How to Get Adult Pull-Ons & Adult Diapers Through Medicaid
This piece has been reviewed for accuracy by Mica Phillips, Vice President of Aeroflow Urology.
Urinary incontinence, or the accidental loss of urine, is a fairly common condition in the U.S. According to the Urology Care Foundation, about 1 of 2 women and 1 of 4 men experience incontinence symptoms. It is especially common among women over 50.
Despite how prevalent it is, adult incontinence carries a stigma that can be hard to overcome. Many people who live with bladder leakage experience embarrassment that can take a real toll on their quality of life. The good news is that for most people, there are simple ways to effectively treat and manage incontinence.
If you or a loved one are experiencing urinary incontinence, it's important to speak with a healthcare provider. Depending on the type of incontinence symptoms you experience, you may benefit from simple lifestyle changes, medications, or pelvic floor exercises to train your bladder. You may also find that the use of discreet bladder control products can help maintain your freedom and mobility. Most Medicaid plans will cover the incontinence supplies needed to manage symptoms effectively for those with a qualifying diagnosis.
Medicaid Health Plan Coverage
Medicaid may be able to cover incontinence supplies for you or your loved one if the products are deemed medically necessary.
While you or your loved one’s coverage is dependent on the state you live in and your individual health plan, many people who are diagnosed with incontinence may require proof of incontinence to have free supplies every month. This means that you will most likely need to make an in-office appointment with your healthcare provider. They will also be required to write you a prescription for incontinence that also lists your underlying condition.
Supplies may include adult pull-ons, sometimes called protective underwear, adult briefs (adult diapers), bladder control pads, gloves, wipes, and more supplemental items.
Criteria for Medicaid Coverage of Adult Incontinence Supplies:
- A prescription from your healthcare provider within the last 12 months.
- You may be required to provide a letter of medical necessity (LMN) in addition to a prescription, depending on what your insurance plan requires.
- Your insurance company may require a copy of your medical history from your healthcare providers to ascertain any underlying conditions related to your continence issues.
- The quantity of products per month that you and your healthcare provider agree are required to best manage your continence issues (i.e. 3 protective underwear, 2 underpads, 1 bladder control pad).
We know that gathering the above information and dealing with Medicaid can be overwhelming, but our Continence Care Experts are specially trained to work with you to get all the information with ease. All you have to do to receive our help and free supplies every month is fill out our secure Eligibility Form.
Health Conditions That May Cause Incontinence In Adults
There are a variety of underlying conditions that are causes of urinary incontinence and fecal incontinence in adults.
Click on condition name for more details.
Disabilities
Individuals with disabilities, such as autism or Down syndrome, often have incontinence due to potty training delays, communication barriers, or sensory sensitivities.
Spinal Cord Injuries (SCIs)
SCI occurs when there is damage to the spinal cord. SCI can cause incontinence but it depends on the level of damage to the spinal cord. Injuries above or at the sacral nerve can cause urinary incontinence due to a diminished ability to communicate with or control the bladder muscles.
Benign Prostatic Hyperplasia (BPH) or Enlarged Prostate
BPH occurs when glandular tissue, smooth muscle cells, and connective tissue change within the transition zone (located in the center around the prostatic urethra) of the prostate gland. This can cause tissue enlargement. Enlarged prostate and BPH can cause symptoms of urinary incontinence in men due to the enlarged prostate squeezing the urethra, blocking urine from emptying.
Pregnancy or Childbirth
Symptoms of urinary incontinence may occur in women who are pregnant due to extra pressure from a baby being placed on the bladder and pelvic floor muscles and hormone fluctuations. Urinary incontinence symptoms like leaking urine can also follow vaginal childbirth because the pelvic floor muscles are weakened during the process.
Menopause
During menopause, women’s hormones- specifically estrogen and testosterone- fluctuate and decrease. This can cause urinary incontinence in women.
Hysterectomy or Prostate Surgery
Certain surgeries like hysterectomies and prostate surgeries can cause symptoms of incontinence to arise in individuals due to the effect they can have on pelvic muscles and support to the bladder.
Post Traumatic Stress Disorder (PTSD)
Post Traumatic Stress Disorder (PTSD) is a psychological disorder defined as difficulty recovering after witnessing or experiencing a terrifying event. Symptoms include nightmares, flashbacks, and anxiety. PTSD has been associated with incontinence in adults due to increased stress and axiety.
Urinary Tract Infection (UTI)
UTIs are infections of the urinary system and can cause symptoms of urinary incontinence, such as frequent urination.
Kidney or Bladder Stones
Kidney stones and bladder stones form from urine that crystalizes. These stones can cause pain and may lead to urinary incontinence since they can block the flow of urine.
Neurological Diseases
Certain medical conditions, such as Parkinson’s disease, Alzheimer’s disease, and spina bifida, can cause incontinence due to a loss of communication with the brain and the bladder or loss of mobility. Individuals with these conditions may experience accidents because they can’t find the bathroom or recognize their bodily signals of needing to void the bladder or bowels.
Weight Gain
Obesity may cause urinary incontinence symptoms in some individuals due to the pressure excess weight can place on the pelvic floor and bladder.
