Does Medicaid Cover Incontinence Supplies or Adult Diapers?
February 1, 2021
Medicaid is a public health insurance program in each state for individuals and families who may be low-income, elderly, disabled or blind. Medicaid programs provide health insurance coverage or long-term care services for over 76.3 million Americans. It is the largest single source of health coverage in the U.S., accounting for about 16% of the federal government’s healthcare costs. The Medicaid program is designed to allow those who qualify access and coverage to receive medically necessary products (including incontinence supplies, urological supplies and other medical supplies), healthcare or long-term care services.
The three categories of people served by Medicaid are individuals with disabilities, low-income families and low-income older adults. The bulk of Medicaid plan spending goes to long-term and acute care costs for older adults and individuals with disabilities.
Each state has its own set of rules defining who may qualify for this public health insurance provider. However, all states adhere to the Affordable Care Act, which requires states to use modified adjusted gross income (MAGI) as the income eligibility for Medicaid coverage. MAGI considers taxable income and tax filing relationships to determine who is eligible for Medicaid coverage. The Medicaid insurance provider program is a partnership between the U.S. Federal Government and local state governments; therefore, the federal government sets eligibility and benefit requirements, and the states administer the Medicaid program with some flexibility under federal guidelines. Alongside eligibility, Medicaid coverage also varies from state to state. To quickly determine if you qualify for Medicaid, you can visit Healthcare.gov and use its Medicaid calculator to input income information to determine if you may qualify to have your incontinence products or urological supplies covered under the Medicaid benefit.
Challenges of Medicaid Benefits
One of the challenges with Medicaid is determining what is and what is not covered under a Medicaid plan. Due to differences by state, there is a lack of clear documentation on covered medical services and support, including incontinence supply coverage. Also, regular changes to coverage/benefits can create a headache for those receiving Medicaid, who often struggle to know all that is covered and how to make the most of their benefits. Generally, Medicaid covers medically necessary treatments, services or products for individuals who may be low-income, elderly, disabled or blind.
A common question we receive is “does Medicaid cover adult diapers, pull-on underwear, bladder control products or other incontinence supplies?”
The short answer is yes; state Medicaid programs typically cover medically necessary incontinence supplies, such as boosters, adult diapers (also known as disposable briefs), pull-on underwear and underpads, including youth products, for specific Medicaid recipients. But there are some important insurance provider rules and requirements you need to know.
Medicaid and Incontinence Supplies
Incontinence supplies are only covered for elderly, disabled or children with complex healthcare needs. Incontinence supplies benefits under Medicaid typically start for children with complex healthcare needs at age of 3-4, because that is the age where children usually develop self-toileting skills.
To receive incontinence supplies through Medicaid, the recipient must obtain at least one of the following:
- Physician’s prescription with qualifying diagnosis
- Prior Authorization (PA)
- Letter/Certificate of Medical Necessity (LMN)
When seeking a medical diagnosis from a physician, the best option may be to request medical records, including a detailed prescription or letter from the physician that indicates the qualifying diagnosis, the medically necessary product type required to treat it and the estimated number of incontinence care products needed per day.
If you feel overwhelmed or confused with all of this information, Tranquility can help. Our team works directly with individuals, caregivers and case managers to navigate insurance provider requirements and specific guidelines of your state. We can help guide you through the process in partnership with Medicaid incontinence providers across the U.S.
What Incontinence Supplies are Covered?
Similar to how Medicaid incontinence benefits vary from state to state, the types of incontinence products and brands that are covered under Medicaid also vary by state. Most states cover youth diapers and offer generic incontinence products brands; others cover only pull-on underwear and adult diapers/tape-tab style briefs. Most states cover some combination of disposable briefs, pull-on underwear, bladder control pads, reusable and disposable underpads, and other medically necessary incontinence products.
The best way to learn about incontinence products covered under your state Medicaid program is to contact a Medicaid incontinence supplier. Also, many incontinence manufacturers, like Tranquility, can help you navigate how to receive incontinence supplies available in your state and assist you in locating Medicaid incontinence suppliers in-network with your Medicaid plan or other insurance provider.
‘Boost’ Protection with Medicaid-Covered Booster Pads
If you – or someone you care for – are currently wearing medically necessary incontinence products covered by Medicaid, such as adult diapers/disposable briefs or pull-on underwear, yet are still experiencing leakage, odors or uncomfortable wetness, booster pads may be a great solution to “boost” absorbent protection. Booster pads continue to grow in popularity as individuals and caregivers are learning how they can make incontinence care more manageable. Plus, like other incontinence care supplies, they are typically covered under Medicaid in most states.
Let’s take a look at how you or someone in your care can receive medically necessary booster pads through Medicaid, as well as the best ways to use booster pads to provide additional security and protection.
How Booster Pads Work
Once you have begun to receive incontinence supplies through Medicaid, you may learn that your Medicaid supply providers only offer generic, low-absorbency adult diapers/disposable briefs and pull-on underwear, which may not provide enough protection for those with heavy incontinence or who regularly experience leakage. If this is the case, adding a medically necessary booster pad could be extremely helpful. If booster pads are covered under your state Medicaid plan or other insurance provider, we recommend that you make the most of your incontinence product coverage by giving boosters a try.
