Purchasing incontinence supplies can be a financial burden, especially for seniors and disabled individuals living on a fixed income. Many people don’t realize that most Medicaid plans cover incontinence supplies like pads, briefs, and guards.
If you’re one of the 13 million people in the US who are living with incontinence, this is great news! In this guide, we’ll explain how Medicaid benefits can help you get some or all of your incontinence supplies for free, depending on your state’s requirements. Here’s what you need to know!
Does Medicaid Pay for Incontinence Supplies?
Yes, Medicaid does pay for incontinence supplies in many cases. The first step to getting incontinence supplies on Medicaid is to qualify for coverage. Although this program is funded by the federal government, qualifications and coverage guidelines are set by individual states.
The program is designed to provide health coverage, long-term care services, and certain medical supplies to individuals and families who are low-income, elderly, disabled, blind, or pregnant. However there may also be special programs available with different benefit requirements, depending on the area where you live.
For example some states offer special programs called “Spend-Down Programs,” for individuals with especially challenging medical conditions, even if their assets are higher than the maximum eligibility limits determined by the state.
Medicaid Plans That May Cover Incontinence Supplies
There are two basic Medicaid plan types that may cover incontinence supplies. The first is called “Fee-For-Service.” Individuals on this plan can go to any healthcare facility that accepts Medicaid and use their benefits to get treatment.
The other is called a “Managed Care Plan.” Managed Care Plans are managed by private insurance companies who contract with the state. Generally, individuals on these plans will need to work with doctors and healthcare facilities within their specific network.
In addition to the basic “Fee-For-Service” and “Managed Care Plans”, individuals under 21 may be able to apply for the “Early and Periodic Screening, Diagnostic, and Treatment comprehensive care program”. This benefit provides screening and treatment to identify medical concerns early and may cover incontinence supplies in some cases.
Incontinence Supplies Covered By Medicaid
So, which incontinence supplies are covered by Medicaid? While coverage depends on your individual state, 45 states plus Washington, DC, do offer some level of coverage for absorbent incontinence supplies.
Some of the incontinence products that could potentially be covered include:
How Medicaid Incontinence Supplies Coverage Works
In order to get your incontinence supplies covered by Medicaid, they must be considered “medically necessary.” This means that they are considered essential for managing or treating a specific health condition.
Medical necessity is determined by your doctor, and each policy has different guidelines for which products qualify. For help understanding how coverage works with your specific plan, reach out to your Medicaid case manager.
Documentation Requirements
Regardless of which products are covered, all Medicaid plans will require some form of paperwork that shows the medical necessity of the product. These documents must be submitted to the insurance provider to receive coverage.
Generally, the documents required fall into one of these categories:
- Physician’s Order (PO): A Physician’s Order is the most common document used by Medicaid to determine coverage eligibility for incontinence care. Essentially it’s much like a prescription that outlines the specific incontinence supplies required for treatment.
- Certificate of Medical Necessity (CMN): A Certificate of Medical Necessity is a state document that establishes the medical necessity of incontinence supplies and other products. They are filled out by your physician and each state decides which information will be required.
- Assignment of Benefits (AOB): An Assignment of Benefits authorizes medical supply companies to submit reinstatement claims on your behalf. With this document the company sends your supplies to you and bills your Medicaid plan for the cost.
- Medical Records: As you’re probably aware, medical records are documents that contain your recorded medical history. They are provided by your doctor. Some Medicaid plans require a review of your medical records in order to approve coverage for incontinence supplies.
- Letter of Medical Necessity (LOMN): A Letter of Medical Necessity is slightly different from a Certificate of Medical Necessity, but it is also written by your doctor to explain why you need incontinence supplies. It details your condition, what products and at what quantities are medically necessary for managing your condition.
Once again, the documents required will vary based on your coverage plan. Some will require a combination of documents, while others will only require one or two. The best way to understand what paperwork is needed is to reach out to your doctor or Medicaid case manager.
Prior Authorization
It’s important to know that prior authorization may be required before the products are received in order to qualify for coverage. In other words, you may not be able to purchase the products out of pocket and then request reimbursement, even if the items are covered by your plan.
Although not every Medicaid plan requires Prior Authorization, it’s essential to find out what your specific plan requires before making a purchase.
State-By-State Medicaid Coverage for Incontinence Supplies
To learn more about the Medicaid coverage options available in your area, reach out to your state’s Medicaid office. They are your best resource for accurate information on eligibility, documentation, and authorization based on your state and individual plan.
How to Get Incontinence Supplies on Medicaid
Once you have been approved for a Medicaid plan, the first step to getting your incontinence supplies covered is to obtain a diagnosis from your doctor. An official diagnosis is required to prove medical necessity before obtaining the required paperwork for submission to Medicaid.
When speaking to your physician, explain your symptoms, what you feel you need, and why the requested supplies are a good solution. While it may be embarrassing to speak openly about your symptoms, it’s the best way to help your doctor understand what you need.
Once you’ve obtained a diagnosis, your doctor or case manager can walk you through the next steps required to receive your supplies. Keep in mind that there may be quantity limitations, such as how many of a particular product will be covered per month or year.
Conditions Associated with Incontinence
There are a wide variety of conditions that may contribute to incontinence. Some of the most common conditions that may make incontinence supplies a medical necessity include:
- Overactive Bladder
- Prostate Issues
- Dementia and Alzheimer’s
- Stroke
- Spinal Injury
- Cerebral Palsy
- Obesity
- Parkinson’s Disease
How Can I Save On Incontinence Supplies if I’m Not Eligible for Medicaid?
Seniors who have not yet been approved for Medicaid may be eligible for free incontinence supplies through various non-profit programs. Area Agencies on Aging may be able to help you find the assistance you need.
Individuals who need assistance may also be able to receive free incontinence supplies through a local diaper bank. Reach out to our partners at the National Diaper Bank Network for more information. Some discount prescription drug cards may also offer limited coverage to help you save.
Shopping for your incontinence supplies online, buying in bulk, and signing up for a recurring subscription is a great way to save money on incontinence supplies. You’ll also have the added convenience of getting your items delivered right to your door, saving you time and money.
Wrapping Up
Although Medicaid does cover incontinence supplies in many cases, coverage is only available to individuals who meet specific requirements. However, there are many ways to save money on the supplies you need.
If you are struggling with incontinence, take our bladder protection quiz to discover which products might work best for you, and we’ll send you a starter pack to try!
Sources:
Illinois Department of Public Health. (n.d.). Incontinence. http://www.idph.state.il.us/about/womenshealth/factsheets/inc.htm#:~:text=Who%20is%20affected%20by%20incontinence,most%20common%20among%20the%20elderly.
Medicaid. (n.d.). Beneficiary Resources. https://www.medicaid.gov/about-us/beneficiary-resources/index.html
Administration for Community Living. (n.d.). About Area Agencies on Aging (AAA). https://eldercare.acl.gov/Public/About/Aging_Network/AAA.aspx
