State Medicaid Agency Reverses Denial of Request for Specialized Breastmilk

stethoscope on a pile of cash money

by Andy Jones
March 22, 2017

The Arizona Center for Disability Law has reached a settlement with the state Medicaid agency and an insurance provider to provide a life-saving breastmilk formula for an 18-month-old child with disabilities.

Kallista Smith was born with eosinophilic gastrointestinal disorder. As such, breastmilk is the only food her digestive system will tolerate, as detailed by the Casa Grande Dispatch. Furthermore, the milk must be dairy-, gluten-, soy- and corn-free.

Her mother breastfeeds her, but Smith’s dietary needs demand that her family purchase additional breastmilk, at a price of $4 an ounce, which is provided through a feeding tube. 

The child’s insurance provider, United Health Care, and the Arizona Division of Developmental Disabilities, initially denied Smith’s request for the formula, on the basis that it does not cover out-of-state treatment. Arizona does not have any breastmilk banks, which receive and collect donated breastmilk.

Smith contact the ACDL, which requested an expedited hearing. Two days before the hearing date, on February 8, United Health Care, the state Division of Developmental Disabilities and the Arizona Healthcare Cost Containment System, the state’s Medicaid agency, reached an agreement to contract with a breastmilk bank in Colorado, thus saving Smith’s life.

“We, too, are so gratified that the State did what is right,” ACDL Staff Attorney Sarah Kader said in a news release. “Medicaid requires that medically necessary services for children be provided, even if that requires contracting outside the network.

“Children getting the services they need, and in this case, food to live, could not be more important. In fact, it is the most basic need any of us have. We are ecstatic that our advocacy resulted in Kallista being able to get the nutrition she needs to grow.”

A video about the Kallista Smith’s story, from FOX 10, can be seen here.

The Arizona Center for Disability Law and Disability Rights Washington are the designated protection and advocacy agencies in Arizona and Washington, respectively, and are members of the National Disability Rights Network.