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LD 865

An Act To Require Mainecare To Reimburse For Lactation Services In The Homes Of Eligible Persons

132nd Legislature (2025-2026) Introduced by Michelle Boyer and 3 co-sponsors

Expands MaineCare to reimburse in-home lactation visits for eligible members, starting Jan 1, 2027, with a new payment model and IT upgrades.

Signed by Governor
#lactationservices #mainecare #medicaid
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Bill Summary · LD 865

Summary — LD 865

An Act To Require MaineCare To Reimburse for Lactation Services in the Homes of Eligible Persons

Purpose

LD 865 requires the Maine Department of Health and Human Services (DHHS) to provide MaineCare (Medicaid) reimbursement for lactation services delivered in the homes of eligible MaineCare members. The intent is to expand access to postpartum and breastfeeding support by covering in‑home lactation visits.

Key provisions

  • Directs DHHS to reimburse for lactation services provided in the home to individuals eligible for MaineCare.
  • Requires DHHS to develop a payment model and rate methodology and to update its information systems to process these payments.
  • Establishes MaineCare coverage for in‑home lactation services beginning January 1, 2027 (implementation date reflected in fiscal notes).

(The bill as engrossed adopted Committee Amendment “A” (H‑627); the amendment and engrossed language were the version enacted.)

Who is affected

  • Primary beneficiaries: MaineCare (Medicaid) members who need lactation support, including postpartum birthing people and caregivers receiving breastfeeding support services at home.
  • Providers: lactation consultants or other qualified providers who deliver in‑home lactation services and who will be eligible to bill MaineCare.
  • DHHS: administrative and IT functions to implement reimbursement and rate-setting.

Fiscal impact (from final fiscal note, engrossed version)

All amounts shown are statewide.
- FY 2025‑26: $0 (no fiscal effect)
- FY 2026‑27:
- Net General Fund cost: $104,250 (includes one‑time and partial‑year ongoing costs)
- Appropriations/allocations also include Federal Expenditures Fund $198,843 and Federal Block Grant Fund $546 (FMAP match)
- Breakdown: one‑time General Fund of $91,993 for technology and development of rate/payment model; ongoing partial‑year General Fund of $12,257 to begin reimbursement (full implementation effective 1/1/2027)
- FY 2027‑28 and FY 2028‑29 (annual projections):
- Net General Fund cost: $24,514 per year (full‑year ongoing cost)
- Annual Federal Expenditures Fund match: $39,884
- Annual Federal Block Grant Fund: $1,091

Implementation & timeline

  • MaineCare reimbursement for in‑home lactation services is set to begin January 1, 2027 (per DHHS fiscal note assumptions).
  • DHHS will complete IT changes and establish rate methodology/payment model using one‑time funds prior to or concurrent with startup.

Legislative status and key actions

  • Introduced: March 4, 2025
  • Committee: Health and Human Services — reported out as OTP‑AM; Committee Amendment “A” (H‑627) adopted
  • Passed both chambers (June 11–25, 2025)
  • Signed by the Governor: July 1, 2025 — Act enacted.

Practical effect

The law expands Medicaid-covered services to include in‑home lactation support, aiming to increase access to postpartum breastfeeding assistance for MaineCare members. DHHS will incur one‑time administrative and system costs and modest ongoing costs shared with federal matching funds.

Compiled from official sources — confirm details with the bill’s official record.

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