Breastfeeding improves health for both infants and mothers. Experts agree that exclusive breast milk feeding is optimal nutrition for the first six months of life. It reduces medical costs, yet Texas continues to face persistent disparities in breastfeeding rates and access to care. CDC’s 2022 National Immunization Survey–Child (NIS-Child) data show 85.7% ever breastfed. This drops to 62.1% of infants at six months. In 2022, US data shows that 47.6% of infants are exclusively breastfed for three months. However, only 27.9% are exclusively breastfed for six months. In Texas, 83.4% ever breastfed. This drops to 57.9% of infants at six months (CDC, 2025). Exclusive breastfeeding rates in Texas are also lower than national rates. Only 43.0% of infants are exclusively breastfed for three months and 26.4% for six months (CDC, 2025).

In 2024, survey data shows that Texas hospital maternity practices fall behind national benchmarks (CDC, 2025). Families often face challenges like inconsistent or absent health coverage, limited paid leave, and fewer lactation providers. Until 2025, families on Medicaid mainly turned to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program for clinical lactation support. House Bill 136 passed in the 89th Texas Legislature. Now, the Health and Human Services Commission must set up Medicaid reimbursement for lactation consultants. This change could help more people access evidence-based lactation care. The success of this policy relies on clear reimbursement pathways, provider readiness, and addressing the disparities that continue to limit breastfeeding outcomes in Texas.

The Texas Lactation Consultant Landscape Analysis gives a statewide look at lactation consultant access and availability. It also explores barriers to accessing care. The results provide a clear picture of the lactation care landscape in Texas, including:

• Highlighting where and how lactation consultants serve families across different settings.
• Pinpoint the main challenges and opportunities that affect Medicaid reimbursement for lactation consultant services.
• Amplify provider input to shape state
• Improve communication with managed care
• Ensure systems are ready for successful

Findings from surveys, interviews, and policy reviews show that Texas faces critical shortages in both access and reimbursement systems for lactation services. These challenges fall hardest on rural communities and families with limited resources.

Key Findings

• Provider Landscape: Texas has an uneven distribution of International Board Certified Lactation Consultants (IBCLCs), with many counties lacking access Hospital-based consultants dominate the field, while fewer are in community or outpatient settings.
• Barriers to Participation: Surveyed IBCLCs cited unclear Medicaid enrollment pathways, inconsistent billing codes, and lack of credentialing as reasons for not pursuing reimbursement. Interviewees raised concerns about low pay, unclear guidance from Managed Care Organizations (MCOs), and administrative
• System Gaps: Families often rely on WIC clinics or hospital discharges for care, but few pathways exist for follow-up or continuity. Without coordination between Medicaid, WIC, and private providers, families face delays, fragmented care, or no care at all.
• Clinical Urgency: Delayed access to care harms breastfeeding outcomes. Medicaid infants in Texas—nearly 190,000 per year—may miss the early intervention window without timely outpatient lactation

Recommendations for Implementation of HB 136

To ensure the success of HB 136, Texas should take short-term actions that reduce barriers and encourage IBCLC participation in Medicaid:

• Create clear billing pathways: Provide public-facing resources that outline Medicaid enrollment, billing, and documentation for MCOs should align on codes and modifier use.
• Support dyad-based care: Design policies that cover both mother and infant during lactation visits. Reimbursement should reflect the clinical intensity of care, including longer initial visits and hybrid or telehealth
• Address the workforce gap: Texas should invest in IBCLC training pathways, support preceptorships, and encourage bilingual and bicultural recruitment. Encourage MCOs to support provider training and
• Track impact: Require MCOs to monitor access by region, language, and payer. Use data to adjust caps, prior authorization rules, and visit

Access the full report to learn more!