Health Insurance Impact on Breastfeeding Care

PRWire:

A $3 billion problem: cutting lactation care costs more than it saves

A change to how a single lactation visit is reimbursed effectively halves payment for care delivered to both parent and baby, threatening access to the most highly credentialed lactation providers.

FALLS CHURCH, Virginia – Beginning September 1, 2026, the nation’s largest health insurer will halve payment for skilled lactation care, a change the International Board of Lactation Consultant Examiners (IBLCE), the American College of Nurse-Midwives (ACNM), and the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), warn will limit new families’ access to care.

The insurer, which covers millions of members across the country, is changing how a single lactation visit is reimbursed so that it no longer recognizes the care provided to both the breastfeeding parent and the infant. A single visit assesses and treats two distinct patients, the parent and the child, each with their own examination and record.¹

Maternal and infant breastfeeding challenges are often interconnected. Given this interdependence, a lactation consultation assesses and treats both members of this dyad. Yet in the absence of payers who pay healthcare professionals for the full complement of necessary services provided, or a companion code corresponding to the pediatric side of lactation support, payment for this Affordable Care Act recommended preventive service will be effectively reduced by about 50 percent.

The need for lactation and breastfeeding care is already acute. While 86 percent of children in the United States are ever breastfed, a majority of dyads encounter difficulties in the first week, and only about 30 percent are still exclusively breastfed at six months, far below the level recommended by leading pediatric, obstetric, and public health guidelines.^2,3,4,5,6 Skilled lactation support is what helps parents bridge that gap.^7,8,9,10

Josie Margulis, a New York City mother of two, shares, “My second baby was prenatally diagnosed with congenital heart disease. I had a totally uncomplicated breastfeeding experience with my first child and thought that feeding my second would be one thing I wouldn’t have to worry about. My daughter’s medical issues were much more complex when she was born, and she was in and out of the ICU for the first three months of her life. I had continuous support of inpatient and outpatient IBCLCs over those first few months. I am so proud of myself for giving the vital nourishment only my body could give to my baby and grateful to the IBCLCs who guided us through that unexpectedly complicated time.”

The consequences of losing that support are measurable:

• Pediatric health: breastfeeding is associated with reduced risk of acute and chronic diseases, including ear infections, gastrointestinal infections, pneumonia, eczema, asthma, obesity, Type I and Type II Diabetes, childhood leukemia, SIDS, and a devastating gastrointestinal complication that occurs in premature infants called Necrotizing Enterocolitis. ¹¹
• Maternal physical health: lactation is associated with reduced risk of Type II Diabetes, breast, and ovarian cancer.¹¹
• Maternal mental health: one 2022 meta-analysis found that parents who did not exclusively breastfeed had roughly 89 percent higher odds of postpartum depression. ¹²
• Cost: suboptimal breastfeeding has been estimated to cost the United States more than $3 billion a year in excess medical costs (in 2014 dollars), and global analyses put economic losses in the hundreds of billions. When combining the US medical, non-medical, and premature death-related cost of not breastfeeding, this number exceeds $25 billion in 2026 dollars.¹³
• Workforce: companies with worksite lactation support report retention rates as high as 94 percent, versus a national average of about 59 percent. The savings are also measurable—one insurer’s lactation program saved over $300,000 in health care and absenteeism expenses, and reduced prescription rates 62 percent. ¹⁴

International Board Certified Lactation Consultants (IBCLCs) are the most highly credentialed lactation care professionals, completing extensive clinical training and rigorous board certification.^15,16 Many practices operate on thin margins, and lactation support professionals, including IBCLCs, have already begun telling families they cannot continue under the new terms. Cutting reimbursement in half, at the very moment demand is highest, will mean more parents left without skilled help.

Scotty Thomson, registered nurse and IBCLC from Alabama, comments, “As payers continue to layer more restrictive billing policies for IBCLCs, the reduction in reimbursement makes it impossible to sustain our businesses and this affects families’ access to care.”

IBLCE calls on the health plan to reverse this change, and on payers broadly to ensure that reimbursement reflects the full scope of care delivered to both parent and infant.

There is a straightforward fix. IBLCE urges the payers to either support a companion code that reimburses the child’s care, or properly reflect the rate on the available code so it reflects that one visit treats two interdependent patients. Fair reimbursement and evidence-based care does not have to mean unlimited cost, but a roughly 50 percent cut, with no offsetting increase, goes further than sustainability requires, and it risks higher spending on the poorer outcomes that follow when families lose access to this care.

Bayyinah Muhammad, Certified Nurse Midwife, Women’s Health Nurse Practitioner, IBCLC, and Immediate Past Chair of the IBLCE Board of Directors, says, “Insurers are treating a visit for two patients as if it were a visit for one, and families are the ones who will pay for it. When skilled lactation care disappears from a network, it does not come back quickly. We are urging this plan to reverse course before that happens.”

IBLCE urges affected families, clinicians, and employers to make their concerns known before the September 1 effective date.

Media availability

IBLCE can arrange interviews with lactation experts and policy specialists and, on request, connect reporters with board certified lactation consultants and families affected by the change. Additional data and background available on request.

