Human Milk from a Licensed Tissue Bank is a Covered Benefit
| Date: | April 22, 2026 |
| From: | Health Plan of San Joaquin/Mountain Valley Health Plan (“Health Plan”) |
| To: | Health Plan OBGYNs, Pediatricians, Hospital NICUs, and Doulas |
| Type: | Regulatory |
| Subject: | Human Milk from a Licensed Tissue Bank is a Covered Benefit |
| Business: | Medi-Cal Managed Care |
The Department of Managed Health Care (DMHC), Office of Planning Licensing (OPL) issued All Plan Letter (APL) 24-023, Newly Enacted Statutes Impacting Health Plans (2024 Legislative Session) on December 20, 2024. This APL outlines newly enacted statutory requirements for health care service plans regulated by the DMHC.
While several newly enacted statutory requirements have been outlined, the focus of this alert is specific to AB 3059 – Human Milk. This assembly bill, codified in Health and Safety Code § 1367.624, 1635.1 and 1648, effective January 1, 2025, specifies that the provision of medically necessary pasteurized donor human milk obtained from a tissue bank licensed pursuant to Chapter 4.1 (commencing with Section 1635) is a basic health care service.
This service is a Health Plan covered benefit. Prior authorization is not required for medically necessary pasteurized donor human milk under AB 3059 and claims for this service follow Health Plan’s normal claims adjudication and processing workflow.
For the full text of DMHC APL 24-023, please visit the following link: https://www.dmhc.ca.gov/Portals/0/Docs/OPL/APL24-023(OPL)-NewlyEnactedStatutesImpactingHealthPlans(2024LegislativeSession)_1.pdf.
For additional guidance on human milk, please visit the Medi-Cal Provider Manual at the following links:
If you have any further questions, please contact your Provider Services Representative, or call our Customer Service Department at 1-888-936-PLAN (7526). You may also visit https://www.hpsj.com/alerts/ for online access to the documents shared. The most recent information about Health Plan and our services is always available on our website www.hpsj-mvhp.org
