How to Get Pediatric Incontinence Supplies through Medicaid

Potty training usually starts when a child is between 18 to 24 months up to 3 years old. However, not all children are alike. Some kids may be ready to be potty trained earlier than others. After a certain age (around 4-5 years old), incontinence in children may be due to an underlying medical condition. If your child is experiencing incontinence, it is recommended to make an appointment with a pediatrician for a check-up and proper medical diagnosis.

If your child is insured under Medicaid and experiencing incontinence, they may be eligible to receive incontinence supplies through their insurance plan. Incontinence products must be medically necessary to treat their condition. Each state Medicaid plan has certain restrictions and coverage will vary.

Are Children's Incontinence Supplies Covered By Medicaid?

The types of incontinence supplies covered by Medicaid will vary by state. The following incontinence supplies may be covered by Medicaid:

• Pull-ups
• Diapers
• Protective underwear
• Reusable underwear
• Underpads 
• Disposable Wipes 
• Moist towelettes, also known as disposable wipes.
• Barrier Creams 

Medicaid Coverage Criteria

• A diagnostic or underlying medical condition that results in incontinence

• A precise record of the diagnosis, including the underlying disease and any accompanying secondary medical conditions

• A prescription or statement of medical necessity written within the last 6 months by the child's physician or healthcare provider

• The amount of incontinence products the child will need on monthly basis to treat their condition

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT)

As part of the federal Medicaid requirement, children under 21 years of age must undergo an EPSDT screening examination to ensure that services, products, and procedures provided are medically necessary to correct or ameliorate their medical condition(s). The screening includes the following:

• Comprehensive health history intake
• Comprehensive unclothed physical exam
• Laboratory tests 
• Health education
• Administering necessary immunizations (according to the Advisory Committee on Immunization Practices)

Is There An Age Requirement For My Child To Receive Incontinence Supplies Through Medicaid?

Some states may require that your child is older than 3 years old in order to receive incontinence supplies. Other states may have a different age requirement (child must be older than 4 years old). It is important to check with your state Medicaid plan for more information regarding benefit coverage. The recipient may not be older than 21 years old.

San Pablo Commercial is a family-owned, small business with a mission to deliver affordable medical supplies to their customers. We offer a variety of incontinence products including SPC underpads, bed mats for children, tuckable bed protectors for potty training, and disposable bed pads for bedwetting. We ship directly to our customer’s home within 2 to 3 business days. We care deeply about our customers and want to make ordering incontinence supplies easier so that they can spend less time cleaning up spills and messes.