Medicaid HMO Coverage for Diapers

Medicaid HMO Coverage for Diapers

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Medicaid HMOS can pay for diapers for your child

The medical term for diapers is incontinence supplies. This includes briefs (diapers that open on each side) and pull-up or pull-on type diapers. Incontinence supplies also includes disposable under pads, liners, disposable gloves and other related items.

Coverage starts at Age 4: Wisconsin Medicaid will only pay for diapers and other related supplies for children ages 4 and older. It’s typical for children under 4 to be potty trained so Medicaid won’t cover the cost of diapers for children ages birth through 3.

Can I go to my local retailer or pharmacy to get diapers?     

This depends on your HMO. The best way to find out is to call your HMO’s Member Services Department. Each HMO has preferred local or mail-order Durable Medical Equipment (DME) or Durable Medical Supply (DMS) providers to supply these products to you every month.

Starting the Process

1st:  Have your child’s primary care provider write a prescription for diapers and/or other incontinence supplies saying that they are medically necessary.

2nd: Contact your HMO’s Member Services Department to get a list of DME providers or local retailers that have been approved to supply these products.

A nurse, or other staff, from your HMO will work with you on intake information and an assessment of your child’s needs. Before you call, be ready with the following information:

  • Your child’s ForwardHealth card number,
  • The name, phone number and address of the provider who’s prescribing the supplies,
  • An estimate of the number of diapers your child uses each day, and
  • Any other products you need like liners, gloves and pads.

3rd:  Call one of the approved DME providers to discuss your child’s needs.

The DME provider will contact your doctor directly to approve your order. You will need to fill out standard paperwork and choose which products work best for your child. Once this process is done, the DME provider will fill your order and deliver your child’s incontinence supplies.

Things to Remember

Be as specific as possible when discussing what works best for your child’s needs with the supplier. Also, bring up your concerns, like needing extra absorbency at night or chafing and irritation with certain products.

Can the DME provider send me samples?                                                                                                                

Yes. After the intake process, you can ask the provider to send samples of their products. We encourage you to do this so you and your child can decide on the best products before an entire month’s supply is shipped to you!

What brands or types of diapers are available?                                                                              

The DME provider only carries certain manufacturers’ products for families covered by Wisconsin Medicaid. They may not have the brand that you used in the past, but you will be able to choose from several brands and manufacturers.

Is there a limit on the number of diapers covered?                                                                               

Part of the intake is to determine the number of diapers your child uses each day. If that number changes, contact your DME provider immediately to adjust of diapers you receive 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 its own limits.

What if the products don’t work for my child?                                                                                   

If your child’s diapers do not work well, call the provider directly and explain the problem. Be sure to give  details about the problem(s) and ask them to send another product for your child to try. You can also call your HMO Member Services Department about your concerns over their incontinence supplies.

Can I use CLTS 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 that are not covered by Wisconsin Medicaid. 

How can I give feedback?                                                                                                                                                    

If you have concerns or questions that cannot be resolved by working directly with your DME provider, call your HMO’s Member Services Department. If your concerns are still not resolved, call ForwardHealth Member Services at 800.362.3002.

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