plans and those who are buying their own insurance but want better options. The (NMHIX) offers a variety of health insurance plans from commercial providers as Blue Cross Blue Shield, Molina, New Mexico Health Connections and Presbyterian. ARE YOU A NATIVE AMERICAN? Native Americans can enroll anytime throughout the year. Even though the federal government provides care through Indian Health Services (IHS), plans through the Exchange expand on the scope and availability of what IHS can provide. Visit the New Mexico Health Exchange website : for more information.

18 A newborn baby has only three demands. They are warmth in the arms of its mother, food from her breasts, and security in the knowledge of her presence. Breastfeeding satisfies all three. -Grantly Dick-Read

19 The following resources were u7lized in this document and provide more informa7on on the Affordable Care Act, + BreasBeeding Support, and BreasBeeding supplies. Resources American Academy of Pediatrics. Federal Support for BreasBeeding 2013 available at: hnp://www2.aap.org/breaspeeding/files/pdf/federalsupporporbreaspeedingresource.pdf American Academy of Pediatrics. Suppor7ng BreasBeeding and Lacta7on:The Primary Care Pediatrician s Guide to GeLng Paid 2014 available at: hnp://www2.aap.org/breaspeeding/files/pdf/coding.pdf Centers for Medicare and Medicaid Services, Affordable Care Act Implementa7on FAQs Set 12, available at hnp:// Sheets and FAQs/aca_implementa5on_faqs12.html. Centers for Medicare and Medicare Services, Medicaid Coverage of Lacta7on Services, (January 10, 2012) available at hnp:// CHIP Program Informa5on/By Topics/Quality of Care/Downloads/ Lacta5on_Services_IssueBrief_ pdf. Inter Tribal Council of Michigan, Health Educa5on and Chronic Disease Department; BreasBeeding: Following Tradi7on Works for Working Women Sault Ste.Marie,MI. Indian Health Service. ACA and You. Available at: hnp:// Medela, The Affordable Care Act: Breastpumps, Lacta7on Services and Coverage Available at: hnp:// %20General%20QA%20rev012113v3.pdf Kime, Patricia. Tricare not yet covering breast feeding Available at: hnp:// breaspeeding defense law/ / Na5onal BreasPeeding Center, Lacta7on Support Services Coverage Under the Affordable Care Act. (Or Why is Everything so Complicated Now?) 2013 available at: hnp://californiabreaspeeding.org/wp content/uploads/2014/02/susanne Madden.pdf Na5onal Women s Law Center. New Benefits for BreasBeeding Moms: Facts and Tools to Understand Your Coverage under the Health Care Law 2014 available at: hnp:// benefits breaspeeding moms facts and tools understand your coverage under health care Naylor AJ. Baby Friendly Hospital Ini7a7ve. Protec7ng, promo7ng and suppor7ng breasbeeding in the twenty first century. Pediatr Clin North Am. 2001;48(2): Slavit W, ed. Inves&ng in Workplace Breas3eeding Programs and Policies: An Employers Toolkit. Washington, DC: Center for Preven5on and Health Services, Na5onal Business Group on Health; United States BreasPeeding CommiNee. Core Competencies in Breas3eeding Care and Services for All Health Professionals. Rev ed. Washington, DC: United States BreasPeeding CommiNee; United States BreasPeeding CommiNee, Na5onal BreasPeeding Center. Model Policy: Payer Coverage of Breas3eeding Support and Counseling Services, Pumps and Supplies. 2nd rev ed. Washington, DC: United States BreasPeeding CommiNee and Na5onal BreasPeeding Center; 2014.