There are many treatment options to manage ongoing urinary incontinence to help reduce the severity and frequency of symptoms. However, throughout treatment, using urinary incontinence supplies can help reduce the risk of accidents or leaks in public, and if you rely on disposable products every day, the costs can add up. While many private insurance plans cover costs, Medicaid recipients may wonder whether their products are covered within their state. Here, we'll go over how to get incontinence products through Maryland Medicaid, including eligibility requirements and how to find a medical supplier that works with your specific plan.
Quick Overview: How to Get Incontinence Supplies Covered by Maryland Medicaid
- Maryland Medicaid may cover medically necessary incontinence supplies for eligible adults and children age three and older.
- Covered products may include briefs, diapers, protective underwear, liners, bladder control pads, and underpads.
- You must have prolonged urinary or bowel incontinence associated with an underlying medical condition or disability.
- A healthcare provider must submit a prescription or Certificate of Medical Necessity that identifies the required products, sizes, quantities, and frequency of use.
- Coverage limits and prior authorization requirements may vary depending on whether you have fee-for-service Medicaid or a HealthChoice managed care plan.
- Supplies must be ordered from a Medicaid-approved medical supplier that participates with your specific plan.
Understanding Urinary Incontinence
Urinary incontinence is the involuntary leakage of urine caused by a loss of bladder control. It's a common condition that affects millions of people throughout the world, with some experiencing occasional leaks, while others have frequent or complete loss of bladder function. The most common types of urinary incontinence include:
- Stress incontinence, which causes leakage when pressure is placed on the bladder through activities such as coughing, sneezing, laughing, or exercising.
- Urge incontinence, which involves a sudden, intense urge to urinate that may be difficult to control.
- Overflow incontinence, which occurs when the bladder doesn't empty completely and causes frequent dribbling.
- Functional incontinence, which happens when physical or cognitive limitations make it difficult to reach or use the bathroom in time.
Bowel incontinence is the inability to control bowel movements, which can result in accidental leakage of stool. Both urinary and bowel incontinence may be associated with medical conditions such as spinal cord injuries, multiple sclerosis, cerebral palsy, dementia, diabetes, autism, prostate problems, or complications from surgery. When incontinence is prolonged, protective products can help prevent complications and make daily activities easier to manage.
Does Maryland Medicaid Cover Incontinence Supplies?
Yes. Maryland Medicaid covers certain incontinence supplies when they're medically necessary and meet the program's coverage requirements. However, incontinence supply coverage can vary based on individual circumstances and health plans, so it's important to review details carefully and work with your doctor to ensure you provide the necessary documentation to receive services and supplies related to the condition.
Maryland regulations require HealthChoice managed care organizations (MCOs) to provide medically necessary disposable medical supplies and durable medical equipment (DME). This coverage expressly includes incontinence pants and disposable underpads for medical conditions associated with prolonged urinary or bowel incontinence when the products are necessary to help prevent institutionalization or infection. Maryland regulations also establish timelines for MCO authorization and delivery.
More Information Regarding Maryland Medicaid Benefits
Maryland Medicaid's fee-for-service program also provides access to medically necessary DME and disposable medical supplies for use in the home. However, the exact coverage process may depend on whether you receive benefits through HealthChoice, Maryland's Medicaid managed care program, or through fee-for-service Medicaid.
If you're enrolled in an MCO, contact the member services number on your insurance card to verify the plan's documentation, authorization, and supplier requirements for covered Medicaid supplies. It's important to note that using an out-of-network supplier may result in a denial even when the products themselves are covered.
It's also essential to understand that Medicaid and Medicare have different coverage policies. Original Medicare generally doesn't cover absorbent incontinence products such as adult diapers, pull-ups, or disposable underpads. While Maryland Medicaid may cover these items for eligible participants who meet its medical criteria.
Requirements for Maryland Medicaid-Covered Incontinence Supplies
Although you may be eligible to receive the necessary incontinence supplies you need to manage leaks through Maryland Medicaid coverage with little to no out-of-pocket costs, the qualification isn't automatic. You must have a prescription from your doctor that outlines a documented medical need for specific bladder control supplies, and you also need to ensure you order according to the managed care plan requirements. Eligibility generally requires the following:
- The individual must be actively enrolled in Maryland Medicaid or a participating HealthChoice MCO
- The individual must have prolonged urinary or bowel incontinence associated with an underlying medical condition
- A qualified healthcare provider must determine that incontinence supplies are medically necessary
- The supplies must be needed to help manage the condition and prevent complications such as infection, skin damage, or institutionalization
- A prescription or Certificate of Medical Necessity (CMN) must identify the products, sizes, quantities, and frequency of use to determine the monthly supply of incontinence products covered
- The products must be obtained through a Medicaid-approved supplier that participates with the individual's plan
- The requested quantity must remain within the program's limits unless additional products are separately authorized based on medical necessity
If you qualify for Medicaid coverage, Maryland's current DME/DMS fee schedule requires a prescription or CMN for covered incontinence products and lists a documentation renewal frequency of every 12 months. Your plan or supplier may request updated records sooner if your condition, size, product type, or required quantity changes.
