Roughly 25 million Americans suffer from some form of incontinence. The good news is that Medicaid does cover incontinence supplies and bladder-control products such as briefs, pads, and pull-ons.
You can’t deny the fact that buying these incontinence supplies really puts a strain on your personal budget. That is why it is very common to ask questions like, Does Medicaid cover incontinence supplies? Or What are the incontinence supplies covered by Medicaid? After all, you just want to assure that you are enjoying the benefits of your insurance to the fullest.
How to Get Medicaid to Cover Incontinence Supplies
For you to be covered under the Medicaid plan of incontinence supplies, it must be deemed medically necessary. But, on your own, you cannot just simply state that subjectively, you need to get a prescription or certificate from your physician to make it more formal.
When applying for the coverage of incontinence supplies under Medicaid, make sure you fulfill these two Ps:
1. Paperwork
These are some kind of documents that you need to submit so that you will get that free pass coverage for incontinence supplies. Well, every Medicaid plan has a different set of requirements about the documents you need to prepare.
Generally, the documents fall under these categories:
[one_fourth_3_first]Assignment of Benefit (AOB)[/one_fourth_3_first][three_fourth_last]This document authorizes someone (most likely, your immediate family), aside from yourself to submit reimbursement claims on your behalf. This allows your medical supply company to provide you with approved incontinence supplies and send the total cost to your Medicaid plan to foot the bill.[/three_fourth_last]
[one_fourth_3_first]Certificate of Medical Necessity (CMN)[/one_fourth_3_first][three_fourth_last]This is a state document used by doctors to write down the need for incontinence supplies are indeed medically necessary. Therefore, this document establishes your need for incontinence supplies. Just make sure that the doctor filled up all the necessary information for it to be accepted.[/three_fourth_last]
[one_fourth_3_first]Letter of Medical Necessity (LOMN)[/one_fourth_3_first][three_fourth_last]Just in case, CMN is not required to submit, you need to submit a letter of medical necessity, written by your physician expressing your need for incontinence supplies upon his/her diagnosis. It entails the reasons why those supplies are needed to treat or manage your condition. Most Medicaid states will prefer this document since it is more detailed and provides a better explanation of why incontinence supplies are medically necessary. [/three_fourth_last]
[one_fourth_3_first]Medical Records[/one_fourth_3_first][three_fourth_last]These documents contain your past medical records and history such as the health care services you received and your past medical conditions. You may request this document to your physician since some Medicaid plans may review this kind of document before they approve the coverage for your incontinence supplies and other services.[/three_fourth_last]
[one_fourth_3_first]Physician’s Order (PO)[/one_fourth_3_first][three_fourth_last]This is the most common and basic document required by most Medicaid plans. This is just a prescription that states what are the incontinence supplies you need to manage or treat your condition.[/three_fourth_last]
2. Prior Authorization (PA)
To get you covered, you need to obtain first a prior authorization before the medical supplier will provide your incontinence products. This is just basically a pre-approval from Medicaid for the coverage of your supplies.
This means that you are not allowed to buy these supplies, and then you will file a claim for reimbursement, even though they are covered by your Medicaid plan.
However, this varies from state to state, so you better call first your local Medicaid office to know more about your specific plan policy, the do’s and don’ts.
List of Incontinence Supplies that are Potentially Covered by Medicaid
Now you know how to get Medicaid to assist you. But what exactly does Medicaid cover?
These are the basic incontinence supplies and products covered by Medicaid, though it varies from state to state:
- Adult briefs (Disposable briefs)
- Adult pull-ups/pull-ons (Protective underwear)
- Bladder control pads
- Booster pads
- Male guards
- Underpads (bed pads/waterproof pads)
Other Medicaid plans will cover barrier creams to help in maintaining the healthy condition of your skin, some disposable gloves, and wet wipes
Eligibility and Coverage for Incontinence Supplies may Vary by State
Remember that Medicaid programs differ from state to state; therefore, they have a different list of incontinence supplies that are considered medically necessary. Therefore, you should ask your state’s Medicaid office in regard to those matters.
The table below breaks down different states and their Medicaid plans. You can use the links to visit your local Medicaid office’s website and find out more about the coverage of your incontinence supplies.
