O2039: Evidence-based Advocacy and Collaboration Among Academic Clinicians, State Government Policy Makers, and Legislators Results in Pasteurized Donor Human Milk Coverage: A Florida Success Story

Background: Human milk is the ideal food for most infants. In its absence, pasteurized donor human milk (PDHM) is recommended for low birth weight infants who are at higher risk of necrotizing enterocolitis (NEC). In Florida, despite years of legislative efforts, PDHM like infant formula was left to hospitals to provide under diagnostic related group (DRG) payments. As a consequence, some hospitals did not provide PDHM because of extra expense. In 2021, the Florida Legislature directed the Agency for Health Care Administration (AHCA) to study PDHM use in Florida Neonatal Intensive Care Units (NICUs). The Agency contracted the Florida Medical School Quality Network (FMSQN) to generate portions of the study.

Methods: FMSQN distributed an electronic 10-question survey to all 73 Florida NICUs. Results of the survey, a cost-benefit analysis, safety considerations, and recommended best practices for milk bank operations were presented to AHCA and subsequently to state legislators.

Results: Survey response rate was 60% (n=44) of Florida's NICUs, representing 83% (n=1780) of beds and all 11 Medicaid Regions. In 2020, approximately 316,500 ounces of PDHM were dispensed by 7 milk banks, with 81% supplied by Florida Mothers’ Milk Bank (Orlando, FL). Geographic variations in access to PDHM were evident. Criteria for use are shown in Figure 1. Prematurity (92%), low birth weight (76%), and neonatologist-determined medical necessity (71%) were most common reasons for providing PDHM, though definitions varied.
Survey respondents indicated that 1682 NICU beds in facilities routinely using a median of 11 oz/bed/month of PDHM expended $1,110,120 per year. Approximately 2755 VLBW infants in Florida NICUs received PDHM in one year. If these NICUs did not provide PDHM, it was estimated that there would have been an increase of 138 more infants per year developing NEC, at an annualized cost of $5,175,000 (using $37,500/case of NEC). Thus, PDHM use in Florida was estimated to have avoided over $4 million in healthcare expenditures annually. This is likely an underestimate considering that hospital readmissions, home healthcare visits, and emergency department visits were not factored into the calculations (Figure 2).
These results and meetings with state legislators about the data informed the crafting of Florida Senate Bill (SB) 1770 / House Bill (HB) 1577, which mandated Florida Medicaid coverage of PDHM and derivatives by accredited donor human milk banks and regulatory agency approved private milk banks. The legislation was signed into Florida law on April 8, 2022 and became active July 1, 2022.

Conclusion: Cooperative collaboration among academic clinicians, state government policy makers, and legislators converted data to action in supporting evidence-based access to PDHM for Florida’s infants. This tripartite relationship serves as an example of opportunities to improve health outcomes for infants, children, and adolescents in Medicaid programs.