Medi-Cal: lactation services

Clear coverage, billing, and managed-care rules can make lactation support easier for Medi-Cal members to obtain.

What the law does ​

• Requires the State Department of Health Care Services to issue updated guidance covering lactation education, basic support, and clinical consultations.
• Requires guidance on billing, reimbursement, and billing codes for covered lactation services.
• Requires managed care plans to cover and reimburse covered services under the department's procedures.
• Specifies that lactation services do not require prior authorization, a prescription, or a referral.
• Requires managed care plans to report how many International Board Certified Lactation Consultants are accessible in their networks for members needing clinical consultations.
• Requires the department to seek stakeholder input on draft guidance.

Who it affects ​

• Medi-Cal members seeking lactation education, support, or clinical consultation.
• Medi-Cal managed care plans and lactation-service providers.

Context ​

Implementation depends on available federal funding and required federal approvals.