New York State Medicaid Coverage of Breast Pumps
Are you currently pregnant, breastfeeding/chestfeeding, or both, and are you enrolled in New York State (NYS) Medicaid? If so, you qualify for a breast/chest pump at no cost!
Your pharmacy benefit is a part of your Medicaid health coverage that helps pay for your prescription drugs and supplies, including breast/chest pumps and other breastfeeding/chestfeeding supplies.
Q1. What is a breast/chest pump?
A1. Breast/chest pumps are devices that help parents with milk supply. They can provide milk when parents are away from their baby, relieve pain from full breasts or blocked milk ducts, help with flat or inverted nipples, and support families who choose to pump milk instead of direct breastfeeding/chestfeeding.
Q2. What are the benefits of using a breast/chest pump?
A2. Breast/chest pumps have many benefits, including:
- They let parents give milk when they are away from their baby.
- They help parents keep breastfeeding/chestfeeding after going back to work.
- They allow parents to control when their baby eats.
- They ensure the baby gets needed nutrients if breastfeeding/chestfeeding is difficult.
- They support families who choose to pump milk exclusively.
Q3. As of April 1, 2023, Medicaid members get their breast/chestfeeding pumps, other than hospital grade pumps, and supplies through NYRx, the Medicaid Pharmacy Program. What does this mean for me?
A3. Once you have a prescription for a breast/chest pump, you can contact any pharmacy or Durable Medical Equipment (DME) vendor that accepts Medicaid to get your pump and supplies. Check the next question to see the types of pumps covered by NYS Medicaid.
Q4. What types of breast/chest pumps does NYS Medicaid cover?
A4. NYS Medicaid includes manual and electric pumps. NYS Medicaid Members may qualify for a new pump for each pregnancy.
Manual pumps can be used daily or occasionally, depending on the parent's breastfeeding/chestfeeding schedule.
Double-electric pumps for personal use are made for parents returning to work or school, with a good milk supply, planning to pump throughout breastfeeding/chestfeeding. They are for individual use only and should not be shared. If another pregnancy happens, a new pump is advised.
Hospital grade electric pumps are meant for those who need to pump milk when they can't be with their baby or when their baby can't breastfeed. They are safe for multiple users and come with a kit for pumping from both breasts/chest at the same time. They can be used for a short or long time depending on the health of the parent and baby. Hospital grade pumps are rented, not owned.
Q5. How do I know if I qualify to receive a breast/chest pump covered by NYS Medicaid?
A5. If you have NYS Medicaid insurance and a prescription/order from your provider, you could qualify for a breast/chest pump. You may also be eligible for a new pump with each pregnancy.
Q6. Do I have to get permission from my doctor before getting a breast/chest pump?
A6. Yes, you must have a prescription from your healthcare provider to get a breast/chest pump. This is to ensure you get the right type of pump for your needs. Without a prescription, NYS Medicaid may not cover the cost and you may need to pay for it yourself.
Q7. How do I get a manual or double electric breast/chest pump covered by NYS Medicaid?
A7. Medicaid Members can get a manual or personal use double-electric breast/chest pump through Fee-for-Service (Straight Medicaid). This is part of the NYRx pharmacy benefits transition for Medicaid Members. For more information on NYRx, visit Scope of Benefits (ny.gov).
Contact a Medicaid-participating pharmacy or medical equipment supplier in your area to learn about getting a pump and what items your insurance will cover. Find pharmacies and vendors in your area by searching here: Search for a Pharmacy or Medical Equipment Supplier (emedny.org). Remember to have your client identification number (CIN) and order/prescription ready.
Q8. How do I get a hospital-grade electric pump covered by NYS Medicaid?
A8. If you meet the criteria, Medicaid will cover the cost of renting a hospital-grade electric pump. Your healthcare provider may assist you in finding a rental if you are enrolled in Medicaid fee-for-service or Medicaid Managed Care. For rental assistance, fee-for-service enrollees can call the Medicaid Helpline at (800) 541-2831. Medicaid Managed Care plan enrollees can reach out to their plan for rental assistance.
Q9. Can I get a breast/chest pump while I'm pregnant?
A9. NYS Medicaid provides coverage for breast/chest pumps throughout pregnancy and for up to 12 months postpartum.
Q10. What should I do if my provider doesn't know about this benefit?
A10. If your health care provider is not familiar with the breast/chest pump benefit, they can refer to the Minimum Breast Pump Specifications Established for Medicaid Reimbursement Effective April 1, 2013
Q11. Can I get a breast/chest pump if I'm working or going back to work?
A11. Yes, NYS Medicaid covers breast/chest pumps up to 12 months postpartum. There are laws that protect your right to pump at work. To learn more about your rights to express milk in the workplace visit the NYS Department of Labor's website.
Q12. Are there NYS Medicaid-covered services that can help me if I have problems with my breast/chest pump?
A12. Yes. If you have NYS Medicaid, you are also eligible for lactation counseling services that can help with breast/chest pump problems. Find out more about lactation counseling services here.
Q13. Where else can I find lactation support?
A13. The WIC Program provides support for breastfeeding through trained staff, peer counselors, assessments, education, and a breast pump program that helps with equipment problems.
Lactation support groups, such as Baby Café USA, are available in many communities to assist parents with any lactation needs/challenges.
There are also several home visiting programs in New York State that provide lactation support. You can learn more about and locate home visiting programs here: https://www.health.ny.gov/community/pregnancy/home_visiting_programs/pregnant_parenting_fam.htm
The NYSDOH home visiting programs can also be contacted through these shared mailboxes:
pichc@health.ny.gov and miechv@health.ny.gov.
For Providers
For details on coverage and reimbursement, refer to the June 2022 Medicaid Update:
New York State Medicaid Update - June 2022 Volume 38 - Number 7 (ny.gov)
For details on the Durable Medical Equipment/pharmacy benefit transition, refer to the March 2023 Medicaid Update:
For details on breast pump specifications, refer to March 2013 guidance:
Minimum Breast Pump Specifications Established for Medicaid Reimbursement Effective April 1, 2013
For Fee-for-Service, the provider must follow DME policy, found in DME Provider Procedure Code Manual ((obtain a Dispensing Validation System (DVS) authorization (this can be used for up to 2 months). Prior approval is required for cases requiring more than 2 months rental (e.g. extreme prematurity, less than 28 weeks gestation). See PA Guidelines (emedny.org) for prior approval requirements).
For more information about the types of pumps, review pages 9-12 of the DME manualor email ohipmedpa@health.ny.gov.