About IBLCE

The International Board of Lactation Consultant Examiners (IBLCE) is the independent international credentialing organization for International Board Certified Lactation Consultants (IBCLCs) and lactation supporters, currently including over 39,000 IBCLCs across 137 countries and upholding rigorous, evidence-based standards.

About ACNM

The American College of Nurse-Midwives (ACNM) is the professional association that represents Advanced Practice Midwives (APMs), including Certified Nurse-Midwives (CNMs) and Certified Midwives (CMs) in the United States.

About AWHONN

The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) is a nonprofit membership organization dedicated to improving the health of women and newborns and strengthening the nursing profession. AWHONN represents the interests of 250,000 nurses working in women’s health, obstetric, and neonatal nursing across the United States.

References

1. International Board of Lactation Consultant Examiners. (2018, December 12). Scope of practice for International Board Certified Lactation Consultant® (IBCLC®) Certificants. https://iblce.org/wp-content/uploads/2018/12/scope-of-practice-2018.pdf
2. Centers for Disease Control and Prevention (2026, July 31). National and state breastfeeding rates: Data results. https://www.cdc.gov/breastfeeding-data/survey/results.html
3. Wagner, E.A., Chantry, C.J., Dewey, K.G., & Nomssen-Rivers, L.A. (2013). Breastfeeding concerns at 3 and 7 days postpartum. Pediatrics, 132(4), e865-e875. https://doi.org/10.1542/peds.2013-0724
4. World Health Organization. (2003). Global strategy for infant and young child feeding. https://iris.who.int/server/api/core/bitstreams/a70b1144-75b7-4b25-b3a9-bd5ee5098e95/content
5. American College of Obstetricians and Gynecologists. ACOG committee opinion No. 756: Optimizing support for breastfeeding as part of obstetric practice (2018). Obstetrics & Gynecology, 132(14), e187-e196. https://doi.org/10.1097/AOG.0000000000002890
6. Meek, J.Y., Noble, L. , & Section on breastfeeding. (2022). Policy statement: Breastfeeding and the use of human milk. Pediatrics, 150(1). https://10.1542/peds.2022-057988
7. Patnode, C.D., Senger, C.A., Coppola, E.L, & Iacocca, M.O. (2025). Interventions to support breastfeeding. Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA, 333(17), 1527-1537. https://doi.org/10.1001/jama.2024.27267
8. Chetwynd, E.M., Wasser, H.M., & Poole, C. (2019), Breastfeeding support interventions by International Board Certified Lactation Consultants: A systematic review and meta-analysis. Journal of Human Lactation, 35(3), 424-440. https://doi.org/10.1177/0890334419851482
9. D’Hollander, C. J., McCredie, V. A., Uleryk, E. M., Kucab, M., Le, R. M., Hayosh, O., Keown-Stoneman, C. D. G., Birken, C. S., & Maguire, J. L. (2025). Breastfeeding support provided by lactation consultants: A systematic review and meta-analysis. JAMA Pediatrics, 179(5), 508–520. https://doi.org/10.1001/jamapediatrics.2024.6810
10. Gavine, A., Shinwell, S.C., Buchanan, P. Farre, A., Wade, A., Lynn, F., Marshall, J., Cumming, S.E., Dare, S., & McFadden, A. (2022). Support for healthy breastfeeding mothers with healthy term The Cochrane Database of Systematic Reviews, 10(10). https://doi.org/10.1002/14651858.CD001141.pub6
11. Ip, S., Chung, M., Raman, G., Chew, P., Magula, N., DeVine, D., Trikalinos, T., & Lau, J. (2007). Breastfeeding and maternal and infant health outcomes in developed countries. Agency for Healthcare Research and Quality. https://www.ncbi.nlm.nih.gov/books/NBK38337/
12. Alimi, R., Azmoude, E., Moradi, M., & Zamani, M. (2022). The association of breastfeeding with a reduced risk of Postpartum Depression: A systematic review and meta-analysis. Breastfeeding Medicine, 17(4), 290-296. https://doi.org/10.1089/bfm.2021.0183
13. M., & Reinhold, A. (2010). The burden of suboptimal breastfeeding in the United States: A pediatric cost analysis. Pediatrics, 125(5), e1048-e1056. https://doi.org/10.1542/peds.2009-1616
14. S. Department of Health and Human Services. The business case for breastfeeding. Health Resources and Services Administration. https://womenshealth.gov/sites/default/files/documents/bcfb_business-case-for-breastfeeding-for-business-managers.pdf
15. IBCLC Commission. (n.d.). Start your IBCLC Journey. https://ibclc-commission.org/how-to-become-an-ibclc/
16. IBCLC Commission. (2026, March 31). Candidate information guide for initial, repeat, and inactive candidates who plan to apply for the IBCLC® examination. https://ibclc-commission.org/wp-content/uploads/2026/04/2026_March-31_Candidate-Information-Guide_FINAL.pdf

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Contact: Sarah Cox – Associate Director, Brand & Communications – 703-560-7330 – scox@iblce.org