SB 1056 — Summary (Medical assistance coverage for donor human milk)
Status (selected)
- Bill number: SB 1056 (Michigan)
- Subject: Amends the Social Welfare Act (MCL 400.1–400.119b) by adding sec. 109o (also appears as 109y in substitute versions)
- Referred to: Committee on Government Operations (as filed 02/03/2025)
- Effective date (as drafted): January 1, 2026
Purpose
- To require Medical Assistance (Medicaid) coverage of donor human milk for infants of Medicaid‑eligible birthing people under specified clinical conditions, for up to two years after discharge/childbirth.
Key provisions
- Adds a new section to the Social Welfare Act allowing an “eligible individual” (i.e., Medicaid‑eligible birthing person/infant) to receive medical assistance coverage for donor human milk for the infant for up to 2 years after hospital discharge or childbirth if both conditions are met:
1. A licensed provider has written a prescription for donor human milk; and
2. Either:
- the birthing person is unable (temporarily or permanently) to provide milk; or
- the infant was born before the 34th week of pregnancy or weighed less than 1,800 grams at birth.
- The coverage window is explicitly up to two years following hospital discharge after childbirth or two years after childbirth.
- Drafted as an addition to Michigan’s Medical Assistance program provisions governing the Healthy Michigan Plan / Medicaid.
Who would be affected
- Primary beneficiaries: Medicaid‑eligible birthing people and their infants who meet the clinical criteria (inability to provide milk and/or very preterm or very low birth weight infants).
- Secondary impacts: milk banks and donor human milk suppliers, prescribing providers (neonatologists, pediatricians, obstetricians, lactation consultants), and Medicaid managed care and fee‑for‑service programs that would process claims.
- State Medicaid program budget and DHHS administrative units (for implementation and potential State Plan amendment).
Fiscal impact (estimates from legislative fiscal analyses)
- Estimated gross cost to Michigan DHHS: ~$26.7 million (based on proxy assumptions).
- Estimated State General Fund/General Purpose (GF/GP) share: ~$9.3 million (assumes FMAP ≈ 65%).
- Basis for estimate: assumed utilization of 542 children consuming 30 ounces/day for 365 days at $4.50 per ounce. Actual costs would vary with utilization, negotiated reimbursement rates, supply of donor milk, and updated FMAP.
- DHHS may incur additional administrative costs related to amending the Medicaid State Plan and program operations.
Procedural/timeline notes
- Draft text sets effective date of January 1, 2026.
- The enactment requires DHHS implementation through Medicaid coverage mechanisms; practical implementation could require State Plan amendment(s), provider reimbursement policies, and program guidance.
Other notes
- The bill includes clinical gatekeeping via a provider prescription and targets infants at higher clinical risk (very preterm or very low birth weight) and situations where the birthing person cannot provide milk.
- Implementation details (coverage coding, reimbursement rates, claims processing, supplier accreditation) would be set by DHHS policy and possible State Plan amendments.