Constipation
Constipation can cause urinary incontinence symptoms due to the extra fecal matter pushing on the bladder.
Diet
Certain foods, such as spicy foods, synthetic dyes, tomato-based products, alcohol, and caffeine are bladder irritants. When your bladder is irritated, it can cause urinary incontinence symptoms, like sudden urges to urinate and frequent urination.
Medications
Certain medications may cause bladder leaks for a variety of reasons. These can include diuretics, antidepressants, blood pressure medications, narcotics, antihistamines, and muscle relaxants.
Diabetes
Diabetes can cause incontinence in a few different ways. Diabetes medications can irritate the bladder, nerve damage can occur in diabetics (neuropathy) leading to a neurogenic bladder, and high blood sugar can lead to UTIs which can also cause incontinence.
Mobility Issues
Mobility issues can sometimes cause incontinence. For example, a person with limited mobility may not physically be able to make it to the restroom in time due to their restrictions, leading to accidents.
Types of Incontinence In Adults
There are several types of urinary incontinence (loss of bladder control) and fecal incontinence (loss of bowel control), each with its own unique symptoms.
Urge Incontinence: Also known as overactive bladder (OAB), people with urge incontinence will feel a strong impulse to urinate that occurs suddenly, sometimes resulting in urine leaks. Conditions such as diabetes, multiple sclerosis, and others can contribute to this type of incontinence.
Overflow Incontinence: People with overflow incontinence may not experience an urge to go, but still experience leaks caused by a weak bladder muscle or blockage when the bladder becomes too full.
Stress Incontinence: If you sometimes experience urine leaks when sneezing, laughing, lifting heavy objects, or exercising, you may have stress urinary incontinence.
Functional Incontinence: People with functional incontinence typically have a normal bladder and urethra function, but due to a mobility issue or physical or mental impairment, cannot reach the toilet in time to avoid urine leakage.
Mixed Incontinence: Mixed incontinence occurs when patients have more than one type of incontinence.
Fecal Incontinence: Unintentional loss of fecal matter.
Diagnosing Adult Incontinence
When you visit your healthcare provider, you may be asked questions about whether you experience leakage while laughing or sneezing, or how much caffeine or alcohol you drink. A bladder control diary can be incredibly helpful to have. Record the type and how much fluid you drink, how often you pass urine, the amount of urine you pass, and how many urine leakage episodes you experience.
Based on your medical history and symptoms, tests may be performed to rule out certain conditions that cause incontinence. Common tests include a cystoscopy to look inside of your bladder for abnormalities, measuring the pressure level in your bladder and stomach, a dipstick test to see if you have a urinary tract infection, a urodynamic test, and more.
Based on the results, your doctor will be able to create a treatment plan. Urinary incontinence treatment options vary based on the type and severity you are diagnosed with. Some options include simple lifestyle changes such as avoiding caffeine and spicy foods, doing kegel exercises to strengthen your pelvic floor muscles, or taking medication.
What Do You Need to Qualify for Medicaid Coverage of Adult Incontinence Supplies?
If you have one or more of the above conditions while also experiencing incontinence, you may qualify for free protective products, but you’ll need:
- A prescription from your healthcare provider for adult incontinence products.
- Your insurance plan may require you to have a signed letter of medical necessity that explains why your products are needed. The letter will include a list of the medical supplies to be used, and how many disposable supplies will be needed on a monthly basis. This letter may need to be signed within the last year.
- A copy of your medical history from your healthcare providers to ascertain any underlying conditions related to your continence issues.
The good news is that Aeroflow Urology can take care of all of this for you! Simply complete our quick and secure Eligibility Form and let us handle all of the paperwork and communication with your healthcare provider and insurance provider.
What Incontinence Products Will Medicaid Cover for Adults?
Once you begin to experience bladder control problems, it is important to contact your healthcare provider. In the meantime, you can explore options for absorbent products to help manage symptoms. Incontinence supplies are typically covered by Medicaid and managed care plans for those with a qualifying diagnosis.
There are a wide variety of discreet incontinence products available with different features and levels of absorbency.
Adult Pull-Ons: Also called protective underwear, may work better for those who need a moderate level of absorbency and can be pulled on and off, similar to standard underwear.
Bladder Control Pads: Sometimes referred to as an incontinence pad, these products are an option for those who need a product that is similar to a menstrual pad that can be secured to undergarments, but can hold more fluid.
Adult Briefs: Adult briefs may work well for some who need an overnight product or one that can handle heavy bladder or bowel leakage. They are also commonly used by people with mobility issues who require the help of a caregiver as they are designed for easy application and removal.
Underpads & Other Supplemental Items: There are also absorbent products like underpads or bed pads available to help protect bedding and furniture.
Many people will find that some combination of incontinence products and treatments works well for their particular diagnosis, and it's important to work with a healthcare provider to find the best solution. No matter what type of adult incontinence you have, with the right products you can remain confident, clean, and most importantly, in control.
Disclaimer
Information provided on the Aeroflow Urology website is not intended as a substitute to medical advice or care from a healthcare professional. Aeroflow recommends consulting your healthcare provider if you are experiencing medical issues relating to incontinence.