How To Get Incontinence Supplies Covered By Medicaid – Medicaid is a joint federal and state health insurance program that runs throughout the United States of America and covers children and adults with low income or disabilities. As of February 2024, nearly 13 million people in America are receiving comprehensive healthcare coverage through the Medicaid program that covers most medical supplies and services. A few Medicaid programs also provide coverage for incontinence products. However, the specifications may vary by state and territory. If you are one of the 13 million people in the USA who are living with incontinence, then you have amazing news. In this comprehensive guide, we will help people answer the most frequent question of ‘How to get incontinence supplies covered by Medicaid’ and will shed light on how you can qualify for these supplies.
Highlights of this Post
Key Takeaways
- Medicaid provides coverage for medically necessary incontinence supplies, which may include diapers, pull-ups, and pads, with specifics varying by state.
- Eligibility for incontinence supply coverage requires a valid prescription, proof of Medicaid eligibility, a medical necessity, and income constraints.
- Incontinence supplies covered by Medicaid can range from adult diapers to bladder control pads, each designed to provide comfort and maintain hygiene.
- Documentation such as a doctor’s prescription, medical records outlining the need for incontinence supplies, and a letter of medical necessity is required for coverage.
- The coverage for incontinence supplies varies by state, with different Medicaid programs having their own set of rules and approved product lists.
What Are Incontinence Supplies? Different Types Of Incontinence
Urinary incontinence refers to involuntary leakage from the bladder that can happen to anyone at any age; however, it is common in young infants and elderly people who are 50 years old. Urinary incontinence is a result of various health conditions such as dementia or cerebral palsy including Alzheimer’s disease.
As per statistics nearly 13 million people in America are living with urinary incontinence. Unfortunately, most of the state’s Medicaid programs provide full or partial coverage for medically necessary incontinence products like diapers for babies, toddlers, adolescents and adults. The coverage requirements and the program specification may vary from state to state and territory.
Types of Incontinence
Here is the list of five types of urinary continents that require medical attention:
- Stress incontinence due to bladder pressure from activities like sneezing, coughing, pregnancy or exercise and causes involuntary leakage of small amounts of urine.
- Urge incontinence caused by a bladder spasm called overactive bladder is a common neurologic issue or irritation and causes a strong urge to urinate that cannot be controlled until reaching the bathroom.
- Mixed incontinence that includes involuntary leakage of urine due to a combination of urgent stress incontinence.
- Overflow incontinence that rises due to neurologic impairments or multiple studios and causes urine leaks.
- Functional incontinence that includes arthritis, injury, restricted mobility or disability due to bladder leaks due to environmental or physical barriers.
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Are Incontinence Supplies Covered By Medicaid?
Yes, most Medicaid programs provide some type of coverage for incontinence supplies that are deemed medically necessary for babies, toddlers and adolescents, including adults. The coverage requirements, as well as the program guidance, may vary depending on the state and territory you are living in. The Medicaid program covers diapers and incontinence products for children who are older than 3 or 4 and younger than 21 years through the Early And Periodic Screening Diagnostic and Treatment Plan.
Conditions Associated With Incontinence
There are a wide variety of medical conditions that contribute to incontinence. The most common conditions that make incontinence supplies deemed medical necessity for individuals include the following
- Overactive bladder
- Stroke
- Obesity
- Parkinson’s disease
- Dementia and Alzheimer’s
- Stroke
- Prostate issues
- Spinal injury
- Cerebral palsy.
Are you curious to know How & When To Renew Molina Medicaid Coverage For Free Diapers In Washington? Then take a look at our next guide to learn all insights.
What Types Of Incontinence Supplies Can Medicaid Cover?
Most state Medicaid programs address incontinence that requires different supplies for different individuals depending on their health conditions. This is the reason why many Medicaid programs cover a variety of incontinence products and provide full or partial coverage for the following incontinence supplies:
Diapers/ Disposable Briefs For Adults
Adult diapers and briefs are designed for absorbance and description, and such undergarments come in different sizes with secure fasteners and tab enclosures to provide comfort and convenience.
Male Guards
They are designed for the male anatomy, and such absorbent pads lock up witnesses and allow the skin to breathe.
Bladder Control Pads And Liners
Bladder control pads and liners are designed for odor shielding and dryness, and such absorbent bad designed to be used inside regular underwear with adhesive strips for secure placement and order shield and advanced dermatology technology for confidence and skin protection.
