Guide · Medicaid billing
Does Medicaid pay for a lactation consultant in your state?
It depends on the state, and on who the consultant is. We have read the Medicaid rules for 27 of 51 jurisdictions. In 11 of them a lactation consultant who is not a nurse can enrol and bill Medicaid in their own right; in 11 they can be paid only through, or alongside, another licensed provider; in 3 we found no route at all.
Last checked .
Why it matters who the consultant is
About 50% of the lactation providers enrolled in the federal provider registry are registered nurses, and a nurse can often bill in ways a consultant without a nursing licence cannot. This page describes the position of a lactation consultant who is not a nurse — typically an IBCLC in private practice — because that is where states differ most.
State by state
Can bill directly
| State | Since | Source | What the state’s rule says |
|---|---|---|---|
| Colorado | 2024-12-01 | Secondary | From 1 December 2024, IBCLCs, CLCs and Certified Lactation Educators may enrol as Colorado Medicaid providers. IBCLCs may practise without supervision and bill directly; CLCs and CLEs must be supervised by an enrolled MD/DO, PA, APN, CNM or IBCLC and may not bill directly. No visit limit; visits billable up to two hours. |
| District of Columbia | 2019-01-01 | State document | DC Medicaid enrols board-certified lactation consultants as providers who bill lactation consultation themselves, under HCPCS code S9443 at $15.63 per 15-minute unit — up to four units a visit and four visits within 120 days of delivery — effective 1 January 2019 (DHCF Transmittal 19-20, issued 26 September 2019). |
| Georgia | — | State document | In August 2022 Georgia's Department of Community Health began enrolling lactation consultants as a new Medicaid provider type — a route for a lactation consultant who is not a nurse to enrol in their own right. Applicants must meet the qualifications set out in the Georgia Lactation Consultant Practice Act, which requires IBCLC certification, as well as Georgia Medicaid's own requirements. |
| Illinois | 2024-01-01 | State document | IBCLCs enrol with Illinois Medicaid as a "Health Support Professional" with the Lactation Consultant specialty, and may enrol as a Regular Individual Sole Proprietor — which means billing directly rather than only through a supervising provider. Per Public Act 102-0665. |
| Louisiana | — | State document | Louisiana lets its Medicaid managed-care plans cover outpatient lactation support in place of other care. Under the Department of Health's manual for this service (8 December 2023), a lactation support provider — including an IBCLC who is not a nurse, enrolled under taxonomy 174N00000X — can enrol and bill individual visits (S9445) and classes (S9443), with up to six sessions allowed without prior authorisation. ⚠ Each plan chooses whether to offer the service, and none is required to contract with every qualified provider. |
| New Jersey | 2023-03-01 | State document | New Jersey's Medicaid state plan covers lactation consultant services and names International Board Certified Lactation Consultants as the qualified providers, so a board-certified consultant who is not a nurse can be paid for them (SPA NJ-23-0006, approved by CMS on 4 May 2023, effective 1 March 2023). The service must be recommended by a physician or other licensed practitioner; each beneficiary may have up to five individual visits and four telephone contacts a year. |
| New Mexico | — | Secondary | New Mexico Medicaid enrols lactation providers who hold a valid IBCLC, CLC or equivalent certification, under its doula and lactation state plan amendment (SPA 24-0004), according to a 2025 managed-care reference guide. ⚠ The state's own SPA pages refused our request, so this is not yet confirmed against them. |
| Oregon | — | Secondary | Oregon Medicaid entitles enrollees to lactation support to six months postpartum with no visit cap. Registered nurses, nurse midwives and OHA-licensed lactation consultants including IBCLCs can bill independently; CLCs and peer counsellors must be supervised. ⚠ Medicaid reimburses only IBCLC-certified providers, and many Oregon counties have no IBCLC at all — so a right to the service is not the same as access to it. |
| Texas | 2025-09-01 | State document | HB 136 requires Texas Medicaid to reimburse lactation consultants and to establish a SEPARATE PROVIDER TYPE so they can enrol and bill directly. Effective 1 September 2025; operational rollout continues through 2026. |
