How to Get Pediatric Diapers and Pull-Ups Through Medicaid
This piece has been medically reviewed by Dr. Jay Levy, Medical Director to Aeroflow Urology.
While some children may be potty trained by the time 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, however for others issues with bladder leakage and loss of bladder control may be present throughout their life.
Parents may not realize that urinary incontinence is actually quite common in children that have been diagnosed with certain medical conditions and developmental delays. 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-ons 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 providers (DME’s) 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 to their loss of bladder control. 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 attribute to incontinence. The below list is not exhaustive. If your child is having issues with bladder leaks, contact your healthcare provider to see if it may be related to an underlying medical condition.
Click on condition name for more details.
Autism ^
Autism is a developmental condition that impairs the ability to communicate and socially interact with others. In children with autism, urinary incontinence may present itself in a variety of ways ranging from an inability to control the bladder to sensing a sudden urge to void but not making it to the restroom in time.
A visit to the child’s healthcare provider can help determine if the child requires specialized potty training, or if their incontinence is the result of a different diagnosis. For some children with autism, incontinence can be treated in as little as a few months, but some may need to manage incontinence symptoms into adulthood.
Developmental Delay ^
Conditions, such as Down syndrome, that are linked to cognitive delays may impact a child’s ability to potty train or control bowel movements. The child’s doctor or 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.
Signs of incontinence in children with developmental delays may include failure to make it to the restroom in time, the inability to recognize (or communicate) the need to void, difficulty fully emptying the bladder, accidents at night, and bladder or bowel leakage. While some children with developmental delays may learn to properly use the restroom over the course of a few months, some will experience lasting incontinence symptoms that may spread over the course of years.
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 symptoms contribute to incontinence in a variety of ways, including bladder spasms, enuresis (nighttime incontinence), the inability to recognize a full bladder, frequent urination, and bladder leakage.
In some cases, cerebral palsy can cause a delay in the ability to potty train, but it’s also common for individuals to experience incontinence symptoms into adulthood.
Neurogenic Bladder ^
Neurogenic bladder is caused by neurological damage and contributes to flaccid and spastic bladder dysfunction. It can contribute to the inability to fully empty the bladder, frequent urination, sudden urges to urinate, lack of sensation for the need to urinate, and uncontrolled loss of urine.
A healthcare provider may prescribe medications to help the bladder properly function, but in a majority of cases, neurogenic bladder symptoms can only be managed, not cured, contributing to lifetime of incontinence.
Nocturnal Enuresis ^
Nocturnal enuresis, also referred to as nighttime incontinence or bedwetting, is characterized by an involuntary loss of urine while sleeping.
Occasional episodes of nocturnal enuresis are typical in children through age seven. However, if the enuresis continues after age seven, you should consult your child’s healthcare provider. Various factors that may affect bedwetting are sleep apnea, hormone imbalances, and the inability to recognize when the bladder is full.
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. Children with ADHD, however, often experience trouble focusing at school and difficulty socializing.
The inability to concentrate may contribute to the rate of urinary incontinence among children with ADHD. They often experience bladder leakage and may wet the bed because they have a lower rate of compliance when it comes to potty training and self-managing their symptoms. They also may not notice the urge to urinate when it occurs. Generally, children with ADHD can become continent, though it may require additional months or years of 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 seem to 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 doesn’t 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, or the inability to feel when the bladder is full.
A doctor may be able to assist with potty training or prescribe a medication to manage symptoms, but many children with severe spina bifida may rely on the use of diapers and other incontinence supplies for the entirety of their lives.
Hirschsprung’s Disease ^
Hirschsprung’s disease makes it difficult for the large intestine to pass stool. As a result, stool collects in the intestine and the colon expands. Babies with Hirchsprung’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 it can also result in a delay in potty training in children.
Crohn’s Disease ^
Crohn’s disease is an inflammatory bowel disease (IBD). The inflammation of the digestive tract 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, causing bowel incontinence.
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 qualification 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.
Didn't find what you're looking for? Find more answers here.
Dr. Jay Levy
Dr. Jay Levy is Medical Director at Aeroflow Urology and a pediatric urologist based in Charlotte, N.C. He is board certified in Urology by the American Board of Urology and also earned the subspecialty certification in Pediatric Urology. Dr. Levy holds a Doctor of Medicine from the University of Texas Southwestern Medical School and a Bachelor of Science in biology from the University of Texas. He has completed residency programs at the University of Texas Southwestern Medical Center at Dallas, the University of Pennsylvania School of Medicine and the Mayo Clinic School of Medicine.