What diapers are covers by medicaid

[Cuteandspoild]

I recently received medicaid and am trying to find out if there are any abdl company's that are under or considered as medical grade that may be covers under the medicaid programs. So far I have not found any info to support the idea that abdl diaper are or aren't .if anyone knows for sure one way or the other please let us all know as I'm sure I'm not the only one who has asked this before. Also if anyone knows of any good premium medical grade diapers that may be covers that too would be helpful.thatnk you all for any useful info.

[Firefly 35]

Northshore is excellent for medical diapers and they also have some ABDL diapers as well.  You might be able to get ABU diapers as well if you have an FSA account: https://abucares.abuniverse.com/en/support/solutions/articles/12000003663-i-received-a-fsa-card-from-my-company-can-i-use-that-for-diapers-

If you have a bedwetting and/or incontence diagnosis, you'll probably have funding to use for diapers.  However medicaid is complicated and the best way to know what is covered under your specific plan is to check for yourself. 

[Cuteandspoild]

What is an fsa

 

[~Brian~]

10 hours ago, Cuteandspoild said:

What is an fsa

 

@Cuteandspoild

An "FSA" account is known as a "Flexible Savings Account"  I will tell you that medicaid DOES cover diapers, but these are of the cheap variety, and they are usually called "diapers" but they are really "tabbed underwear" and are cloth covered and are NOT acceptable - You will be peeing through anything that they give you that they cover, and when I started using these, I got 300 Prevail Air "diapers" and some prevail underpads.  

These are NOT diapers, and they are not designed to be absorbent or to last.  They think that someone is gonna change diapers every hour to 2 hours, and that is basically something that is set by state rules governing nursing facilities.  They are not even strong enough to deal with the voids that you would release, and I sure as hell would not want to do a BM in these.

I am WARNING You right now:  If you are going to ask Medicaid to help you, INSIST that you get a plastic backed diaper.  I use the Northshore Megamax - These are REALLY good diapers, and you wont be sorry.  I say INSIST, because they are going to tell you that all they have is the cloth backed products, which do NOT even hold anything, and they may say that want you to TRY them - But I would basically try to show "medical necessity" for the diapers.  That will help you, because once you do that, and you get a supplier, they usually have a "Prior Authorization" and it lasts for maybe a year, and each year, it has to be reauthorized.  Mine are reauthorized every 6 months.

What they made me do was to try the ones that they cover, and when they did not work, I had to have them do a Prior Authorization:  I was told that plastic backed diapers ARE covered, but that would be after they had me try the ones that were terrible.  I was told that they understood my IC, and that they knew that I would need more protection.  I told them that they need more suppliers, and they NEED to pay them so that they can AFFORD to compete, and so that they can get QUALITY diapers.......State of Vermont was able to get a "special rate" and a supplier in New Hampshire that was willing to accept it.......Now I don't have to worry about my diapers. I GOT the Northshores.........You may have to  "do your homework" to find a supplier, but make sure you ask them what suppliers are carrying, and call them yourself to get information about what they have in your area.  I had to give them my "top 5" choices of diapers, and once they had that, they were able to agree on them, and told me I "hit the mark" and got the Northshore Megamax - These diapers are AWESOME!  @NorthShoreAdamand his crew are TOP NOTCH - Check them out

I hope this information helps you - If I can be of any further help, please let me know

Brian

 

 

Edited November 13, 2020 by ~Brian~
Added Additional Information

[steveg]

before asking what company diapers for ABDL pleases understand  that the state will only pay so many cents per diaper and provide so many diapers as we the Medicaid fee schedule for your state its between .78 -.90 per as per 5A-3.pd looks loke you will get 192 diaper a month.  now all you have to do is find a company who does the billing generally its a local company but there are national companies do a google search for "north Carolina Medicaid incontinence supplies"

you'll be lucky to get 

Attends
Tenas
Mckessens
First Quality 

Be sure to ask about Gloves, Uderpads, Wipes or barrier cream and periwash 

Hope this Helps any question feel free to PM me 
 

[~Brian~]

21 hours ago, steveg said:

before asking what company diapers for ABDL pleases understand  that the state will only pay so many cents per diaper and provide so many diapers as we the Medicaid fee schedule for your state its between .78 -.90 per as per 5A-3.pd looks loke you will get 192 diaper a month.  now all you have to do is find a company who does the billing generally its a local company but there are national companies do a google search for "north Carolina Medicaid incontinence supplies"

you'll be lucky to get 

Attends
Tenas
Mckessens
First Quality 

Be sure to ask about Gloves, Uderpads, Wipes or barrier cream and periwash 

Hope this Helps any question feel free to PM me 
 

@steveg@Cuteandspoild

For @Cuteandspoild to be able to get the diapers that are BETTER than the ones that are supplied by medicaid, he would have to show medical necessity,  In order to do that, he would mostlikely have to talk to his doctor, and get a script for the diapers he needs.  The doctor usually writes the prescription, and "specifies" the TYPE of diaper. or the BRAND, and if he says "brand necessary" they have to provide what he prescribes.

The ONLY thing is: you would have to show medical necessity.  and you would have to get what we call in Vermont, a "Prior Authorization."  Sure, the doctor can script "diapers. gloves, chux/underpads and anything else that is needed."  If that is where we would STOP, he would get the types of diapers you listed.  "First Quality" is the company that makes the Prevail Line of Briefs, and the Prevail Underpads.

