Does Medicaid Cover Medical Supplies and Equipment?
- Understanding how Medicaid covers medical supplies and equipment can help you make the most effective use of these important benefits. Learn more now.
Medicaid is a program designed to provide medical insurance for low-income people in the United States. It offers assistance in paying for medical care for disabled and elderly individuals as well as certain low-income adults, children and families. The program is directly administered by the Centers for Medicare & Medicaid Services under the oversight of the U.S. Department of Health and Human Services. Eligibility for Medicaid and the specific coverage offered by the program are determined at the state level. This can make it tricky to determine if medical equipment and supplies will be covered by Medicaid.
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What Supplies Does Medicaid Cover?
As previously discussed, the coverage offered to Medicaid recipients varies from state to state. In general, however, Medicaid covers medical equipment and supplies only if they meet the following criteria:
- The equipment or supplies have been deemed to be medically necessary by your physician, which usually means they're important for your overall health, recovery or mobility.
- The equipment is cost-effective, which generally means it falls into the most basic and affordable category of medical equipment. This could mean that you will receive a cheaper version of the equipment recommended by your doctor rather than a deluxe model.
- Medicaid has categorized the medical devices or supplies as durable medical equipment, which means that it will stand up to repeated use, can be used at home and is not useful to individuals who do not suffer from an illness or an injury. Another term sometimes used for durable medical equipment is assistive technology.
Your state Medicaid office can provide more information about the types of medical equipment covered in part or in whole by the program.
Where You Live Makes a Difference
What is covered by Medicaid varies by state and by the environment in which you live. In skilled nursing homes, for instance, the process may be invisible to the patient and his or her family. Nursing home staff members work directly with Medicaid to make sure that necessary medical equipment is obtained and provided for patients in these environments. This can make it much easier to acquire the durable medical equipment and supplies patients need in these skilled nursing facilities.
For patients who live at home, the process of obtaining durable medical equipment coverage may be more complex. These individuals are usually covered under the Home & Community Based Services (HCBS) programs administered by Medicaid, which are also known as 1915 Waivers or Medicaid Waivers. Medicaid Waiver programs are designed for individuals who feel comfortable taking a more active role in the acquisition and approval process. Some of the steps involved in the process are listed below:
- Under the Medicare Waiver program, individuals are responsible for obtaining a medical justification letter from their doctor.
- The patient will then choose a supplier from a list of Medicaid-approved durable equipment vendors and submit the medical justification letter to this supplier.
- The vendor will fill out a Prior Approval application and will submit it to the state Medicaid office.
- The purchase will be approved or denied by the Medicaid office, which will also provide notice of its decision to both the vendor and to the patient.
- If the purchase is approved, the durable medical equipment will be delivered to the patient and the costs paid by Medicaid.
- If the request is denied, Medicaid will provide a detailed explanation of the reason for the denial to the individual, who can then appeal the decision.
These Medicaid Waiver programs vary from state to state and offer added help for patients who live outside of nursing homes or hospital settings.
Making the Transition From Nursing Home to Home
The Money Follows the Person (MFP) Medicaid program is specifically designed to help patients make the transition from skilled nursing homes back to their own homes or to other residential environments in the community. Currently, 44 states have instituted some form of MFP program for their residents. According to the Medicaid website, the MFP program is intended to achieve the following goals:
- Eliminating barriers and obstacles to long-term care for patients at home or in any other setting
- Increasing support for in-home and in-community care options while reducing dependence on services performed in medical and care facilities
- Assisting patients who want to transition from skilled nursing facilities back to their own homes or to independent or assisted living environments
- Implementing quality assurance for HCBS services
If you need durable medical equipment or assistive technologies, the MFP Medicaid program may be able to provide the coverage you need for this necessary equipment. This is especially true if the equipment will make it easier for you to return home from a stay in a hospital or skilled nursing facility.
Contacting your state Medicaid office can provide you with added information on coverage for durable medical equipment. Your Medicaid advisor can work with you to make sure that you have the resources you need to enjoy better health and an improved quality of life in a skilled nursing home, an assisted living facility or your very own home.