|
STATE |
ARE INCONTINENCE SUPPLIES COVERED |
TYPE OF MEDICAID PLAN |
REQUIREMENT/S |
|---|---|---|---|
|
Yes |
Fee-For-Service |
• Must be prescribed by your doctor |
|
|
Yes |
Fee-For-Service Managed Care |
• Must be prescribed by your doctor • Children who are 3 years old and below are not covered • Requires prior authorization |
|
|
Yes |
Fee-For-Service Managed Care |
• Must be prescribed by your doctor |
|
|
Yes |
Fee-For-Service |
• Must be prescribed by your doctor |
|
|
Yes |
Fee-For-Service Managed Care |
• Must be prescribed by your doctor • Children who are 4 years old and below are not covered • Needs prior authorization |
|
|
Yes |
Fee-For-Service Managed Care |
• Must be prescribed by your doctor |
|
|
Yes |
Managed Care |
• Must be prescribed by your doctor |
|
|
Yes |
Fee-For-Service Managed Care |
• Must be prescribed by your doctor |
|
|
Yes |
Fee-For-Service Managed Care |
• Must be prescribed by your doctor • Children who are 3 years old and below are not covered • Requires prior authorization |
|
|
Yes |
Managed Care |
• Must be prescribed by your doctor • Children who are 3 years old and below are not covered • Requires prior authorization |
|
|
Yes |
Fee-For-Service |
• Must be prescribed by your doctor |
|
|
Yes |
Fee-For-Service Managed Care |
• Must be prescribed by your doctor |
|
|
Yes |
Fee-For-Service Managed Care |
• Must be prescribed by your doctor • Children who are 4 years old and below are not covered • Needs prior authorization |
|
|
Yes |
Fee-For-Service Managed Care |
• Must be prescribed by your doctor |
|
|
Yes |
Fee-For-Service Managed Care |
• Must be prescribed by your doctor • Children who are 3 years old and below are not covered • Requires prior authorization |
|
|
Yes |
Fee-For-Service Managed Care |
• Must be prescribed by your doctor • Children who are 3 years old and below are not covered • Requires prior authorization |
|
|
Yes |
Fee-For-Service Managed Care |
• Must be prescribed by your doctor • Children who are 3 years old and below are not covered • Requires prior authorization |
|
|
Yes |
Fee-For-Service |
• Must be prescribed by your doctor • Children who are 3 years old and below are not covered • Requires prior authorization |
|
|
Yes |
Fee-For-Service Managed Care |
• Must be prescribed by your doctor • Children who are 3 years old and below are not covered • Requires prior authorization |
|
|
Yes |
Fee-For-Service Managed Care |
• Must be prescribed by your doctor |
|
|
Yes |
Fee-For-Service Managed Care |
• Must be prescribed by your doctor |
|
|
No |
NOT COVERED |
NOT COVERED |
|
|
Yes |
Fee-For-Service Managed Care |
• Must be prescribed by your doctor • Children who are 4 years old and below are not covered • Requires prior authorization |
|
|
Yes |
Fee-For-Service |
• Must be prescribed by your doctor |
|
|
Yes |
Fee-For-Service Managed Care |
• Must be prescribed by your doctor • Children who are 3 years old and below are not covered • Requires prior authorization |
|
|
Yes |
Fee-For-Service Managed Care |
• Must be prescribed by your doctor • Children who are 3 years old and below are not covered • Requires prior authorization |
|
|
Yes |
Fee-For-Service |
• Must be prescribed by your doctor |
Explanation of the two types of Medicaid plans : Fee-for-service vs Managed Care
In the table above we mentioned two types of services in the “Plan” column. Here’s an explanation of what that means, and how it affects you when receiving treatment for incontinence.
Fee-for-service |
Managed Care |
|---|---|
|
This is a type of Medicaid plan wherein the healthcare providers are compensated for every health service they provided to eligible Medicaid patients. As an eligible Medicaid beneficiary, you cannot go to any medical facilities to seek medical treatment and other services unless these facilities are accredited by Medicaid. |
This is a health care delivery system offered by Medicaid, wherein the delivery of Medicaid benefits and other services are managed by a private insurance company or their managed care organizations (MCO) through contracted arrangements. Through this, the state can lower the cost of Medicaid programs to deliver better health care services to their beneficiaries. |
Difference Between these Two Plans:
The difference between these two plans is the network of coverage. For example, under the fee-for-service policy, there is no network requirement implied on this plan. This means that you can seek medical treatment for incontinence and other services to any medical facilities as long as it is accredited by Medicaid.
On the other hand, for managed care plans, there is only a network of hospitals and doctors that will provide health care. You cannot seek treatment or services outside of that network. Otherwise, it will not be covered by Medicaid.
Who are Eligible for Medicaid?
For you to gauge if you are qualified for the Medicaid’s coverage of incontinence supplies, you need to meet first the certain requirements set by your local state because each state has its own set of eligibility requirements.
However, there are some qualifications that are common and apply in all states. Medicaid coverage provides for the most common ones such as:
- Low-income family
- Persons with disabilities
- Pregnant women
- Elderly
- Medically Needy
The Medicaid program follows federal guidelines, however, the coverage may vary from state to state; therefore, the best way to know your state’s coverage is to contact your local Medicaid office.
On the other hand, there are a lot of factors that contribute to incontinence, or the so-called underlying factors. People from all ages are affected by incontinence. Therefore, another qualification to check by Medicaid is a proper documentation of the underlying condition.
Conclusion
Incontinence is certainly inconvenient, but luckily Medicaid will cover the cost of your incontinence supplies in most cases.
We’ve listed the documents you need to submit to your Medicaid office, as well as the list of incontinence supplies that are typically covered.
Have you had a successful experience applying for Medicaid coverage of your incontinence supplies? Tell us how you did it in the comments!
