This article was contributed by Tranquility® Products – Real Life Protection for real, everyday demands.
Medicaid is the largest insurance provider in the U.S., covering over 72 million Americans. The Medicaid program is designed to provide health insurance, Long-Term Care services, and potentially medical supplies such as incontinence care products, to individuals and families who may be low-income, elderly, disabled, or blind. It became law in 1965 as part of the Social Security Act and is a federal government program that is administered by each state. Due to the nature of the federal and state government partnership, each state is allowed to administer the program under its own guidelines, while adhering to certain federal eligibility and benefit requirements. Across the U.S., Medicaid covers three primary categories: low-income families, low-income older adults, and individuals with disabilities.
Interested in learning the difference between Medicare and Medicaid? Read the NAFC article titled Medicare vs. Medicaid: What’s the Difference?
WHAT IS COVERED BY MEDICAID?
For many people, the biggest challenge of Medicaid is determining what products and services are covered, such as incontinence care products. Below are examples of mandatory and optional Medicaid benefits.
MANDATORY MEDICAID BENEFITS INCLUDE:
- Inpatient and outpatient hospital services
- Nursing home or home health services
- Rural health clinic services
- Physician services
- Case management
- Physical therapy
- Personal care (potentially including incontinence care products)
- Speech, hearing and language disorder services
- Prescription drug coverage
View the full list of mandatory and optional Medicaid benefits here. To understand all the specific services and benefits that are covered in your state, we recommend contacting your state-provided plan, your insurance provider or conducting research on your state’s Medicaid website.
ARE INCONTINENCE SUPPLIES ARE COVERED?
Incontinence supplies and diapers for children and adults fall under the optional, personal care category as a type of medical supply. Most – but not all – state Medicaid programs cover incontinence supplies, adult diapers, and pull-ons from sizes youth to bariatric. As of 2019, approximately 45 states cover some incontinence supplies under Medicaid. As described in the Tranquility blog Does Medicaid Cover Incontinence Supplies or Adult Diapers?, those wishing to obtain incontinence supplies under Medicaid need one of the following: a physician’s prescription with qualifying diagnosis, Prior Authorization (PA) or a Letter/Certificate of Medical Necessity (LMN). If you feel overwhelmed or confused with this information, Tranquility works directly with individuals, caregivers, and case managers to help navigate specific state Medicaid benefits.
WHAT TYPES OF INCONTINENCE SUPPLIES ARE COVERED?
Similar to how each state Medicaid program covers different services and products, the types of incontinence supplies covered vary state by state. Most states cover some combinations of the following products:
- Disposable Briefs (tab-style diaper)
- Disposable Underwear (pull-on style)
- Bladder Control Pads (worn in underwear)
- Booster Pads (worn in another absorbent product)
- Underpads (bed pad or chux)
HOW TO GET THE BEST INCONTINENCE PRODUCTS COVERED UNDER MEDICAID
Medicaid recipients who are older or disabled typically have a case manager assigned to help support their needs and navigate Medicaid benefits and services. If you, your parent, or your disabled child has incontinence and has taken the steps to receive incontinence supplies under Medicaid, you may be receiving a “default” absorbent product from your medical supply provider. These default products tend to be lower-quality, generic products that may work well for those with light incontinence but cause significant challenges for those with moderate to heavy incontinence. Leaking products, clothing and bedding changes, and fear of an accident do not have to be a normal part of living with incontinence. Better solutions are available.
When contacting your pharmacy or medical supply provider, ask them to change your Medicaid order to the specific product or brand of product that you desire. Should they push back or deny your request, contact Tranquility or another medical supply provider. The incontinence supplies benefit belongs to you, the Medicaid recipient. Don’t settle for a default product if it is not performing. If your provider will not cover the products available to you in your state, find another supplier. You could be eligible for better products; you just have to ask for them!
MAKE THE MOST OF YOUR MEDICAID COVERAGE
If you are a Medicaid recipient and have incontinence or are caring for someone with incontinence, you are likely dealing with a variety of challenges. Here are a few tips to ensure you make the most out of your Medicaid benefits, to make managing incontinence easier:
- Contact your state-provided plan or insurance provider to request what types of incontinence products are covered.Obtaining a list or breakdown of what incontinence products (briefs, pull-ons, booster pads, etc.) are covered in your state is the first step to making the most of your benefits. Once you know the type(s) of products available to you, you can begin to learn more about these items and find the products that are the best for you or those in your care.
