How to Get Pediatric Diapers and Pull-Ups Through Medicaid
This piece has been medically reviewed by Samantha Eaker, DNP, CPNP-PC, Medical Advisor to Aeroflow Urology.
While some children may be fully toilet trained by the time that they are 3 years old, others may struggle with urinary incontinence, or lack of bladder control, until they are older. For some, incontinence may resolve with age, development, and maturation; however, for others, incontinence may be something with which they struggle throughout their life.
Parents may not realize that urinary incontinence can be quite common in children that have been diagnosed with certain medical conditions and/or are developmentally delayed. With a qualifying medical diagnosis and eligibility to receive incontinence supplies through insurance, families can successfully manage incontinence for their child without spending a fortune on supplies.
Medicaid Health Plan Coverage
Did you know that Medicaid can cover incontinence supplies for children if they are deemed medically necessary? Early Periodic Screening, Diagnosis, and Treatment (EPSDT) is part of the pediatric health provision of Medicaid: EPSDT ensures that children under the age of 21 who are enrolled in Medicaid programs receive age-appropriate screening and preventative services to discover and treat conditions as early as possible.
Part of EPSDT includes “home healthcare” which is broadly interpreted to include medical supplies and equipment needed for a Medicaid recipient to treat a diagnosed condition. This includes incontinence supplies such as diapers and pull-ups, as well as some supplemental supplies such as wipes and gloves.
Criteria for Medicaid Coverage of Pediatric Incontinence Supplies:
- A signed medical necessity letter or prescription from the child’s doctor or healthcare provider within the last 12 months.
- An accurate record of diagnostic information pertaining to the underlying condition as well as any other medical diagnoses.
- An underlying medical condition or diagnosis that causes incontinence.
- The number of times per day the child’s doctor or healthcare provider has ordered the incontinence supplies to be used.
- The number of disposable incontinence supplies requested per month.
- The maximum authorization to receive up to three months of products at a time with updated clinical notes.
Gathering all of the above information and dealing with Medicaid can sound overwhelming. The good news is that durable medical equipment (DME) providers such as Aeroflow Urology, are specially trained to work with insurance providers to maximize insurance benefits. Simply complete our form below and let us take care of the rest.
Health Conditions That May Cause Incontinence in Children
If your child is over the age of 3 or 4 and still experiencing incontinence, they may have a medical condition that is contributing. Often, children with special needs have a harder time controlling their bladder--both at night and during the day. There are many conditions that can cause or contribute to incontinence, including—but not limited to—those listed below. If your child is having issues with bladder leakage, contact their healthcare provider to see if further workup of a possible underlying cause or condition is warranted.
Click on condition name for more details.
Autism ^
ASD is a neurological and developmental condition that impairs the ability to communicate and socially interact with others. In children with autism, urinary incontinence may occur due to multiple etiologies ranging from an inability to control the bladder to constipation to sensing a sudden urge to void but not making it to the restroom in time.
A visit to and an evaluation from your child’s healthcare provider can help determine if they require specialized potty training and scheduling, or if their incontinence is the result of a different diagnosis. Depending on the cause and the child’s level of function, incontinence in children with ASD may be able to be treated promptly within weeks to months, but some may struggle with incontinence for indefinitely.
Developmental Delay ^
Conditions that are associated with cognitive delays, such as Down syndrome, may impact a child’s ability to potty train and/or control their bowel movements. The child’s healthcare provider can help parents learn effective potty training techniques, determine if incontinence is caused by a physical condition, and help develop an effective incontinence management plan.
Even in children with developmental delays, incontinence can occur from failure to make it to the restroom in time, the inability to recognize (or communicate) the need to void, and difficulty fully emptying the bladder. It can occur during the day or at night. While some children with developmental delays may learn to properly use the restroom over the course of a few months, some may experience more chronic incontinence.
Cerebral Palsy ^
Cerebral palsy (CP) is a group of movement disorders that appear in early childhood. According to the Autism and Developmental Disabilities Monitoring (ADDM) Network, cerebral palsy is the most common motor disability found in children--affecting approximately 1 in 323 children. Symptoms can include muscle weakness, poor coordination, and loss of sensation. Cerebral palsy can contribute to incontinence in a variety of ways. These patients may experience bladder spasms, enuresis (nighttime incontinence), the inability to recognize a full bladder, and frequent urination.
In some cases, cerebral palsy may cause a delay in the ability to potty train. Similarly, these individuals may experience incontinence symptoms into adulthood.
Neurogenic Bladder ^
Neurogenic bladder is caused by neurological or traumatic damage and contributes to flaccid and/or spastic bladder dysfunction. It can be associated with incomplete bladder emptying, decreased or absence of sensation, and/or overactivity leading to urinary frequency, urgency, and incontinence.
Depending on the function of the bladder, a healthcare provider may be able to address or treat incontinence due to a neurogenic bladder with behavioral modifications, medications, catheterizations, and/or continence procedures. However, some individuals with a neurogenic bladder may struggle with incontinence chronically.
Nocturnal Enuresis ^
Nocturnal enuresis, also referred to as nighttime incontinence or bedwetting, is characterized by an involuntary loss of urine while asleep.
