After four years running breastfeeding support groups and training to get her lactation consultant certification, Beth Waters was excited in 2020 to launch a nonprofit in a small city east of Portland.

Oregon appeared to be a prime location: The state had decided that year to make lactation consultants, who teach parents how to breastfeed and overcome complications, eligible to bill Medicaid. The change was meant to increase access to breastfeeding assistance among groups who more commonly struggle to start or continue, including women of color and low-income parents .

But only two years later, she had to close the nonprofit. Though she was eligible to bill Medicaid, Waters’ claims for reimbursement were constantly rejected by local organizations administering Medicaid benefits. Beca

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