1. Introduction Breastfeeding promotion is currently a significant focus of national health policy. In January 2011, the U.S. Surgeon General’s Call to Action to Support Breastfeeding was released, which summarizes the research and benefits of breastfeeding. In addition, the Patient Protection and Affordable Care Act (ACA) provides states with additional opportunities to strengthen breastfeeding support. State maternal and child health agencies use Title V to support breastfeeding by developing and disseminating breastfeeding resources, and partnering with others including state chronic disease departments, home visiting programs, WIC, policymakers, employers, and hospitals. Breastfeeding Provisions in the ACA New insurance plans required to provide coverage for preventative health services, including breastfeeding support, supplies and counseling Support for community efforts to promote breastfeeding, such as Best Fed Beginnings, an initiative designed to help 90 hospitals nationwide obtain baby-friendly designations Requires employers to provide reasonable break time, and a private (non-bathroom) area to allow nursing mothers to express milk Methods An environmental scan was performed of the Health Resources and Service Administration (HRSA) Title V Information System to understand where work was being done on implementation of the ACA’s breastfeeding provisions. Five states that have implemented innovative strategies to promote breastfeeding were selected, and leaders from each state Title V agency were interviewed for further details. An issue brief was published in December 2013, which highlights the results. Nebraska Distributed information about changes to the Fair Labor Standards Act to more than 4,200 businesses Offered assistance and guidance for businesses, including examples of breastfeeding friendly worksites Worked with partners to develop recommended room layouts for businesses North Carolina Established designation for childcare centers Adapted HRSA Business Case for Breastfeeding, distributed to businesses Proposed a benchmark definition of lactation support and counseling for IBCLC coverage New York Using Community Transformation Grant funding (ACA) to help hospitals achieve Baby Friendly status Created a state plan amendment requiring reimbursement for lactation counseling by IBCLCs Established minimum breast pump standards Oregon Health Authority provides a free employer packet to help employers become “Breastfeeding Mother Friendly” A leader in ensuring workplace accommodation for breastfeeding women, the federal law was modeled after Oregon law Provides technical assistance to employers to implement Breastfeeding Friendly Hospitals Home Visiting Breastfeeding Childcare Centers Friendly Worksite Accommodations Dissemination of information Changes to Medicaid Legend Legislation California All general acute care hospitals with a perinatal unit must have an infant feeding policy that is clearly posted and routinely communicated to all staff All general acute care and special hospitals with a perinatal unit must adopt the “Ten Steps to Successful Breastfeeding” by January 2025 Using the Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) to collect breastfeeding duration data Building Innovative Collaborations in Breastfeeding Promotion: How States are Leveraging the ACA and Title V Association of Maternal & Child Health Programs Carolyn Mullen; Carolyn McCoy, MPH