Did you know your Medicaid HMO can pay for diapers for your child?
The medical term for diapers is incontinence supplies. This includes briefs (diapers that open on each side), pull-up/pull-on type diapers and other belted garments. Incontinence supplies also include disposable under pads, liners, disposable gloves, catheters, and other related supplies.
- Coverage starts at Age 4: Wisconsin Medicaid will only pay for diapers and other related supplies for children ages 4 and older. It’s normal for children under 4 to be potty training so Medicaid won’t cover the cost of diapers for children ages birth through 3.
Does Medicaid and BadgerCare Plus cover diapers for children? YES. Wisconsin Medicaid and BadgerCare Plus will pay for diapers and other incontinence supplies starting when your child turns four.
Can I go to my local retailer or pharmacy to get my diapers? That depends on which HMO you are enrolled in. The best way to find out where to order your incontinence supplies is to call the HMO’s Member Services Department. Each HMO has preferred local or mail order durable medical equipment (DME) or Durable Medical Supply (DMS) providers who will supply these products to you on a monthly basis.
What do I need to do to have my HMO cover these supplies? You should contact your child’s doctor and explain that you are want coverage for diapers or other incontinence supplies. The doctor will then write a prescription for the supplies, indicating that the diapers or other supplies are medically necessary.
Next, contact your HMO’s Member Services Department. They will give you a list of DME providers or local retailers that have been approved to supply these products. You can then call one of these providers to discuss your child’s needs.
A nurse (or other staff) will work with you on intake information and an assessment of your child’s needs. Before you call, consider the following:
- How many and what type of diapers or pull-ups work best for your child?
- Does your child need one type of diaper for daytime and another at nighttime?
- Does your child have problems with leakage/absorbency, chaffing or irritation from certain products?
Keep these things in mind when you talk to the supplier and try to be as specific as possible when discussing your child’s needs.
The DME provider will then contact your doctor directly to approve your order. You will need to fill out standard paperwork and make a choice of what products work best for your child. Once this process has been completed, the DME provider can fill your order and send out your incontinence supplies.
Can I receive samples from the DME provider? Yes. After the intake process, you can request samples of their products so you and your child can determine which products will work best. We encourage you to request samples before a month’s supply is shipped to you!
What brands or types of diapers are available? The DME provider may have only certain manufacturers available to families covered by Wisconsin Medicaid. They may not have the specific brand that you used in the past, but they do have several brands and manufacturers to choose from. Try to be as specific as possible to explain what works best for your child.
How many diapers will be covered? Is there a limit on the number of diapers? During the initial intake process you will work with a nurse to determine how many diapers your child needs each day. If that number changes, contact your supplier immediately. They will work with you to deliver the quantity you need each month. In most cases, there is a limit of 300 diapers per month and a limit of 150 pull-up/pull-on type diapers, however each HMO may have their own limits.
What if I am not satisfied with the quality of the diaper? If the diapers you received do not work well for your child, the first step is to call the provider directly and explain the problem. They should send another product for you to try. You can also call your HMO Member Services Department to discuss your concerns and other options for incontinence supplies.
If my child is covered by a Children’ s Long-Term Support (CLTS) Waiver can I use waiver funds to pay for diapers? No. Diapers and incontinence supplies are a Medicaid card covered service, so CLTS waiver funds cannot be used. However, CLTS funds can be used for wipes or other incontinence supplies not covered by Wisconsin Medicaid.
How can I give feedback? If you have concerns or questions that cannot be resolved by working directly with the provider, call the Member Services Department at your HMO. If your concerns are still not resolved, call Forward Health Member Services at 1-800-362-3002.