Medical Necessity for Medicaid: A Guide to Get Incontinence Supplies Covered
How to Navigate Medicaid for Free Incontinence Products
Medicaid covers incontinence supplies based on medical necessity. That means that you may be able to get free diapers, pads, pant liners, pull-ups, and more if you meet the medical necessity (and other) requirements. As an essential first step for Medicaid coverage, proving medical necessity can:
- Take time, especially if you haven’t received an incontinence diagnosis yet
- Require various tests and evaluations conducted by health care professionals
- Involve specific documents that will need to be submitted to Medicaid.
Here’s why, with clear answers regarding:
- What Is Medical Necessity?
- What Is a Letter of Medical Necessity?
- How Do I Get a Letter of Medical Necessity?
- Who Can Write a Letter of Medical Necessity?
- What Does a Letter of Medical Necessity Look Like?
- When Should I Get a Letter of Medical Necessity?
This guide to medical necessity for Medicaid highlights key info in less than ~5 minutes. When you’re ready for free incontinence supplies with Medicaid in Washington, Oregon, or Idaho, contact MyMedSupplies.
As a preferred medical supply provider throughout the Northwest U.S., MyMedSupplies has a hard-earned, well-deserved reputation for excellence, expertise, first-class service, and the highest-quality incontinence products.
What Is Medical Necessity?
Medical necessity means a product, service, or treatment is required to address or manage a specific health condition or impairment. As a fundamental requirement for Medicaid approvals, medical necessity for incontinence is typically determined based on:
- A documented medical condition that results in incontinence, such as neurological disorders, spinal cord injuries, or age-related conditions.
- A healthcare provider’s assessment, showing that the incontinence supplies are essential for managing the condition and preventing complications, like infections.
- A patient’s inability to control bladder and/or bowel function, requiring an official diagnosis and products to manage their condition
Without proof of medical necessity:
- Incontinence supplies and other products may be viewed as convenience based, rather than medically essential.
- Medicaid will NOT approve coverage for incontinence supplies.
What Is a Letter of Medical Necessity?
A Letter of Medical Necessity (LMN) is a formal document from a healthcare provider that:
- Explains why a patient needs certain incontinence products (and/or specific treatments)
- Serves as “proof” that incontinence supplies are a required part of a patient’s medical care plan, rather than a personal choice.
An LMN is typically required when Medicaid needs additional documentation to justify coverage. When LMNs are required, these letters must clearly outline:
- The patient’s diagnosis and how it contributes to incontinence.
- The medical risks of not having the necessary incontinence supplies.
- The specific type and quantity of supplies needed (This information will also be in the prescription for incontinence supplies.)
- A statement from the provider explaining that the supplies are medically necessary for managing the condition.
If Medicaid requests an LMN, quick and accurate submissions can keep things moving, avoiding potential delays in receiving incontinence products.
How Do I Get a Letter of Medical Necessity?
If you or a loved one needs Medicaid-covered incontinence supplies, here’s what you can do to obtain a Letter of Medical Necessity:
- Schedule an appointment: Visit your primary care physician, urologist, or another specialist familiar with your condition. If you have not yet been diagnosed with incontinence, this diagnosis will need to occur, so it can be included in your LMN.
- Discuss your needs: Explain your daily struggles with incontinence and the supplies you rely on for health and hygiene.
- Request an LMN: Ask your provider to write up a Letter of Medical Necessity, specifying your diagnosis, the severity of your condition, and your supply needs.
- Double check your LMN: Before submitting this document, take a moment to verify it contains complete and accurate information, including your diagnosis, the medical justification for the incontinence supplies needed, and the recommended products.
- Submit your LMN: Your LMN will typically be sent directly to Medicaid or to a medical supply provider, like MyMedSupplies.
Having a well-documented LMN can make ALL the difference in securing Medicaid-covered incontinence products.
Who Can Write a Letter of Medical Necessity?
Not just anyone can write an LMN—Medicaid requires it to come from a qualified healthcare professional who has evaluated your condition.
Consequently, health care providers who can issue a valid LMN include:
- Primary care physicians (PCPs): Family doctors who oversee general health and chronic conditions can write LMNs.
- Urologists: Specialists who treat bladder and urinary system disorders can author Letters of Medical Necessity.
- Gastroenterologists: Physicians who manage bowel-related conditions leading to incontinence can also put together LMNs.
- Neurologists: Doctors treating neurological disorders affecting bladder or bowel control are valid authors of these documents.
- Nurse practitioners (NPs) and physician assistants (PAs): In some cases, these professionals can also issue an LMN.
Remember, LMNs must come from a provider who:
- Understands your medical history
- Can effectively justify your need for incontinence products
- Clearly and accurately detail your need for incontinence supplies month to month.
What Does a Letter of Medical Necessity Look Like?
A Letter of Medical Necessity is a professional medical document that’s not associated with a single format, look, or style. In fact, while formats and overall appearance may vary, LMNs for incontinence supplies must include the following details:
- Patient information, including the patient’s full legal name, date of birth, and Medicaid ID number
- Provider information, including the provider’s (author’s) name, specialty, clinic name, and contact details
- Medical diagnosis, specifying the condition that’s causing incontinence (e.g., childbirth, sleep apnea, overactive bladder, spinal cord injury, multiple sclerosis, and/or post-traumatic stress disorder)
- Medical justification, explaining how incontinence affects the patient’s daily life and why incontinence supplies are required
- Product recommendation, detailing the type and quantity of supplies needed each month
- Provider’s signature and date, verifying authenticity and making the medical necessity determination official for Medicaid purposes
If an LMN omits any of these crucial details, coverage can be delayed or denied.
When Should I Get a Letter of Medical Necessity?
Before you apply for Medicaid-covered incontinence supplies, it’s usually best to have an LMN. If you do, you can avoid extra delays in the process.
In fact, as a rule of thumb, it’s generally prudent to request a new or updated LMN if:
- You are applying for Medicaid coverage for the first time.
- Medicaid requests additional documentation to approve your incontinence supplies.
- Your medical condition changes, and you now require different incontinence products (types or amounts).
- You switch health care providers or Medicaid plans, so it’s necessary to resubmit medical proof of your condition.
- Medicaid denies coverage, and you need an LMN to appeal the decision.
Proactively securing an LMN can minimize the chances of interruptions, denials, or problems getting the incontinence products you need.
How to Get Incontinence Supplies with Medicaid in WA, OR & ID
MyMedSupplies can help you get free incontinence supplies with Medicaid in Washington, Oregon, and Idaho.
We work directly with the Medicaid programs in these states, ensuring all required documents—including LMNs—are correctly submitted. With that, our experienced, knowledgeable team can help you:
- Determine your eligibility.
- Gather the necessary documentation.
- Navigate the process with minimal disruptions.
- Access to the high-quality incontinence supplies you need.
- Get discrete home deliveries for optimal convenience and unbeatable peace of mind.
With 40+ years of experience in the medical supply and Medicaid space, MyMedSupplies is fully accredited by the Accreditation Commission for Health Care, Inc. (ACHC) to provide Durable Medical Equipment, Respiratory Services, and Medical Supplies. We are also committed to providing top-tier service and reliable access to top-of-the-line incontinence products.
To find out more — or get help getting free incontinence products with Medicaid — simply talk to a professional coordinator at MyMedSupplies.
We are here for you, ready to help now.