Boosters are not like personal care pads and other absorbent liners, which have a waterproof backing and are designed to be worn inside of regular underwear. Instead, booster pads must be used inside a disposable absorbent product, such as adult diapers/tab-style briefs or pull-on underwear. They are designed to absorb a certain amount of fluid before they allow additional fluid to pass through to the disposable product underneath, effectively adding absorbent capacity and extending the wear time of the disposable product.
It is important to distinguish personal care pads from booster pads. Personal care pads have a waterproof backing and should not be worn inside of another disposable product, such as pull-on underwear. Personal care pads are not designed to allow fluid to pass through like boosters do; instead, when personal care pads reach capacity, excess fluid could actually leak out of the disposable product.
Where to place booster pads
Boosters offer great flexibility and personalization because they can be placed in the specific area where extra coverage is needed. For women or girls, this may be more in the center of the disposable product holding it; while for men or boys, it may be needed more in the front of the disposable product. Boosters can also be placed on the side of the disposable product to help stop leaks near the leg openings, especially for side-sleepers at night. Just make sure the booster does not extend outside of the disposable product; otherwise, excess fluid that passes through it could leak outside of the product, as well.
Booster pads can be folded for better placement and even doubled on top of each other, but you should never cut a booster. This could affect the pad’s ability to retain fluid and properly pass it to the disposable product holding it.
How to Get the Supplies and Brands You Want
If you have a preference in the brand or type(s) of incontinence supplies you want for yourself, your child or someone you care for, you can request medically necessary products by their specific brand name, product style/model or item number. Talk to your physician about the brand or type of incontinence products covered by Medicaid that you prefer, including pull-on style disposable underwear, adult diapers/tape-tab style briefs, personal care pads, booster pads, underpads, cleansing wipes and more. If you are new to incontinence and do not yet have a preference, be open with your doctor about this so you can get more information and may try a range of recommended products. You can also request samples of all the incontinence products covered by your Medicaid supply provider, to determine which ones meet your individual incontinence or caregiving challenges.
You may also ask your physician to include a specific brand of diapers or incontinence supplies to be documented in the LMN (Letter of Medical Necessity). While some states may not be able to accommodate the specified brand, you may be able to obtain it via waivers or an alternative Medicaid program plan.
Tranquility, Medicaid and Supplies Covered
Tranquility works with Medicaid incontinence supply providers across the U.S. that choose to offer the best product brands and options. While our incontinence products and supplies are not covered in all 50 states, we will work with you to determine if you can receive the Tranquility Product Family, including Tranquility Premium, Tranquility Essential and Tranquility Specialty, as medically necessary products under Medicaid. If the incontinence supplies and medically necessary products you need to help with bladder control or other forms of incontinence are not initially covered – don’t give up hope yet!
Tranquility offers a full line of superabsorbent incontinence products, including youth to bariatric sizes in adult diapers/tab-style disposable briefs, pull-on underwear, booster pads, underpads, wipes and more. As an incontinence care manufacturer for over 60 years, our products are a top choice among clinicians, case managers, caregivers and wearers. We pride ourselves on making the highest-quality, most durable and comfortable incontinence products.
Want to try a free sample of our medically necessary products covered under Medicaid? Click here and fill out our form to receive a free sample! This is a great way to try the best incontinence products in the market. If you are new to incontinence or just want to try a few different products, this also a fantastic way to discover what product options work best for your incontinence care challenges.
To receive incontinence supplies samples, we just need to know your state, what type of product you prefer, your Medicaid incontinence supply provider and a few other simple questions to determine what product is right for you or the person you are caring for. Then, our National Medicaid Account Executive, Janet Firestone, or a Tranquility Consumer Service representative will contact you to help you obtain the best incontinence products for you through your Medicaid supply provider.
Janet has worked in the incontinence and Medicaid field for over 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 incontinence products they need. She even teamed up with Parenting Special Needs Magazine to record this webcast covering important tips for parents who are new to Medicaid coverage of incontinence supplies.
Everyone deserves access to quality products, and the Tranquility team does a tremendous job working directly with Medicaid recipients and their care coordinators to help navigate the process and explain each state’s details in-depth. Don’t wait – Request a free sample or contact us today!
Does Medicare cover incontinence supplies as of 2022?
Curious about Medicare? It is important to note that Medicare is a completely different program from Medicaid. Medicare is another federal program that provides specific healthcare coverage for people who are over the age of 65, certain younger people with disabilities, and people with end-stage renal disease. Medicare typically does not cover incontinence products. All incontinence products must typically be paid for out-of-pocket under Medicare, including bladder control pads, adult diapers/tab-style briefs, pull-on underwear and other supplies to help manage incontinence. For additional information regarding Medicare, we recommend visiting the federal website for Medicare at https://www.medicare.gov/.
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