New York State Medicaid Coverage of Lactation Counseling Services
If you are pregnant or breast/chestfeeding and enrolled in New York State (NYS) Medicaid, you can receive lactation counseling services at no cost!
Q1. What is lactation counseling?
A1. Lactation counseling is a service offered by a certified health professional who focuses on supporting breastfeeding/chestfeeding. The goal is to provide guidance, education, and encouragement to parents and caregivers in reaching their breastfeeding/chestfeeding goals.
Q2. Does NYS Medicaid cover the cost of personalized lactation counseling?
A2. Yes, NYS Medicaid provides coverage for individual lactation counseling for up to 12 months following the end of the pregnancy.
Q3. Does NYS Medicaid cover the cost of breast/chestfeeding group classes?
A3. Yes, NYS Medicaid covers the cost of one breast/chestfeeding group patient education session prenatally and one group patient education session postpartum per Medicaid Member, per pregnancy. You can choose to attend a class while you are pregnant and a class after you have your baby.
Q4. Do I have to get permission from my doctor before getting lactation counseling?
A4. Yes, you must have an order (also called a referral) before receiving lactation counseling services, such as individual counseling or group patient education sessions. Without an order/referral, NYS Medicaid might not pay for the services, and you might need to pay for them yourself. Reach out to your Obstetrician, Midwife, Primary Care Provider, Nurse Practitioner, or Physician's Assistant to get an order/referral for lactation counseling services.
Q5. Which professions are covered by NYS Medicaid for lactation counseling?
A5. A lactation counseling provider needs to be a licensed health professional, such as Physicians (doctors), Physician's Assistants, Nurse Practitioners, Midwives, and Registered Nurses. They must also be a Medicaid provider and have one of these certifications:
- International Board-Certified Lactation Consultant (IBCLC)
- Certified Lactation Specialist (CLS)
- Certified Breastfeeding Specialist (CBS)
- Certified Lactation Counselor (CLC)
- Certified Lactation Educator (CLE)
- Certified Clinical Lactationist (CCL)
- Certified Breastfeeding Educator (CBE)
Q6. How do I find a NYS Medicaid lactation counseling provider?
A6. For Fee-for-Service and Medicaid Managed Care members, reach out to your provider (such as a Physician, Midwife, Pediatrician, etc.), local breastfeeding coalitions, local lactation support groups, or other community lactation support organization. Medicaid Managed Care members can also get in contact their health plan.
Q7. Where else can I find lactation support?
A7. 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)
