Expanding Coverage Requirements for Human Donor Milk

Beginning January 1st, 2025, MetroPlusHealth’s Qualified Health Plan (QHP), Essential Plan (EP), Gold & GoldCare members will now have access to coverage for Human Donor Milk in Outpatient Settings. Coverage for Pasteurized Donor Human Milk (PDHM) includes milk with medically necessary fortifiers. Only a licensed medical practitioner may order the milk. Furthermore, specific clinical criteria for the mother or infant must be met for coverage including:

• Infants weighing < 1500 g, those with a high risk for developing necrotizing enterocolitis, or have a congenital or acquire condition necessitating donor milk.
• Mothers unable to produce any or inadequate amounts or milk, those lacking lactation support, among others.