Disposable/ Protective Underwear Known As Pull-Ups or Pull-Ons
Protective underwears and pull-ups are convenient under governments that are similar to adult diapers and come with a stretchable size and cloth-like backings.
Underpants And Bed Pads
Underpants and bed pads provide overnight mattress protection. These are large absorbent pads that are used for couches, chairs, car seats and surfaces that require a barrier from potential leakage.
Wipe And Washcloths
Even though wipes and washing clothes do not address incontinence directly, they play an integral role in maintaining personal care and hygiene routines.
Skin Care Product
A few Medicaid programs cover powders, creams and other products that protect skin from the damaging effects of incontinence. Apart from these types of incontinence supplies, many supplies are covered by the Medicaid program, and the brand and amount may vary depending on the program.
Want to know whether incontinence supplies are covered by Healthy Connections Medicaid in Idaho? Head to our next guide here.
What Are The Eligibility Criteria To Get Incontinence Supplies Through Medicaid?
Following is the list of eligibility criteria required to obtain free incontinence supplies through the state Medicaid plan.
- Must have a valid prescription from your healthcare provider for incontinence applied for the individuals in question and details of the type of incontinence supplies needed, including the quantity every month.
- Must be eligible for the Medicaid program.
- Must have income at or below 133% of FPL depending on your state of residence.
- Must have a medically based need for incontinence supplies and the healthcare provider must confirm the medical necessity.
- There must be a medical condition diagnosed by a licensed healthcare provider as well as documents in the form of medical records that cause mild to severe incontinence.
What Paperwork Do You Need To Qualify For Incontinence Supplies Through Medicaid?
Irrespective of which incontinence products are covered, most Medicaid plans require some form of documents that show the medical necessity of the product. Following is the list of documents that you need to submit to your insurance provider to receive the coverage:
- Physicians’ order is most commonly used by Medicaid programs to determine the coverage eligibility for incontinence products. The prescription must outline your specific medical condition and incontinence supplies needed for further treatment
- Assignment of Benefits authorizes the medical supply companies to submit the reinstatement claims on your behalf.
- Letter of medical necessity from your healthcare provider to explain why you need incontinence supplies and details of your medical condition, including the products that you need depending on your condition and what quantities to manage the condition.
- Medical records or documents that comprises recorded medical history to approve coverage for incontinence supplies
It is critical to know that prior authorization may be required before the incontinence products have been received to qualify for the coverage. You will not be able to purchase the products out of your pocket and request reimbursement even if the items are covered by your plan. Even though not every Medicaid plan needs prior authorization, it is important to find out what your specific medication blend requires before making a purchase.
The documentation requirements are similar for parents who How Molina Cover Adult Diapers In Washington.
Step-By-Step Process To Get Incontinence Supplies Covered By Medicaid
Medicaid, being a joint federal and state program, has different rules and coverage in different states. The process of obtaining coverage for diapers and incontinence products in your state of residence may not be the same in other U.S. states. Following is the step-by-step process that will help you to seek your coverage for incontinence supplies.
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Verify Medicaid Coverage
You can check with your state’s Medicaid program to decide whether you are covered or not and if so what are the coverage options for diapers and incontinence supplies. It is important to remember that Medicaid coverage has different names in different states, for instance Community Health Plan of WA, PacificSource, Blue Cross Blue Shield, Molina, Trillium and so on.
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Obtain A Doctor’s Prescription
The Medicaid Program requires a prescription from your healthcare provider or doctor to cover the incontinence supplies. The doctor’s prescription must specify the type of incontinence supplies required depending on your health condition as well as the quantity required every month.
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Gather Relevant Documents
Your doctor or healthcare provider needs to submit relevant documents to verify your medical necessity for the incontinence supplies. This includes medical records, prescription for the incontinence products and a letter of medical necessity outlining your medical condition and why the supplies are important for your well-being and health.
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Find An Approved Supplier Of Incontinence Products
Not every incontinence product supplier accepts Medicaid coverage, so you need to find an approved product supplier. Make sure the supplier can work closely with you to help with the paperwork and process. Submit the relevant documents to the Medicaid provider for approval.
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Understand The Coverage Limit And Renew If Required
You need to get familiar with the limits to your Medicaid coverage for any incontinence supplies such as limits on monthly product amount or type of products that are covered. You can revisit the covered list every year to make sure the incontinence products are covered under your state’s Medicaid plan. The Medicaid may require periodic reevaluation of your medical need for incontinence supplies.
