Pediatric Incontinence2019-07-08T13:32:24+00:00

Pediatric incontinence is a very common elimination disorder among children. It’s simply defined as the inability to control urine or involuntarily emptying the bladder due to a variety of contributing factors that are diagnosed by a qualified physician.

Incontinence in children is a completely normal condition physically and emotionally that generally fades over time. Oftentimes children aren’t diagnosed with pediatric incontinence until the ages of 5 – 7 depending on the type they suffer from.

Incontinence in Children

Medicaid Diapers for Children

Medicaid will cover monthly incontinence supplies if the diapers are considered to be a medical necessity due to a specific diagnosis. To have pediatric incontinence supplies covered by Medicaid the following criteria must be met:

  • A signed medical necessity letter or prescription from a member’s treating physician/nurse practitioner, physician assistant within the last 12 months.
  • Accurate diagnostic information pertaining to the underlying diagnosis/condition as well as any other medical diagnoses/conditions, to include the member’s overall health status.
  • Diagnosis/condition causing incontinence.
  • The number of times per day the physician/NP/PA has ordered incontinence supplies to be used.
  • The number of disposable supplies requested per month.
  • Maximum authorization of up to 3 months at a time with updated clinical notes.
  • Your child must be over the age of 3 or 4 depending on your state Medicaid requirements.

Medical guidelines for the authorization of incontinence supplies which include: diapers, briefs, pull-ups, liners, underpads, and emollients.

Medical Conditions That May Cause Incontinence Include: 

  • Intellectual/Developmental Delay
  • Autism
  • Epilepsy
  • Neurogenic Bladder
  • Spina Bifida
  • Paraplegia
  • Cerebral Palsy
  • Crohn’s Disease
  • Fetal Alcohol Syndrome
  • Down Syndrome
  • Overactive Bladder
  • Hirschsprung’s Disease
  • ADHD
  • PTSD
  • Intellectual/Developmental Delay
  • Autism
  • Epilepsy
  • Neurogenic Bladder
  • Spina Bifida
  • Paraplegia
  • Cerebral Palsy
  • Crohn’s Disease
  • Fetal Alcohol Syndrome
  • Down Syndrome
  • Overactive Bladder
  • Hirschsprung’s Disease
  • ADHD
  • PTSD
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What Products will Medicaid Cover?

Based on the cause of pediatric incontinence, your child’s age, and lifestyle there are a variety of products to help them stay comfortable, protected, and sanitary during the day and night.

Medicaid covers products such as:

  • Diapers

  • Briefs

  • Pull-Ups

  • Liners

  • Underpads (Chux)

Depending on your child’s condition these products could be needed for varying lengths of time. Sometimes incontinence supplies are needed for a few months, a few years, or during their entire life. It’s best to work with your doctor to determine the necessity for incontinence products and to put together a proper treatment and management plan.

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Frequently Asked Questions About Medicaid Coverage

Does Medicaid have to be my primary provider?
No, incontinence products can be provided for Medicare beneficiaries who have Medicaid as their primary or secondary provider.

How many diapers does Medicaid cover per month?
Medicaid provides a monthly amount of incontinence supplies depending on individual need as determined by your child’s care provider. This amount will be made clear to you when you begin receiving diapers through Medicaid.

I have Medicaid – so why don’t I qualify for supplies?
The reason could be one of the following:

  • Aeroflow Urology is not in network with your Medicaid plan or our contract may not allow us to provide the supplies you are requesting.
  • You may not meet the age requirement from your insurance provider.
  • Incontinence supplies are not a covered item under your Medicaid plan.

If you fit any of these areas, please feel free to reach out to your insurance provider to answer any questions you may have regarding your plan.

What if my child is not yet 3 years old but needs diapers?
Medicaid cannot make any exceptions for diaper coverage based on age, unfortunately, even under appeal or with medical necessity.

Aeroflow Healthcare does offer high-quality incontinence supplies for sale at the lowest allowable price on Aeroflow Direct.

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