| Virginia | — | Secondary | Virginia DMAS lists "Lactation Consultant, Non-RN" (NUCC taxonomy 174N00000X) as an enrollable provider type, so a board-certified lactation consultant who is not a nurse can enrol with Virginia Medicaid and bill in their own right, without physician oversight. This is the position North Carolina lacks, and the two states share a border. |
| Washington | 2025-01-01 | State document | State Medicaid was required to cover DOH-certified lactation consultants from 1 January 2025. |
Only through another provider
| State | Since | Source | What the state’s rule says |
|---|---|---|---|
| California | — | Secondary | Medi-Cal does not recognise a lactation educator-counselor or IBCLC certification as a designated profession that can be assigned a provider number or bill directly. Lactation support IS payable, but only when rendered by a community perinatal health worker, medical assistant, RN, NP or PA who holds one of those certifications, billed under that provider's Medi-Cal number. A non-RN IBCLC in independent practice has no route. |
| Delaware | 2017-06-02 | Secondary | Delaware Medicaid has paid for lactation counselling as a separate pregnancy-related service since 2 June 2017 — but only when it is given by a physician, nurse practitioner, physician assistant, midwife or registered nurse who also holds CLC or IBCLC certification. A lactation consultant without one of those licences does not qualify. ⚠ The state's document refused our request; this rests on its text as indexed. |
| Hawaii | — | Secondary | Med-QUEST, Hawaii's Medicaid programme, reimbursed lactation care only when a physician or nurse practitioner billed it, and did not pay IBCLCs unless the IBCLC completed the visit with, or was also licensed as, a physician or nurse practitioner — as described in an October 2021 article in the Hawaiʻi Journal of Health & Social Welfare. We have not found a newer Med-QUEST policy. |
| Kansas | — | Secondary | Kansas Medicaid policy requires that IBCLCs be "employed by the physician or physician group". Unlike doulas, who may bill independently, IBCLCs must be affiliated with a hospital or clinical office eligible to bill. Practitioners who attempt to bill independently receive no reimbursement. |
| Michigan | — | Secondary | Michigan Medicaid bulletin MSA 15-46 requires the rendering provider for lactation services to be a Medicaid-enrolled physician, nurse practitioner, physician assistant or nurse midwife. When one of them delegates to and supervises an IBCLC within their scope of practice, that practitioner may bill — so a lactation consultant who is not a nurse can be paid only through them. ⚠ Michigan's site refused our request; this rests on the bulletin's text as indexed. |
| Minnesota | — | State document | Minnesota Health Care Programs do not enrol lactation consultants in their own right. The provider manual's only route is prenatal education: clinics and outpatient hospitals whose programme is directed by an enrolled provider may bill for registered nurses, or for health educators with a relevant degree or a certification such as IBCLC. A lactation consultant who is not a nurse can be paid only through such a clinic or hospital. |
| New York | 2013 | Secondary | New York Medicaid has paid for lactation counselling since 2013, and from July 2022 (fee-for-service) and September 2022 (managed care) widened the accepted certifications to include IBCLC, CLC, CBS, CLS, CLE, CCL and CBE. ⚠ But the biller must be a LICENSED health professional — physician, PA, NP, midwife or RN — who also holds one of those certifications. The certification is an add-on to a licence, not a route of its own, so a non-RN IBCLC cannot enrol and bill independently. Codes S9445/S9446. |
| Ohio | 2022-01-01 | State document | Ohio Medicaid pays for lactation consulting (OAC 5160-8-42, in effect since 1 January 2022) only when a licensed practitioner gives it. Since the October 2024 amendment, practitioners who also hold the IBCLC credential — registered nurses without supervision, licensed practical nurses, physical, occupational and speech therapists, dentists, dietitians and pharmacists — can receive a separate professional payment. An IBCLC without one of those licences is not on the list. |
