Are My Incontinence Products Covered By Medicaid?

Question: I’m On Medicaid. Are My Incontinence Products Covered? 

Answer:  Medicaid is a health insurance program available to over 76 million Americans who are low-income, elderly, disabled or blind. Medicaid provides those who qualify with access and coverage to receive medically necessary supplies, including incontinence products. However, determining whether the particular incontinence products you wish to use are covered and how to locate a supply provider that carries them can be tricky, because each state follows its own Medicaid guidelines.

State Medicaid programs typically cover medically necessary incontinence supplies, including youth products, such as disposable tape-tab briefs, pull-on underwear, underpads and booster pads. Incontinence supplies benefits under Medicaid typically start for children with complex healthcare needs at ages 3 or 4*, which is when children are usually potty-trained. 

You can see if you qualify and learn about Medicaid rules affecting you a few different ways:

• Visit the Medicaid.gov website and select your state from the state profiles page
• Visit Healthcare.gov and fill out the Medicaid calculator
• Complete an application for the Health Insurance Marketplace 

You will also need to talk to or meet with your physician for medical documentation to receive incontinence supplies through Medicaid. You typically must obtain at least one of the following:

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

If you desire a specific brand or style of incontinence product, make sure to mention this to your doctor. You should also provide your doctor with an estimated number of products you use per day.

If you are confused with the Medicaid process, Tranquility® can help. Our team will work with you and your family to navigate Medicaid guidelines in your state and locate a Medicaid incontinence supply provider in your area. 

Contact us today to get started.

*Parents or caregivers of children born with a disability are encouraged to immediately explore potential Medicaid benefits or other social services for which their child may be eligible. They will typically work with a social services professional, often referred to as a “case manager,” who will help them navigate the Medicaid application process or other social services their child may be eligible for starting at birth.