You can learn more about whether the popular insurance provider Trillium covers diapers In Oregon.
list of states or territories that provide incontinence supplies
To learn more about Medicaid coverage options for incontinence available in your area you need to reach out to your state’s Medicaid office. They can provide your credit information on the eligibility, authorization and documentation based on your plan and state.
The following is the list of states or territories that provide incontinence supplies for eligible enrollees who are 21 or older in age.
- Alaska
- Arizona
- Arkansas
- California
- Colorado
- Connecticut
- Delaware
- District of Columbia
- Florida
- Hawaii
- Idaho
- Illinois
- Indiana
- Iowa
- Kansas
- Kentucky
- Maine
- Maryland
- Massachusetts
- Michigan
- Minnesota
- Mississippi
- Missouri
- Montana
- Nebraska
- Nevada
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Rhode Island
- South Carolina
- South Dakota
- Tennessee
- Texas
- Utah
- Vermont
- Virginia
- Washington
- West Virginia
- Wisconsin
- Wyoming.
The states or territories that do not cover any incontinence supplies for enrollees who are more than 21 years old are:
- Alabama
- Georgia
- Louisiana.
Our next guide will answer the most frequent question among many Medicaid Recipients: Does UnitedHealthcare Cover Incontinence Supplies In Washington?
How Many Free Incontinence Products Are Covered By Medicaid?
Free incontinence products through Medicaid are available in Washington, Oregon, Idaho and many other states throughout America. The amount that you get for free depends on your state of residence, whether you are looking for adult or pediatric diapers and whether you are eligible for an exception to the rule based on your medical condition.
Washington
In the state of Washington Medicaid generally covers:
- 200 free disposable adult diapers every month for those who are 3 and up
- 200 free briefs or pull-ups for those 3 to 18 years old per month
- 200 free pads, guards and pant liners per month
- 150 free briefs or pull-ups for those 19 and up per month
- 100 pairs of disposable gloves per month.
Idaho
In the state of Idaho Medicaid program generally covers:
- 240 free disposable diapers per month irrespective of the age
- 240 free briefs or pull-ups per month irrespective of the age
- 150 free under pads per month
- 50 pairs of disposable gloves per month.
Oregon
In the state of Oregon Medicaid generally covers:
- 200 free disposable diapers per month irrespective of your age
- 200 free briefs or pull-ups per month for any age
- 200 free pads, guards and pant liners per month for any age
- 500 pairs of disposable gloves per month
- 100 free underpants per month.
This comprehensive guide will not only help you learn how to get free diapers from Medicaid but also how many free diapers are covered by Medicaid?
What Are The Other Ways To Get Free/ Low-Cost Incontinence Products?
In case your Medicaid program does not cover incontinence products that you need, or if you require supplies that exceed the permissible items or maximum dollar amount, then you must look for assistance elsewhere.
You can check with food banks, diaper banks and community organizations that provide low-cost or free incontinence products. They often offer incontinence supplies and adult diapers for those in need:
- Veterans can seek assistance from the US Department of Veterans Affairs, which covers incontinence products. Active duty military members, veterans and their families are eligible for incontinence supplies through Tricare ECHO (Extended Care Health Option).
- Older adults enrolled in the Program of All-Inclusive Care for Elderly Programs or PACE can get diapers and incontinence supplies covered through this initiative.
- National Diaper Bank Network offers free diapers and incontinence supplies to those in need.
- Even though the original Medicare program does not cover incontinence products or diapers, the Medicare Advantage plan can help you in case you are diagnosed with permanent urinary retention or permanent urinary incontinence. Medicare Part B offers coverage for urological supplies such as external urinary collection devices and urinary catheters.
Readers can have a look at our comprehensive guide to learn how PacificSource OHP Cover Diapers & Incontinence Supplies In Oregon.
Conclusion
To sum up, most Medicaid programs provide some type of incontinence products for babies, toddlers, adolescents and older adults. These supplies are considered medically necessary by healthcare providers. The coverage requirements may vary depending on your state or territory. Generally, you need to have a physician’s prescription along with the qualifying medical diagnosis that requires prior authorization. A lot of Medicaid programs like Washington, Oregon, and Idaho will limit the number of incontinence supplies and diapers you can order along with your monthly spending. We hope this guide has been helpful to you and provided all the insights needed to know how to get incontinence supplies covered by Medicaid.
You can go through our blogs at Get Government Grants to avail free resources and government programs for low-income families. Our guide has numerous supportive programs and names of organizations that help people in times of need.
