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Unlocking the Benefits: How Medicaid Covers Incontinence Supplies for Millions of Americans!

Unlocking the Benefits: How Medicaid Covers Incontinence Supplies for Millions of Americans!

 As you may already know, Medicaid is a public health insurance program in each state for individuals and families who may be low-income, elderly, disabled, blind, or have some other uncommon problem. Medicaid programs provide health insurance coverage or long-term care services for over 76.3 million Americans. It is the largest single source of health coverage in the U.S., accounting for about 16% of the government’s healthcare costs. This program is designed to allow those who qualify for access and coverage to receive medically necessary products (including incontinence supplies, urological supplies, and other medical supplies), healthcare or other care services.

This blog will focus on Medicaid benefits for incontinence supplies.

The categories of people who are designated to receive Medicaid benefits are individuals with disabilities, low-income families, and low-income older adults. The bulk of Medicaid program costs goes to long-term and acute care costs for older adults and individuals with disabilities.

Every state has their own set of rules defining who may have this public health insurance provider. However, all states adhere to the Affordable Care Act, which requires states to use modified adjusted gross income (MAGI) or the income eligibility for Medicaid. MAGI takes into account income/tax relationships to determine who is eligible for Medicaid coverage.

The Medicaid insurance provider program is a partnership between the U.S. Federal Government and local state governments; therefore, the federal government sets eligibility and benefit requirements, and the states administer the Medicaid program with minimal flexibility under guidelines set by the federal government.

The U.S. Department of Health and Human Services has many resources to help you figure out your eligibility for Medicaid: 

First, find out if your state is expanding Medicaid and learn what that means for you. If your state is expanding Medicaid, use this chart to see what you may qualify for based on your income and family size. Even if they told you that you didn’t qualify for Medicaid in the past, you could qualify under the new rules. You can see if you qualify for Medicaid 1 of 2 ways: 

Fill out an application in the Health Insurance Marketplace. When you finish the application, we’ll tell you which programs you and your family qualify for. To quickly determine if you qualify for Medicaid, you can visit Healthcare.gov and use its Medicaid calculator to input income information to determine if you may qualify to have your incontinence products, urological supplies or related medical supplies covered under the Medicaid benefit.

Challenges of Medicaid Benefits for Getting Incontinence Supplies

One of the hardships with Medicaid is determining what is not covered under a Medicaid plan, such as incontinence resources. Because of the different types by state, there is a lack of concise documentation on medical services and also support, including incontinence supply coverage. Also, frequent changes to coverage/benefits can create a headache for those receiving Medicaid, who more than likely struggle to know all that is covered and how to make the most of their benefits. Generally, Medicaid covers medically necessary treatments, services or products for individuals who may be low-income, elderly, disabled or blind.

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 A common question we receive is “can Medicaid cover adult diapers, pull-on underwear, bladder control products or other incontinence supplies”

The short answer is yes; your local Medicaid programs typically cover medically necessary incontinence supplies, such as boosters, adult diapers (also known as disposable briefs), pull-on underwear and underpads, some youth products, for specific Medicaid recipients. But there are some important insurance provider rules and requirements you need to know.

Medicaid and Incontinence Supplies

Incontinence supplies are covered for elderly, disabled or children that have complex healthcare needs. Incontinence supplies benefits under Medicaid typically start for children with complex healthcare needs at age of 3-4, which is the age when children usually develop self-toileting skills.

To receive incontinence supplies through Medicaid, the recipient has to have at least one of the following:

  • Physician’s prescription with a qualifying diagnosis
  • Prior Authorization (PA)
  • Letter/Certificate of Medical Necessity (LMN)

When looking for a medical diagnosis from a physician, the best option may be to request medical records, including a detailed prescription or letter from your physician that indicates the common diagnosis, the medically necessary product type required to treat said medical condition and the estimated number of incontinence care products needed per day.

What Incontinence Supplies Are Covered?

Similar to how Medicaid incontinence benefits are different from state to state, the types of incontinence products, types, and brands that are covered under Medicaid also vary by state. Many states cover youth diapers and offer generic incontinence products brands; some may cover only pull-on underwear and adult diapers style briefs. Most states cover some combination of disposable briefs, pull-on underwear, bladder control products, reusable/disposable underpads, and other medically necessary incontinence products.

‘Boost’ Protection with Medicaid-Covered Booster Pads

If you, someone you care for, or a family member are currently wearing medical incontinence products covered by Medicaid, such as adult diapers/disposable briefs or pull-on underwear, yet are still experiencing leakage, uncomfortable witness, or odors, booster pads may be a great way to “boost” your protection. Booster pads are a type of bladder control pads, which continue to grow in popularity as individuals and caregivers are learning how they can make incontinence care more manageable. Plus, just like other incontinence care items, they are usually covered under Medicaid in most states.