I think that was done in my case because of documented Cerebral Palsy, Incontinence due to immobility,  Diverticulitis and IBS, and having "accidents,"  The doctor was able to show these conditions, as well as the fact that the general diapers provided by medicaid, all cloth backed, cheap and unusable would NOT help me, and cause me discomfort and medical issues, because the diapers need to be able to HOLD what I release.

TRIALS WITH CHEAP DIAPERS AND LOW REIMBUSEMNETS

Of course, I tried the cheap diapers, and after a while,  I did NOT like them, and I wanted the plastic backed diapers, so after a miserable month and a half of flooding, wetting the floor, leaking/messing and having terrible trouble using the prevail diapers, as well as looking at 20 or more other  brands of "tabbed underwear" and pull ups, I  RESPECTFULLY went  OFF on the companies that think that these incontinence products help anyone, with iC, or with other issues.  They don't HOLD anything, and they are NOT designed for any type of use where a person has to empty their FULL BLADDER into them - They are designed for people who have LIGHT to moderate bladder releases, and they are made cheaply because Nursing Homes apparently have a rule that says you change someone every 1 to 2 HOURS, so a more absorbent and comfortable product is NOT needed, so they get away with doing what @steveg says:  they pay something like $13 per script for diapers, (that is what Vermont medicaid gets for these reimbursements for these products) when plastic backed ones cost $24/bag - I basically said "You are selling substandard products to those who have severe IC issues, and you expect someone to use cheap products?"  They said "Plastic backed diapers are known to cause infections, skin breakdown, rash, and other problems."  I responded by saying that the products I was using are no better then doing your business in a "colored paper towel."  I also stated that my IC is NOT being dealt with with these products, and I was going to keep on the state UNTIL I GOT what I wanted and needed!  The State complained that they  would have to pay $1,000 a MONTH for these, and I said "so, my health care choice is being determined by a NUMBER?"  After a couple of days, the state called me and said that we would have to submit a "prior authorization" for the diapers, and my Community Health Team took it and ran with it - Everything was put together in a couple weeks, and a supplier agreed to Vermont's special rate of payment: and I got my First Choice of the diapers:  The Megamax.

THE PRIOR AUTHORIZATION:ASK FOR WHAT YOU NEED

The Prior Authorization is basically a request for medicaid to cover things that ARE above and beyond what is normally covered, and you are basically asking the state to cover things that they normally will not.  I had to get a diagnosis of "incontinence due to limited mobility. Diverticulitis and IBS." and then I had to ask for the plastic backed diaper/briefs.  The doctor then puts in a request (The "PA") and deals with the State.

GETTING PLASTIC BACKED DIAPERS  IS POSSIBLE THROUGH MEDICAID - However, you have to go through the "PA" process, discuss it with your doctor, and once he determines that there is medical need, and there is a way that the information is submitted to the state for approval.  My doctor had to go a few times around with medicaid, and I was asked by the "Clinical Unit" to provide them with 5 plastic backed brands:  They asked me then, to rank them 1 to 5, as to my preference, and then they would "approve" the request (in my case I needed them ASAP) as "soon as it hits the clinical nurses desk."  We then had to deal with funding, and there was some sort of problem where the billing was going to MEDICARE, and medicaid pays for diapers.  The company that contracted to provide them at Vermont's agreed reimbursement rate, suddenly had to STOP providing them for a month or so, because the funding was messed up, and had to be redone, and the PA had to be redone, because the supplier was getting $.03 cents/diaper when they should have been getting like $3.00/diaper.   They also had to EMPHASIZE the words "BILL MEDICAID DIRECTLY" because the supplier was attempting to bill Medicare, and that was always denied.  Once that was dealt with, my reorder request was filled, and I have had no problems getting them.

My PA's call for:

"540 Plastic backed briefs"  (These amount to 90 diapers a month), and the PA is active for 6 months from the time of issue, and is renewed every six months.  Medicaid Billed Directly

As I said, the prescription PEN is powerful.  I say that because the doctor writes the script, and with a PA, it can open doors that just a normal script request would keep closed  A doctor can SPECIFY that he/she wants you to have a particular med, and BRAND, and IF he/she writes "Brand Necessary" they CANNOT substitute for the generic or off-brand.  I think my Doctor SPECIFIED "Northshore Megamax Plastic Backed Briefs", Medium and added "NorthShore Boosters, Large" to the script for the December renewal, and I was at his office yesterday:  I am all set for another 6 months:  I believe that I don't HAVE to do anything else, unless I need to change something, because I have proven what I needed, and they say I won't be denied for the products I need. 

@CuteandspoildYou will probably discover that MOST online medical supply places have limited involvement with medicaid, and what they can provide you WITHOUT a PA is substandard.  I have even been laughed at when they asked me where I live, because they have to determine whether they can help me.  Most of the problems I have found, result from low reimbursement rates, and that results in companies getting the low end, cheap garbage products, because Medicaid won't cover plastic backed briefs, unless you jump through  the hoops I've explained:  You CAN get the good stuff, you just have to do a little extra work.

Good Luck! and if you have any questions, feel free to respond or PM me

Brian

Edited November 14, 2020 by ~Brian~
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