Occasional episodes of nocturnal enuresis are not uncommon in children through the age of five. However, if the enuresis continues after age six or seven, you can consult your child’s healthcare provider for management options. Organic factors that may contribute to bedwetting include, but are not limited to, constipation, deep sleeping and the subsequent inability to recognize when the bladder is full, obstructive sleep patterns or sleep apnea, and hormone imbalances.
Attention-Deficit/Hyperactivity Disorder (ADHD) ^
Attention-deficit hyperactivity disorder, or ADHD, is a condition that is characterized by an inability to control impulses and pay attention. Individuals with ADHD may be restless and extremely active, and children with ADHD may experience trouble focusing at school and difficulty socializing.
The inability to concentrate may contribute to urinary incontinence in said children. They may leak urine from incomplete bladder emptying due to inattentiveness and sphincteric overactivity—causing poor relaxation. They may also have incontinence from holding their urine in for too long and are more likely to wet the bed due to central nervous system delays impairing their ability to identify and acknowledge bladder signals. Generally, children with ADHD can become continent, though it may require additional time for practice.
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 flashbacks, nightmares, and severe anxiety.
While PTSD is not known to directly cause incontinence, the two conditions may be associated. The heightened stress and anxiety after a traumatic event could cause accidental urine leakage or total voiding of the bladder. Children who suffer from PTSD may need to use incontinence products, attend therapy, and require medication to work through their emotional and physical symptoms.
Spina Bifida ^
Spina bifida is a condition in which the spine does not properly form during fetal development--resulting in neural tube defects.
Based on the severity of symptoms, a child with spina bifida could experience involuntary losses of urine, spasms that result in urine leakage, and/or the inability to feel when the bladder is full. This is often due to having a neurogenic bladder. As stated above, these patients may be able to adequately treat their incontinence with behavioral modifications, medications, catheterizations, and/or continence procedures.
Hirschsprung’s Disease ^
Hirschsprung’s disease makes it difficult for the large intestine to pass and empty stool. As a result, stool collects in the intestine causing colonic expansion. Babies with Hirschsprung’s disease may begin to vomit, become fatigued, develop a swollen stomach, become gassy, or experience diarrhea shortly after birth. Surgery can often help the colon function normally, but these children may experience a delay in toilet training.
Crohn’s Disease ^
Crohn’s disease is an inflammatory bowel disease (IBD). The inflammation of the digestive tract associated with Crohn’s disease can lead to severe abdominal pain, diarrhea, fatigue, and more. In children and adults, Crohn’s disease can result in inflammation of the rectum--which can make it difficult to hold liquid stool and cause bowel incontinence or fecal encopresis.
There is no cure for Crohn’s disease. However, management techniques include the use of special diets and anti-inflammatory or anti-diarrheal medications.
What You Need to Qualify for Medicaid Coverage of Supplies
If your child has one or more of the above conditions while also experiencing incontinence, you will need a prescription from their healthcare provider for pediatric incontinence products. You will also need a signed letter of medical necessity that explains why the 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 must be signed within the last year.
You will also need accurate diagnostic information pertaining to the underlying condition, as well as any other medical diagnosis.
The good news is that Aeroflow Urology can take care of all of this for you! Simply complete our quick insurance Eligibility Form and let us handle all of the paperwork and communication with your child’s pediatrician and insurance provider.
What Incontinence Products Will Medicaid Cover for Your Child?
Diapers – Diapers (also referred to as briefs, particularly as the child ages into youth and adult products such as adult diapers) may be the most familiar term for most people when it comes to incontinence products. Diapers have tab closures that allow for changing without the need to completely undress. For young children, children with limited mobility, and those that are wheelchair-bound, the tearable side panels make removal easier and more hygienic than pull-ups/pull-ons.
Pull-Ups – Protective underwear, also called pull-ons or pull-ups, are a form of absorbent, disposable underwear with elasticized waist and leg openings that can be easily pulled on or off. These products don’t have fasteners or tabs, and work well for older, mobile children who prefer a product that closely resembles typical, cloth underwear.
Underpads! – Also known as chux, underpads are used to protect furniture such as mattresses or car seats from leaks. They have a soft, absorbent layer on top, with a liquid-proof under side. Underpads can make clean ups easier, as they can simply be placed in the trash after use.
Disposable Wipes – Disposable wipes are moist towelettes that can help make clean up easier.
Barrier Creams – Barrier creams are used to moisturize, lubricate, protect skin from rashes, and maintain skin integrity while using incontinence products.
Please note that a child’s coverage for the above products will vary depending on their specific Medicaid plan and the state they live in. 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 throughout their entire life. It is best to work with the child’s doctor to determine the right mix of incontinence products for the child’s specific type of incontinence.
Frequently Asked Questions About Medicaid Coverage
Does Medicaid have to be my primary provider?
No, incontinence products can be provided for 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 healthcare 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:
- You may not meet the age requirement from your insurance provider.
- Incontinence supplies are not a covered item under your state Medicaid plan.
If any of the above apply to you, 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.
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