Getting incontinence supplies covered by Medicaid is essential for patients who are in need of these services. Incontinence supplies are important non-durable medical products but they are never covered by Medicare except during hospitalization. They are often covered by most state's Medicaid programs under certain circumstances. Yet, each state has different guidelines and finding the exception to those guidelines is tricky. There are limitations that states put on incontinence supply costs per patient and stated requirements that must be part of each prescription for incontinence supplies. In addition, when someone is over the income level for Medicaid, there are specific ways to go about gaining Medicaid-approved coverage for incontinence supplies. Incontinence supplies are an important part of improving the quality of life for patients and their caregivers. Here are important considerations when pursuing how to get incontinence supplies covered by Medicaid.
In general, the answer is maybe. While Medicare may cover the cost of adult diapers if you or a loved one are admitted to a hospital or rest home, Medicaid will generally cover bladder control supplies without hospitalization. This of course, varies from one state to the next, so it is important to check with your state's Medicaid office.
Many states have imposed a limit on how the cost of incontinence supplies that they will pay for per patient in a given month. This is not true of all states. For example, Tennessee began limiting incontinence supplies in 2014.
You will need a prescription from your doctor that specifies that specified your incontinence type. For example, light bladder leakage is different from full incontinence. The prescription will need to spell out your incontinence diagnosis so that Medicaid can evaluate your eligibility. The actual requirements vary by state so be sure to check with your local Medicaid office. Most states require that in addition to the diagnosis that there be a time limit or duration of need, a specific product type, and how often the product should be used.
In most states, the answer is yes. Medicare will also usually cover catheters. In both situations, a prescription is needed by your doctor. Many states limit the type or brand of catheters that they will approve. It is important that your prescription list the type of catheter that you need.
In most states, one of the requirements for coverage is the impairment of the person's ability to perform their ADLs - Activities of Daily Living. What this means is that a person with limited mobility may qualify for pull up briefs if the product helps them maintain their independence. Those sorts of considerations need to also be spelled out by the doctor when they write the prescription or as part of an ongoing case evaluation.
All is not lost if you are over the income level for Medicaid. The best place to turn in this situation is to your state's Medicaid planning professionals at your state's Medicaid office. Be prepared to show that you cannot afford your cost of care, including incontinence supply costs. This is true for states that have an income cap and for those with that are spend down states.
No, Medicaid will only pay for incontinence supplies when they come from an authorized Medicaid supplier. These are companies that are registered with Medicaid. If you buy incontinent supplies from a non-authorized provider you will not be reimbursed and will have to pay out of pocket.
In most states, they are covered. However, they must meet specific criteria. Those include a valid diagnosis without improvement through bowel and bladder training programs. The incontinence must also be caused by an approved medical condition.