Which Durable Medical Equipment is Covered by Medicaid

Medicaid is a health insurance program for people with low incomes and limited resources. Medicaid covers a variety of medical services, including durable medical equipment (DME). DME is equipment that is used to treat or manage a medical condition and can last for three years or more.

Medicaid coverage for DME varies from state to state. However, there are some general rules that apply to all states. For example, Medicaid will only cover DME if it is medically necessary and if it is prescribed by a doctor.

What is DME?

DME is a broad category of medical equipment that can be used to treat or manage a variety of medical conditions. Some examples of DME include:

• Continuous positive airway pressure (CPAP) machines: CPAP machines are used to treat sleep apnea.

• Crutches: Crutches are used to help people walk who have difficulty walking on their own.

• Hospital beds: Hospital beds are used to provide support and comfort to people who are bedridden.

• Infusion pumps: Infusion pumps are used to deliver medication or fluids into a person's body.

• Lancet devices and lancets: Lancet devices and lancets are used to prick the finger to get a blood sample for testing blood sugar levels.

• Nebulizers: Nebulizers are used to deliver medication into the lungs.

• Oxygen equipment: Oxygen equipment is used to deliver oxygen to people who have difficulty breathing.

• Patient lifts: Patient lifts are used to help people who are unable to stand or walk.

• Pressure-reducing support surfaces: Pressure-reducing support surfaces are used to help prevent bedsores.

• Suction pumps: Suction pumps are used to remove fluids from the body.

• Traction equipment: Traction equipment is used to treat bone fractures and other injuries.

• Walkers: Walkers are used to help people walk who have difficulty walking on their own.

How to Get DME Coverage

To get DME coverage, you will need to talk to your doctor. Your doctor will determine if you need DME and will write a prescription for it. You will then need to take the prescription to a DME supplier. The DME supplier will work with your doctor to get you the equipment you need.

What is Not Covered by Medicaid

Medicaid does not cover all DME. Some examples of DME that is not covered by Medicaid include:

• Cosmetic surgery: Cosmetic surgery is not considered to be medically necessary.

• Experimental treatments: Experimental treatments are not considered to be proven effective.

• Luxury items: Luxury items are not considered to be medically necessary.

Other Resources

If you have questions about DME coverage, you can contact your state Medicaid agency. You can also find more information about DME on the Medicaid website.

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The information contained on this website is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment.