Supporting Premature Infant Nutrition Act of 2025

Summary

Requires Medicaid and CHIP plans to cover human milk fortifier for eligible infants and bars any cost-sharing for that product beginning January 1, 2026. It defines covered “human milk fortifier” as a donor human milk–derived specialty nutritional product for infants under one year when a qualified clinician determines it is medically necessary for prematurity, low birth weight/insufficient growth, or certain congenital/acquired conditions.

• Creates a new Medicaid and CHIP covered benefit for human milk fortifier, effective January 1, 2026.
• Prohibits any Medicaid or CHIP cost-sharing, copayments, or similar charges for the product.
• Defines human milk fortifier as donor human milk–derived specialty nutrition for infants under 1 year when medically necessary.
• Limits medical necessity to prematurity (≤34 weeks), low birth weight (<1,800 grams) or current poor weight, or certain congenital/acquired conditions.
• Requires State Medicaid plans, medically needy coverage, and benchmark/alternative benefit plans to include the product.
• Specified clinicians (MD, NP, PA, RD, or other authorized professional) must determine medical necessity.
• Will require state plan amendments, updates to benchmarks and managed care contracts, and operational changes for claims and coverage.
• Eliminates out-of-pocket costs for eligible families covered by Medicaid/CHIP for this product.