MedicaidCoverageMedium impact
Electric Breast Pump Change in Benefit Frequency without Prior Approval
Illinois Medicaid - HFS·IL · OB-GYN, Family Medicine, Pediatrics +1 more·Provider Notice
Effective date
Jan 1, 2024
We identified it
Jun 20, 2026
Summary
Illinois Medicaid has increased the benefit frequency for electric breast pumps from one every 5 years to one per year without prior approval, effective January 1, 2024. Additional pumps within the same year will still require prior authorization.
Action Required
Immediately: Billing team must update authorization requirements for electric breast pump claims. Remove 5-year frequency limits and allow one pump per year without prior auth for Illinois Medicaid patients. Ensure prior authorization is still obtained for any additional pumps requested within the same year. Update billing system rules and staff training materials.