Q&A: NJ law now requires health insurers to cover donated breast milk

Thomas Hegyi

A New Jersey law went into effect on Jan. 1, 2019, requiring all health insurers in the state to cover donated human breast milk for infants under certain circumstances. Insurers must cover the costs if the infant is aged younger than 6 months, the milk comes from a milk bank that meets the quality guidelines of the Human Milk Banking Association of North America or is licensed by the New Jersey Department of Health, and it is prescribed to the infant by a physician. Similar laws are in place in California, New York, Missouri, Kansas, Texas and Washington, D.C.

Thomas Hegyi, MD, vice-medical director of the SIDS Center of New Jersey and professor and co-chair of pediatrics at Rutgers Robert Wood Johnson Medical School, spoke with Infectious Diseases in Children about the potential impact of the New Jersey law. – by Erin Michael

What is the clinical importance of New Jersey’s new breast milk law? What should pediatricians know?

Breast milk is best milk, basically. This confirms the importance of feeding this optimal nutritional substance to newborn babies because there’s no comparison to the benefit of breast milk vs. formulas. This final statewide support confirms the fact that this is optimal food for optimal brain development, for prevention of disease, for prevention of other complications, and for the reduction of sudden infant death syndrome. This is a wonderful thing because it gets babies started on the right nutrition at the very beginning of life.

What evidence supports this law?

There’s plenty of evidence in the literature, looking at the benefits of breast milk in enhancing intellectual capacity, preventing disorders such as gastrointestinal problems, allergies and in reducing SIDS. There’s plenty of scientific evidence that breast milk is the optimal formula for newborn babies.

Which infants will benefit most from donated breast milk in New Jersey now that it’s covered by insurance?

All babies benefit from breast milk. If you compare breast milk with formula, there’s really no comparison. Although formula can provide nutrition that may be equivalent to breast milk, breast milk has so many other non-nutritional benefits that are given to babies that protect against infections, all kinds of immunological and growth factors. This begins the nutritional journey of the human being very properly. This nutritional journey, unfortunately, deviates very early in childhood as children and adults grow and start consuming foods that are not good for them, which results in many of the complications in adulthood that we see. There’s plenty of evidence right now that the foods that humans ingest are associated with problems such as stroke and heart disease. If we can get people to eat healthy and avoid the foods that cause these medical issues, then our health care system and our quality of life would be tremendously improved. However, you have to begin with babies, and the best beginning for babies is breast milk. There’s important scientific evidence that specific foods increase the risk of stroke, heart disease, obesity and diabetes. All these conditions are related to what we are ingesting, and if we could just educate the population on the dangers of eating these kinds of foods, we would make a tremendous impact on the health care and finances of our country.

What is the benefit for high-risk infants in having insurance cover the cost of donated breast milk?

High-risk infants benefit because they are at the greatest danger of having an infection and developmental abnormalities, and there are certain infections in high-risk premature infants that are clearly ameliorated by breast milk. For example, necrotizing enterocolitis can kill and maim premature infants, and this condition responds very nicely to the preventive aspects of breast milk. There are very clear-cut, identifiable benefits of breast-feeding, and we encourage all mothers of premature, high-risk infants to provide breast milk.

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Do you see other states following suit given the importance of breast milk to an infant’s development?

There’s no question that this is the way to go. There should be a national effort to support breast-feeding. And new mothers should receive resources, time and support in giving breast milk to their babies.

Do you think a similar law could be passed at the federal level? Do you see it happening in the near future?

Again, this is not a statewide initiative; it should be a federal initiative. However, with the turmoil in Washington right now, I don’t think breast-feeding infants is a priority among the politicians.

Would laws like this benefit insurance companies in the long run?

In the long run, if you reduce the complications of infections and reduce long-term hospitalization because you’re preventing certain disorders, such laws would benefit insurance companies. Reducing the need for emergent care is financially responsible in the long run and will benefit all involved including families, hospitals and insurance companies.

References:

NANN. Reimbursement for Donor Human Milk for Preterm Infants. http://nann.org/publications/e-news/march2017/health-policy-and-advocacy. Accessed January 10, 2019.

New York State Department of Health. New York State Medicaid Reimbursement for Pasteurized Donor Human Milk. https://www.health.ny.gov/health_care/medicaid/program/update/2017/2017-11.htm#donormilk. Accessed January 9, 2019.

Disclosure: Hegyi reports no relevant financial disclosures.