| Oklahoma | — | State document | SoonerCare contracts lactation consultants only when they are IBCLCs AND licensed as a registered nurse or a registered dietitian. A lactation consultant with neither licence cannot contract with the Oklahoma Health Care Authority, so cannot be paid in their own right. |
| Tennessee | — | Secondary | ⚠ Corrected 2026-09-10. TennCare allows IBCLCs to contract with its managed care organisations as independent providers — but the qualifying language is "IBCLCs WITH MEDICAL LICENSURE". That is a licensed clinician who also holds the IBCLC credential, not a non-RN IBCLC. Recorded here as supervised-only until TennCare's own provider page can be read directly. |
| Vermont | — | Secondary | Vermont Medicaid enrollees may receive unlimited in-home lactation support from an IBCLC — but because Vermont has no lactation licensure, an IBCLC must hold an ADDITIONAL credential such as an RN or NP licence to meet the licensure criteria in the Medicaid lactation policy. A non-nurse IBCLC therefore cannot satisfy it alone. |
Legislated — not verified live
| State | Since | Source | What the state’s rule says |
|---|---|---|---|
| Arkansas | 2026-01-01 | Secondary | ⚠ Effective 1 January 2026 under Act 627 (HB 1333, April 2025), which mandates Medicaid and commercial coverage of lactation consultation and requires the state to create a new provider type. Our most recent source is from summer 2025 — before that date, when the benefit was still in implementation planning — so whether it is operational today is not verified. The Act covers services from an IBCLC "or a certified lactation counselor under supervision of a contracted and in-network healthcare provider"; whether an IBCLC will bill independently is not yet established. Arkansas Medicaid had not previously covered lactation services at all. |
| Maine | — | State document | Maine law (22 MRSA §3174-PPP, enacted by Public Law 2025, chapter 468) requires MaineCare to reimburse lactation services given by a licensed health professional or by a consultant or counsellor certified by a national organisation the department approves — which includes a lactation consultant who is not a nurse. The department must adopt rules to carry it out, and we have not verified that enrolment and payment are operating. |
No route to bill
| State | Since | Source | What the state’s rule says |
|---|---|---|---|
| Arizona | — | Secondary | AHCCCS, Arizona's Medicaid programme, does not cover lactation support visits with an IBCLC or another lactation care provider, according to 2026 reporting on the Legislature's attempt to change that. HB 2051, which would have required AHCCCS to reimburse lactation care, passed the House in February 2026, but the bill record shows no action by the Governor. |
| Florida | — | Secondary | IBCLCs are not on the Florida Medicaid provider list, so they cannot bill directly. Lactation education is reimbursed only under doula services or where the provider is enrolled as a Medicaid physician or nurse practitioner — which excludes the majority of IBCLCs, who are neither. Florida also has no state regulation of lactation practitioners at all, so there is no licence to fall back on. |
| North Carolina | — | Secondary | North Carolina Medicaid's Provider Permission Matrix has no dedicated taxonomy code for non-RN IBCLCs, so a board-certified lactation consultant who is not a nurse can neither enrol in nor bill Medicaid directly. They must bill incident to a licensed practitioner. This is the worst position of any state researched. |
Not checked yet.
Alabama, Alaska, Connecticut, Idaho, Indiana, Iowa, Kentucky, Maryland, Massachusetts, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, North Dakota, Pennsylvania, Rhode Island, South Carolina, South Dakota, Utah, West Virginia, Wisconsin and Wyoming. A state missing from the tables above is unchecked, not a “no” — ask your plan directly.
If you have Medicaid
- Call the member services number on your Medicaid or managed-care card and ask whether lactation consultation is covered, and which consultants are in network.
- Ask the consultant, before you book, whether they bill your plan themselves, bill through a clinic or hospital, or expect you to pay.
- If your state is marked “Only through another provider”, ask your pediatrician’s or obstetrician’s office whether a lactation consultant works with them.
- Check the credential yourself — it takes about a minute.
Every state page links the document we read and the date we read it. How we record Medicaid positions · Questions to ask before you book