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How to Get Pediatric Incontinence Supplies through Medicaid

incontinence supplies medicaid potty training

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.

What Causes Incontinence In Children?

While it is common for a child to wet the bed at night, a child may also experience incontinence during the day. This can be due to urinary tract infections (UTIs), bladder infections, kidney infections, issues with the urinary tract, or nerve issues. 

Types of Incontinence in Children

Incontinence in children can be caused by a variety of medical conditions. This includes but is not limited to a malfunctioning bladder, constipation, or a child holding in urine for too long. The different types of incontinence in children include:

  • Overactive bladder or urge incontinence

When a child’s bladder muscles suddenly contract, an urgent impulse to urinate will occur. This may happen when a child is not near a bathroom and they cannot control the sudden urge to pee, resulting in unwanted leakage. 

  • Underactive bladder

When a child rarely feels the urge to urinate and will only occasionally empty their bladder. Your child may strain when peeing, have a weak stream of urine, or have stop-and-go flow due to weak bladder contractions.

  • Disordered urination

When a child’s bladder muscles and nerves may not work together properly, they may experience disordered voiding. As their bladder empties, the sphincter or pelvic floor muscles may stop urine flow too soon. This results in urine left in the bladder that may leak unexpectedly.

  • Nocturnal Enuresis

When a child pees while they are asleep, it is called bedwetting. This often happens at night since the child is undergoing a longer sleep cycle and may not feel the urge to wake up to go to the bathroom.

  • Post-Traumatic Stress Disorder (PTSD) 

When a child experiences post-traumatic stress disorder (PTSD), they may experience loss of bladder control during flashbacks, nightmares, or extreme uneasiness.

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.

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