Breast milk is sometimes referred to as “liquid gold.”
The nickname typically refers to the nutritional benefits of breast milk, but it’s also a fitting nickname economically. In modern-day currency, breast milk can cost hospitals or families upward of $4.50 per ounce. If not covered by insurance, that can add up to thousands of dollars a month paid out of pocket.
Nevada may soon decide to become the latest state to pick up the tab for donor breast milk for the premature babies who would benefit most from it.
Introduced earlier this month by state Sen. Scott Hammond, Senate Bill 86 would require Nevada Medicaid to cover doctor-prescribed donor breast milk and human milk-based fortifiers, the latter of which is essentially a formula made from breast milk instead of cow milk. Coverage would be limited to infants with a birth weight of 1,500 grams (3.3 lbs) or less, as well as babies who have intestinal conditions that create a high risk of feeding intolerance or serious medical complications.
Medicaid is the single largest payor of births in Nevada, according to the DHHS. In 2018, Medicaid covered 58% of births statewide.
Hammond, a Republican, first introduced the bill during the 2019 session and received bipartisan support, with Democratic state Sens. Yvanna Cancela and Pat Spearman signing on as cosponsors. But the bill failed to make it out of the Senate Health and Human Services committee.
“Sometimes politics get involved,” said Hammond. “This might have had some of that, but most people agreed that it was a worthy issue to tackle.”
Hammond says hospitals who supported the bill in 2019 asked him to reintroduce the bill during the current session.
“Some of the hospitals don’t have the ability — the financing — to offer (donor breast milk),” he added. “It came out (last session) that some hospital systems do, but others can’t afford it.”
The proposed donor breast milk bill hasn’t yet been scheduled for its first committee hearing, but when it does, one of the dominant questions is likely to be: Can the state afford it?
In 2019, the Nevada Department of Health and Human Services attached to the bill an estimated fiscal impact of $7.8 million over a biennium. This year, the department has submitted a similar estimated fiscal impact — $7.7 million over the upcoming biennium.
That amount reflects what would be the state’s portion; the federal government would cover 75% of the cost of donor breast milk. Only a handful of states require their Medicaid plans to cover donor breast milk.
The price tag raised eyebrows during the failed 2019 bill’s hearings, and amid fiscal uncertainty caused by the coronavirus pandemic the cost will no doubt be another hurdle this session.
Hammond says he believes the state’s estimate is conservative and the actual cost will be lower. He and medical experts also believe the upfront cost of donor breast milk for premature babies is cheaper than the continued medical costs associated with treatment of necrotizing enterocolitis (NEC), a devastating disease of the intestine that is rare in full-term infants but common in premature infants.
Up to 40% of infants who develop NEC die from it, according to the U.S. National Library of Medicine. While many infants fully recover from NEC, survivors can have lifelong neurological and nutritional complications, according to the NEC Society, a nonprofit research and advocacy organization.
“The savings is on the backend,” says Hammond. “There’s savings across the early lifespan.”
In 2019, medical professionals from Dignity Health St. Rose Dominican testified in support of the bill and cited research estimating the cost of treating surgical NEC at between $300,000 and $600,000. The lifetime cost for just one NEC baby could be in the millions.
The World Health Organization and the American Academy of Pediatrics recommend feeding premature babies pasteurized donor breast milk. Research has linked formula use in premature infants with higher rates of NEC.
However, for a variety of reasons, sometimes mothers cannot produce what their medically fragile or premature babies need.
In those cases, hospitals can turn to what is essentially the modern-day wet nurse industry, where they typically pay between $3 and $5 per ounce. The source of breast milk is often a national or state donor breast milk bank, but the human milk industry also includes for-profit companies, some of which pay lactating women for their oversupply.
One of those companies is Boulder City-based Medolac, whose founder, Elena Medo, first pitched the donor breast milk bill to Hammond.
“The public mainly hasn’t set foot in (the neonatal intensive care unit),” says Medo. “They may have seen a picture of a premie, but unless you see a premie in real life you’re not going to get it. They really are a fetus. They’re on life support.”
Medolac, which relocated from Oregon to Nevada in 2018 with the help of the state’s tax abatement program, is attempting to develop a large-scale production facility for its human-milk fortifier products, which it believes can drive down the cost of breast milk and reduce the prevalence of NEC. She points to stories from across the country of hospitals rationing out their breast milk supply.
“Health care rationing is a whole subject,” says Medo. “It makes sense if you have a kidney that you can get to a recipient. It’s not going to be a 95-year-old guy who chain smokes. It’ll be a 17-year-old who got into an accident. But to rationalize something as life saving as human milk for a premie?”