Why Are So Few TennCare Moms Getting Lactation Help?

We finally made progress in 2023 when TennCare updated its policy to include lactation services for members. That sounds like a win—but the reality is far more complicated and disappointing.

TennCare proudly stated in its FY24 report that 26 lactation consultants were enrolled, and that the MCOs are actively recruiting more. But here’s what they didn’t say:

🔍 The Numbers Tell a Bigger Story

• In 2020, Tennessee had 89,000 pregnancies — or about 7,416 per month.

• Roughly half of these are covered by TennCare → that’s ~3,700 pregnant people monthly.

• According to TennCare’s own report, only 157 members/month got lactation help in 2024.

• That’s 4% access — or fewer than two people per county.

Why so few? Because TennCare only lets IBCLCs enroll if we are also licensed as an RN, MD, PT, or SLP. But lactation is its own board-certified profession, and Tennessee does not offer us independent licensure.

That means private-practice IBCLCs — many of whom are the most accessible, affordable, and community-rooted providers — are excluded.

The page of the 2024 Tenncare Annual Report highlighting the lactation support services program.

💬 My Story

I’ve been an IBCLC since 2013. I’ve helped thousands of families in East Tennessee. I’ve begged TennCare for years to allow me to join their network. But every time, I was told no. First no was at the statewide TIPQC meeting, and being told by the Tenncare medical director that there was no money to pay for breastfeeding help. Next was the crazy run around I received with Tenncare telling me to get the okay from an insurance company before Tenncare would issue a Medicare ID and the insurance company saying yes once Tenncare issued the Medicare ID. Next came the patronizing "go work for a pediatrician or ob/gyn" which would have resulted in a significantly reduced hourly wage. And the biggest no has been this policy of requiring licensure to provide breastfeeding help. They did include a provision for non-licensed IBCLCs - we could work for a licensed provider.

That’s not sustainable. That’s not ethical. And it’s not how we improve public health outcomes.

I would gladly serve TennCare clients. In fact, I feel it is my obligation to do so. But the current system makes it impossible — and that’s not just my story. It’s a statewide barrier to care.

🧭 What Needs to Change

• TennCare must allow IBCLCs to enroll based on their own credential — not require additional licensure.

• Licensure might be a solution as it has been in other states but is a cumbersome solution. If that is truly a barrier to care, Tennessee must consider an independent licensure pathway for IBCLCs,

• We must stop letting red tape stand in the way of mothers feeding their babies.

Let’s be real: when we restrict care providers, we restrict care. And when insurers and agencies limit access from the top down, families suffer at the bottom.