For new parents in Ohio, especially those navigating challenges with breastfeeding, in-home lactation consultant services can be a lifeline. These services offer personalized care in the comfort of one’s home, addressing complex breastfeeding issues and promoting successful outcomes backed by evidence. However, accessing these services through Medicaid presents unique challenges due to state-specific regulations and provider requirements that ultimately exist to protect the public.
Understanding Ohio Medicaid’s Coverage for Lactation Services
The Ohio Department of Medicaid (ODM) provides coverage for lactation consultation services under Rule 5160-8-42 of the Ohio Administrative Code. This rule specifies that Medicaid will reimburse for lactation consultations rendered by:
- International Board-Certified Lactation Consultants (IBCLCs)
- Advanced Practice Registered Nurses (APRNs)
- Physicians
- Physician Assistants
While IBCLCs are recognized as rendering providers, they must be licensed to obtain an Ohio Medicaid Number. In an effort to expand care access while still complying with this licensure requirement, ODM allows for IBCLCs who have either a Dentist, Dietician, Doula, Licensed Practical Nurse, Occupational Therapist, Physical Therapist, Registered Nurse or Speech Therapist license with the State of Ohio to register for a Medicaid number and indicate IBCLC specialty for lactation care reimbursement from Ohio Medicaid Managed Care Plans. IBCLCs operating as sole practitioners without a license, while equally as skilled, are not eligible for direct Medicaid reimbursement unless they are employed by or contracted with an eligible billing entity such as a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), or an ambulatory health care clinic.
Implications for IBCLCs
For unlicensed IBCLCs, this regulatory framework can create significant barriers to providing Medicaid-covered services. Without the ability to bill Medicaid directly, these professionals may face financial challenges and limited capacity to serve low-income families who rely on Medicaid for healthcare services. Additionally, this limitation can restrict access to lactation care in rural and underserved areas where healthcare resources are already scarce.
Strategies to Enhance Access to Lactation Care
To bridge the gap in lactation care access, several strategies can be considered:
- Collaboration with Medicaid-Enrolled Entities: Unlicensed IBCLCs can partner with FQHCs, RHCs, or ambulatory clinics to offer lactation services under the umbrella of these organizations, ensuring Medicaid reimbursement. This may not allow for in-home, evidence supported IBCLC care.
- Advocacy for Licensure: Advocating for licensing IBCLCs in Ohio could pave the way for direct Medicaid reimbursement, aligning with models in other states where licensure has expanded access to lactation care that improves health outcomes while protecting the public from unlicensed care (National Lactation Consultant Alliance). This requires agreement among Ohio legislators that the highest standards for this care be met, and a license is necessary as in all other healthcare entities to provide public protection and recourse for any unqualified or unethical healthcare.
- Telelactation Services: Offering virtual lactation consultations can overcome geographical barriers, especially in rural areas, and provide flexible options for families seeking care. However, many rural areas lack access to reliable broad band services while unlicensed IBCLCs are present throughout rural areas and could help in person if licensure was established.
- Community-Based Programs: Engaging in community outreach and education can raise awareness about available lactation services and encourage Medicaid recipients to seek the care they need. Robust efforts associated with education are established through the Ohio Department of Health and statewide Women, Infants and Children (WIC) services. However, education cannot replace clinical level lactation care when it is necessary.
While Ohio Medicaid offers coverage for lactation consultation care, the requirement for providers to be affiliated with Medicaid-enrolled billing entities presents challenges for unlicensed IBCLCs. By exploring collaborative partnerships, advocating for licensure, and expanding telelactation services where broadband is reliable, there is potential to enhance access to essential lactation care for families across Ohio.
What are the options with Nurture?
All providers at Nurture Columbus maintain the highest standard of lactation care as International Board Certified Lactation Consultants with international board oversight and equal skill to provide this care. Some of us have qualifying licenses in Ohio to provide IBCLC care that is reimbursed by Medicaid plans. Through these providers, Nurture trialed offering Medicaid covered IBCLC care for a 6 month period. However, without all of our providers licensed and therefore eligible for obtaining a Medicaid provider number, timely care was limited by availability of our licensed providers. Additionally, while we had high hopes for continuing to grow Medicaid coverage among our team and locations, we unfortunately hit many speed bumps while trying to navigate the 7 managed plans that provide medicaid coverage. The trial quickly became beyond our small business administrative capacity.
Nurture’s mission continues to be access to care without financial barrier. We now have a hardship fund to which anyone may donate to contribute to sustaining this mission for those with financial hardship and without insurance coverage aligned with contracts consistent with our administrative capacity. This will hopefully allow timely access to all of our highly skilled IBCLCs for any mother seeking this care.
Along with the Ohio Lactation Consultant Association, we are proud to have been a part of advocating for what does exist in this healthcare space in Ohio. We look forward to contributing to solutions for future generations so that the maternal, infant, economic and environmental advantages of breastfeeding as part of our physiological norm are realized as much as possible. All women with goals to breastfeed who are experiencing challenge deserve access and coverage for lactation care regardless of socioeconomic background. We will continue to advocate for them in Ohio❤️
Overview of Nurture Medicaid Trial:
