What Diabetic Supplies are Covered by Medicaid?

What Diabetic Supplies are Covered by Medicaid – Overview

Medicaid coverage for diabetic supplies and services varies by state, with each state having its guidelines for what is covered.

Medicaid provides coverage for individuals with low income or certain disabilities, including coverage for diabetes-related services and supplies, subject to state-specific guidelines.

To avail of these services under Medicaid, you must be eligible and enrolled in your state’s Medicaid program.

Medicaid programs may cover insulin and other diabetes supplies, with specific coverage depending on the state’s formulary and policies.

Diabetes Supplies are Covered by Medicaid

Medicaid coverage for diabetic supplies varies by state but may include blood glucose monitors, test strips, and other necessary supplies:

Blood Sugar Self-Testing Equipment and Supplies

Medicaid covers blood sugar level self-testing equipment and supplies. Medicare Part B covers such equipment and supplies for Medicare beneficiaries. This provision is available even if you do not need to use insulin.

Some commonly used self-testing equipment for diabetes that is covered under Medicaid:

#1. Blood sugar monitors

#2. Blood sugar test strips

#3. Lancet devices and lancets

#4. Glucose control solutions

State Medicaid programs determine the extent of coverage for diabetic testing equipment and supplies, including eligibility for frequency and quantity of supplies.

For instance, if you use insulin, then you may be able to receive up to 300 test strips and 300 lancets once every 3 months. If you don’t use insulin, you can get 100 test strips and 100 lancets every 3 months.

The availability of additional test strips and lancets for Medicaid beneficiaries is determined by each state’s Medicaid program and may require a physician’s prescription indicating the medical necessity.

The term “medically necessary” means that you need the supplies or services to diagnose or treat your medical condition if they meet the standards of medical practice.

Medicaid coverage for continuous glucose monitors (CGMs) depends on the state, with some states covering CGMs for individuals meeting specific criteria.

This helps to make diabetes treatment decisions, such as changes in diet or insulin dosage.

Medicaid requires a prescription from a healthcare provider for coverage of blood glucose testing equipment and supplies. This prescription should include:

#1. If you have diabetes

#2. The kind of blood sugar monitor you require and the reason you require it

#3. If you use insulin

#4. Frequency of testing your blood sugar

#5. The number of strips and lancets you need in a month

#6. To learn specific criteria for this, you can visit the official website at https://www.medicaid.gov/medicaid/benefits/.

Getting Diabetes Supplies and Equipment under Medicaid

You can order and pick up your diabetes supplies and equipment at the local pharmacy. Or, you can order your diabetes supplies or equipment from a medical equipment supplier.

Usually, your medical supplier is any person, company or agency that sells/provides you a medical item or service, except in cases where you are an inpatient in a skilled nursing facility or hospital.

For such an instance, you will require a prescription from your physician to place the order, as your physician will not be able to order it for you.

For Medicaid, you must obtain diabetes supplies and equipment from providers or pharmacies enrolled in your state’s Medicaid program.

Make sure to ask for refills for your supplies and get a new prescription from your physician for new strips and lancets every 12 months.

When you order the required diabetes testing equipment, you will only need to pay your coinsurance amount when you get the supplies from a supplier or pharmacy.

Getting Insulin Pumps under Medicaid

Medicaid coverage for insulin pumps and insulin for the pump is subject to state-specific guidelines, with some states covering these for eligible individuals under certain conditions.

Certain insulin pumps are considered medically necessary durable equipment, hence covered by Medicaid.

If you need an insulin pump, you will need your physician’s prescription.

Cost-sharing for Medicaid beneficiaries varies by state.

Getting Therapeutic Inserts and Shoes

If you have Medicaid and suffer from diabetes with certain conditions, then Medicaid will cover the cost of therapeutic shoes if you need them. Medicaid covers the following types of shoes:

#1. One pair of depth-inlay shoes and 3 pairs of inserts

#2. If you don’t wear depth-inlay shoes due to a foot deformity, you will need one pair of custom-molded shoes, including inserts, and two additional pairs of inserts.

To be covered for therapeutic shoes under Medicaid, the requirements are set by individual state programs and may vary, but typically involve a physician’s certification of diabetes, significant foot risk conditions, and a statement that the patient is under a comprehensive diabetes care plan.

Conclusion

Under Medicaid, you can easily get various types of diabetes self-testing equipment and supplies, such as insulin, insulin pumps, and therapeutic shoes and inserts.

Make sure to check with your physician so they can help you receive the benefits of your medical insurance.

Grants for Medical

What Diabetic Supplies are Covered by Medicaid?