Are Incontinence Supplies Covered for Children?
Maryland Medicaid may cover pediatric incontinence supplies for children ages three and older when incontinence extends beyond the age at which toilet training would typically be expected and is related to a medical condition or disability. There are also certain pediatric urinary conditions that result in incontinence that may extend coverage.
For example, a child with autism, cerebral palsy, spina bifida, a neurological disorder, or another qualifying condition may require diapers or pull-ons beyond the usual toilet-training years. A pediatrician or specialist must document the condition and explain why the supplies are medically necessary. Diapers for children who haven't reached toilet-training age aren't generally considered medical supplies.
Which Incontinence Supplies Does Maryland Medicaid Cover?
The coverage for medically necessary incontinence products includes various different items, and what you'll receive typically depends on factors such as age, mobility, level of independence, and severity of incontinence. The following incontinence supplies may be covered depending on your needs:
- Adult briefs or diapers
- Adult productive underwear
- Pediatric briefs or diapers
- Pediatric protective underwear
- Youth briefs and pull-ons
- Bariatric briefs
- Liners, shields, guards, and bladder control pads
- Disposable underpads
- Reusable underpads
- Reusable briefs or protective underwear
Your doctor can help you choose products covered by Medicaid based on your condition and required absorbency levels. There are also typically limitations to the number of supplies you can receive each month. Your doctor can help you determine the estimated number of incontinence products you need.
How to Get Incontinence Supplies Covered by Maryland Medicaid
Once you're enrolled in Maryland Medicaid, you can begin the qualification and ordering process by following these steps.
Step 1: Schedule an Appointment With Your Healthcare Provider
Make an appointment with your primary care provider, pediatrician, urologist, or another qualified healthcare professional. Explain your symptoms, how frequently leakage occurs, and how incontinence affects your health and daily routine. Your provider may evaluate your medical history, medications, mobility, skin condition, and any underlying diagnosis contributing to urinary or bowel incontinence.
Step 2: Obtain a Prescription or Certificate of Medical Necessity
If your healthcare provider determines that supplies are medically necessary, they'll need to prepare a prescription or CMN. Accurate information is important, as missing details or incorrect information can result in a denial or delay. The documentation should include:
- The medical condition associated with incontinence
- The type of incontinence being managed
- The type and size of each prescribed product
- The number of products needed per day or month
- The anticipated length of need
- An explanation of why the supplies are medically necessary
Step 3: Confirm Your Plan’s Coverage Requirements
If you're enrolled in a HealthChoice MCO, contact member services to ask whether prior authorization is required and which suppliers participate in the plan's network. The phone number should be printed on the back of your Medicaid member ID card.
Step 4: Choose an Approved Medical Supplier
You'll need to order through a medical supplier authorized to bill Maryland Medicaid, like Byram Healthcare, or contracted with your HealthChoice plan. Byram can confirm your benefits, collect the necessary documentation, and determine which products are available under your coverage.
Step 5: Submit the Required Documentation
Your supplier will often work with your healthcare provider to obtain the prescription, CMN, and supporting medical records. The supplier may also submit a prior-authorization request when required. Respond promptly if the supplier or Medicaid plan requests additional information. Delays often occur when records don't include a diagnosis, product quantity, frequency of use, or sufficient explanation of medical necessity.
Step 6: Select and Receive Your Supplies
After coverage is confirmed, you'll select products that match the authorized category, size, and absorbency. Covered supplies can then be delivered discreetly to your home. If there are any issues with the product or fit, contact your doctor about adjusting your prescription to try different products available.
Step 7: Addressing a Denial
If your request has been denied, it doesn't necessarily mean that the supplies aren't covered. Rather, your claim may be denied for missing information or larger quantities than the limit. Your provider can help, but Maryland Medicaid participants have the right to appeal decisions that deny, reduce, suspend, or end covered services. Review the instructions in your notice and consult the Maryland Medicaid appeals page for current requirements.
Get Insurance-Covered Incontinence Supplies Through Byram Healthcare
For more than 50 years, Byram Healthcare has helped individuals and caregivers access the medical supplies they need from the comfort of home. We offer a wide range of incontinence products, including protective underwear, briefs, liners, pads, and underpads for different ages, sizes, and levels of absorbency, free or low-cost through various insurance providers, including Medicaid. Contact us to learn more or start your order to receive incontinence products discreetly delivered to your door.