- Learn more about the products and brands that are available to you.After you determine what types of incontinence supplies are available, you can learn more about each type and various brands to find out if you can use and benefit from them. Starting with the NAFC Trusted Partners, search around the web for specific information about each item that is available to you. If available, we recommend trying a free sample to determine if the product works well for your needs.
- Request the product(s) that will make your incontinence situation more manageable.This is an important step in making the most of your incontinence benefits. For those who are new to incontinence or still learning about various products, we recommend taking advantage of booster pads and underpads if they are covered in your state! While disposable briefs, disposable underwear, and bladder control pads are the most widely used products, you are likely already receiving one of those under your Medicaid benefits. Booster pads and underpads are additional incontinence products that make managing incontinence easier for many caregivers and incontinent individuals.If you or someone you care for is experiencing leakage, odors or uncomfortable wetness in their disposable brief or underwear, booster pads are a great way to boost the absorbency of that product! Booster Pads are flow-through pads designed to add absorbent capacity to your primary incontinence product. The flexible design allows for personalized positioning to add protection when and where you need it – ideal for pairing with protective underwear or tab-style products. Some states only cover generic, low-absorbency briefs and underwear, making the addition of a booster pad extremely helpful to those with heavy incontinence or who regularly experience leakage.Similarly, if you experience or worry about leaking urine or stool damaging your mattress, couch, vehicle seats or other furniture, underpads are a great product to protect those surfaces. These pads can be place directly on top of your mattress, furniture and vehicle seat to protect against unexpected accidents.
THE TRANQUILITY DIFFERENCE
At Tranquility, we design products to help with the most challenging incontinence care needs with higher absorbent protection. If you are struggling to manage incontinence with the low-absorbency, default products supplied under your Medicaid benefit, we can help. We have assisted parents, older adults and case managers across the U.S. in making the switch to Tranquility products through their Medicaid benefits.
The best way to determine if Tranquility Products are right for you is to try a free sample. Visit our Free Medicaid Sample page, fill out the form and we will send you a free sample of the products that are covered by Medicaid in your state. Then, we will work directly with you or your case manager to help you obtain Tranquility products from your local medical supply provider, shipped right to your front door. Finding the right absorbent product can make all the difference, and we have received thousands of testimonials from wearers, caregivers and case managers about the life-changing impact of finding Tranquility products.
“My caseworker, Sarah, ordered cases of the Tranquility pull-ons through Medicaid and I have been satisfied to no end. I feel so confident now. I can go anywhere now with complete confidence. Thank you again to Sarah and Tranquility Products.” – Wearer with Parkinson’s Disease, age 73
“Our son quickly outgrew traditional sized diapers. Before starting to use Tranquility Products, we used different brands and sizes of traditional diapers. We continued to have problems with leaks and skin irritation. I’m very glad we made the decision to use Tranquility Products. We no longer have leaks or skin irritation. Our son seems to be much more comfortable!” – Mother and Caregiver
If you or someone in your care are eligible to receive incontinence supplies that are covered through Medicaid, Tranquility has a new option for you to try. Our Tranquility Essential Breathable Briefs – Heavy have been newly designed to meet the highest Medicaid product performance requirements. Plus, our high-absorbency booster pads and underpads are covered by Medicaid and waivers in many states.
If you need help determining what products are Medicaid eligible for you or someone in your care, contact our National Account Executive Medicaid, Janet Firestone. Janet has worked in the incontinence and Medicaid field for 25 years. She holds extensive knowledge and information regarding Medicaid and incontinence supplies and has helped thousands of Medicaid recipients and their case managers acquire the absorbent products they need. Contact us today or request a free Medicaid sample and we’ll reach out to you.
We guarantee Tranquility products absorb and contain their stated fluid capacity no matter how much pressure is applied to the product. Whether you’re sleeping, sitting or on-the-move, you can rely on our clinically proven design to protect you, so you can live freely and confidently with fewer worries.
Visit our website today to learn more about Tranquility Products. If you are ready to give Tranquility a try, just complete our Medicaid Free Sample form and we will send you a sample of Tranquility.