Colorado WIC Program Policies and Procedures Section: Nutrition Services Revised: 06/01/2025

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Breastfeeding: Human Milk Fortifier

Policy: Local agencies may issue human milk fortifier (HMF) to participants with proper medical documentation to promote and support continued breastfeeding.

Regulations: CFR 246, 79 FR 12273 C (5)(f), USDA FNS WIC Breastfeeding Policy and Guidance (July 2016), Colorado WIC Policy

Procedure/Additional Guidance: Human milk fortifier (HMF) is predominantly a protein and mineral supplement, that when added to human milk boosts the calories and nutrition to better meet the needs of very premature infants. Studies have shown the addition of HMF is associated with improved growth, bone mineralization and neurologic outcomes. HMF is initiated in the hospital and may be maintained after discharge with proper medical oversight and documentation. • HMF is classified as an exempt infant formula by USDA. • For clients with Medicaid insurance, WIC staff should refer to a Medicaid Durable Medical Equipment (DME) provider to obtain requested HMF. Medicaid is the first payer for HMF in Colorado. • For clients who do not have Medicaid insurance, issuance of HMF through WIC is allowed with monthly authorization by the infant’s health care provider (provided on the Physician Authorization Form – PAF). • WIC participant must have access to a breast pump (either from or outside of WIC). • WIC participant must be provided with breastfeeding support and continued, regular follow up (ideally weekly). • Breastfeeding definition guidance: o If receiving HMF not from WIC (from other sources only – e.g., Medicaid):  If the infant is not receiving any HMF/formula from WIC, the infant's BF Description can be “Prim Excl/No Food Package”. The infant must be marked as receiving something other than breast milk and marked as receiving formula rarely (record the date HMF or any formula was started) in the nutrition interview. Choosing rarely to formula (while not entirely accurate) will allow for correct data collection of HMF start date and allow a fully breastfeeding food package to be issued. Add HMF issuance in the notes/care plan in Compass.  Mother may be considered fully breastfeeding and receive the appropriate food package. o If receiving HMF from WIC:  Since USDA classifies HMF as formula, the infant must receive a Breastfeeding Description of “Part BF” and be marked as receiving formula regularly in the nutrition interview.  The mom's food package is based on the infant's BF Description. Therefore, mom will get a Part BF Food Package.  Once HMF from WIC is discontinued, the infant’s BF Description can be changed to “Prim Excl/No Food Package” and the mother can be transitioned back to the fully breastfeeding package. • Infant must be monitored closely by their health care provider (thus require monthly PAF submitted). • HMF is most often discontinued prior to discharge and is not necessary or healthy to receive on a long-term basis. HMF must discontinue once the infant is 12 weeks post-discharge from the hospital or as indicated by the health care provider. • HMF cannot be reconstituted/fed on its own as an infant formula to provide proper nutrition, it must be added to human milk. • HMF cannot be added to formula or used in conjunction with formula “sprinkles” to fortify human milk. HMF is the preferred source of fortification for human milk as research indicates fortification of human milk with formula is inferior nutritionally to HMF. • HMF cannot be issued with other infant formula. HMF is authorized for use when a mother is, or is attempting to be, exclusively breastfeeding.

For questions or more information, refer to the Colorado Guidelines for Health Care Professionals for Human Milk Fortifier after NICU Discharge (plus mixing instructions) available on the Colorado WIC website.