Bill
SB 1056
Medicaid will cover donor human milk for eligible infants up to two years after birth when prescribed and the infant is very preterm, very low birth weight, or the parent can’t pro
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.
Compiled from official sources — confirm details with the bill’s official record.
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