Living with urinary incontinence (UI) can significantly impact your life, especially if you experience leaks or accidents. Luckily, regardless of whether you're young or a senior citizen, there are products designed to help you maintain a high quality of life. With the proper documentation, many of these products are covered by insurance policies—including Medicaid. Still, when insured by Medi-Cal (California's Medicaid program), it's important to take the time to understand your benefits and coverage. Your policy should outline the details, but you may need to contact a representative to confirm. In the meantime, here's some essential information on how to get incontinence supplies covered by California Medicaid.
What is Medicaid?
Medicaid was first introduced as part of the Social Security Act of 1965. It’s a public insurance program that both federal and state governments jointly fund. Medicaid was created to help provide health coverage to low-income individuals and families, but eligibility depends on several factors. However, children, parents, seniors, pregnant women, and people with certain disabilities are welcome to apply.
Although the federal government created Medicaid, partially funded on a federal level, each state has its own eligibility criteria, benefits, and administration. There are a few broad federal guidelines, but states have a lot of flexibility with their individual Medicaid programs. This means that Medicaid coverage eligibility and benefits can vary from state to state. Medicaid differs from Medicare, federally administered and funded health coverage for people over 65.
Who is Eligible for Medicaid?
Coverage may differ from person to person, depending on the rules in your state. Typically speaking, coverage is for the following groups of people:
- Children of low-income families
- Pregnant women with low incomes
- People with certain disabilities
- Seniors with low income
- Parents or caregivers with low-income
- Children in foster care
Unfortunately, some families and individuals may not qualify for Medicaid, even if they fall below the poverty line. To understand your coverage, it's important to work with a representative or an in-state advisor.
What is Medi-Cal?
Medi-Cal is California's Medicaid healthcare program. It's a state-run insurance under federal Medicaid programs, with extended coverage to low-income adults, families, children, and individuals with certain disabilities. You need to apply for coverage and enroll in the program in order to be covered by Medi-Cal and receive benefits.
California Medicaid Eligibility
To be eligible for California Medicaid, you need to be a resident of the state of California. You also must be either a U.S. national, citizen, permanent resident, or legal alien who needs healthcare but qualifies as low or very low income. You must also meet one of the following criteria:
- Be responsible for a child 18 years of age or younger, or
- Pregnant, or
- Have a disability, or
- Have a family member in your household with a disability, or
- Blind, or
- 65 years of age or older
You may also qualify for California Medicaid if you are:
- Under 21
- In a skilled nursing or intermediate care home
- On refugee status for a limited time
- Have been screened for breast and/or cervical cancer
- Enrolled in CalFresh
- Enrolled in SSI/SSP
- Enrolled in CalWorks (AFDC)
- Enrolled in Refugee Assistance
- Enrolled in Foster Care or Adoption Assistance Program
You can find more information regarding California Medicare eligibility and benefits by visiting the website here.
Coverage Details for Incontinence Products Through California Medicaid
Medi-Cal recipients can receive incontinence products as long as they're prescribed and fulfill a medical need. They can be prescribed by a doctor, physician assistant, nurse practitioner, or clinical nurse specialist, but the prescription must outline the cause of incontinence alongside any other important details. According to the fine print, "incontinence medical supplies are covered only for use in chronic pathologic conditions causing the beneficiary's incontinence." A written (or electronic) prescription needs to be signed and dated within 12 months of the claim. It must include the following information:
- Recipient’s name
- Full name, address, and telephone number of the prescribing provider, if not pre-printed on the prescription
- Diagnosis name and ICD-10-CM code specific to the medical condition/diagnosis causing incontinence
- Diagnosis name and ICD-10-CM code specific to the type of incontinence for which the supply is required
- Supply description or product type
- Anticipated frequency of use
- Quantity to be dispensed
Medi-Cal covers individuals who are five years old and up. Medi-Cal may also reimburse for incontinence supplies through the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Supplemental Services benefit when incontinence is due to a chronic physical or mental condition, including cerebral palsy and developmental delay and at an age when a child would normally be expected to achieve continence. This could be due to underlying conditions such as autism, but it's important to confirm directly with your doctor and a Medi-Cal representative.
To receive incontinence supplies that Medi-Cal covers, you must have the following:
- A medical condition that requires incontinence supplies (For example, autism, diabetes, down syndrome, Parkinson's disease, etc.)
- Prior authorization and documented proof within the last six months stating the medically necessary items
- Estimated amount of incontinence supplies needed per day
The products that are covered under California's Medicaid plan include:
- Disposable adult briefs or adult diapers — These are absorbent, single-use garments with fasteners designed to manage moderate to heavy urinary or bowel incontinence.
- Liners, shields, guards, pads, undergarments — Thin, absorbent inserts that provide protection for light to moderate incontinence, typically worn inside regular underwear for added comfort.
- Disposable adult protective underwear (adult pull-ons) — Pull-on style undergarments that are disposable, providing discreet protection for moderate to heavy incontinence without needing fasteners.
- Adult reusable underwear — Washable, absorbent underwear designed for repeated use, offering an eco-friendly solution for managing incontinence.
- Disposable underpads, bed pads, chux pads — Absorbent, waterproof pads placed on bedding or furniture to protect surfaces from incontinence leaks.
How to Receive Incontinence Supplies Through California Medicaid
Byram Healthcare has been the market leader in home medical supplies for over 50 years. We specialize in incontinence supplies covered by Cali-Med and several other insurance types. Partnering with Byram will streamline the delivery of your urologic product. You'll enjoy:
- Zero out-of-pocket costs for eligible Medicaid recipients
- No hassle regarding insurance paperwork and prescriptions
- Clinical and educational support at your fingertips
- Discreet delivery directly to your doorstep
- A full range of urology products to help you manage a range of conditions
Some of the most common incontinence supplies covered by California Medicaid include protective underwear, adult diapers, liners, bladder control pads, male guards, and more. To learn more about our wide range of products, visit our incontinence product catalog today.
Dealing with the insurance process when trying to order your incontinence supplies covered by Cali-Med can be frustrating at first, but there is an easier way. Byram Healthcare is here to help you throughout every step of the ordering process. As one of the leading medical supply companies in the country, we work with Medicare, Medicaid, and most private insurance providers to help you navigate the intricate process of obtaining insurance-covered incontinence products. Byram provides a better patient financial experience because we’re in-network with over 260 million covered lives. This translates to lower co-pays and deductibles. Learn more about our mission and get started today.
