If the senior in your life requires durable medical equipment, like a walker or a commode chair, you might be looking into ways to get this equipment at a discount or for free. Paying for these items out of pocket can quickly add up and cause a huge hit to your bank account. Luckily, if your senior is covered by Medicaid, the costs of this equipment may be covered.

Because Medicaid is regulated at the state level, there are no overarching national guidelines dictating how or what equipment will be covered. However, by following Florida’s individualized policies, you’ll be able get your loved one the equipment they need to thrive.

How Florida Defines Durable Medical Equipment

In Florida, Medicaid defines durable medical equipment as a device that is “medically-necessary” and able to be used several times, has a defined medical purpose, and has a helpful function when used in the patient’s home as determined by the Agency for Health Care Administration. How does this differ from normal medical equipment? Well, Medicaid also defines this as “medically-necessary” items, but further qualifies them as disposable or expendable and not very helpful when used in the patient’s home.

Overall, the four main components that help to classify durable medical equipment include:

  • Being medically necessary
  • Having a correct and appropriate function for the individual patient
  • Being helpful for the medical condition at hand
  • Being only for the use of the intended patient

What Medicaid Actually Covers

With all of this in mind, you might still be wondering what counts as durable medical equipment and what doesn’t. Here are few examples of equipment that Medicaid typically covers:

  • Hospital beds
  • Bedside commodes
  • Wheelchairs
  • Orthopedic footwear and prosthetic devices
  • Augmentative and assistive communication devices
  • Diabetic supplies
  • Suction pumps
  • Canes, walkers, or crutches
  • Oxygen supplies and nebulizers
  • Enteral nutrition supplements
  • Urological and ostomy supplies

Believe it or not, you can actually get durable medical equipment that’s brand new, used, or rented. It all depends on the initial cost of the device and what Medicaid will cover.

Coverage Limitations

Just because Medicaid covers these items in some cases, doesn’t mean they are always covered. There are certain things you’ll have to do ensure Medicaid foots the bill.

No Coverage Without a Prescription

Medicaid won’t pay for anything unless the patient has a prescription written for it. In particular, this prescription must come from a:

  • physician
  • physician’s assistant
  • advanced registered nurse practitioner
  • podiatrist

This prescription must include the date, the physician’s signature, and their license number in order to be valid.

If your senior is receiving care from a home health agency, the process is a little different. The agency must create a plan of care and then get it signed by one of the above to have the patient qualify for durable medical equipment.

Coverage Based on Provider

Medicaid will only reimburse you if you choose specific providers. In particular, these providers must:

  • Be accredited by a national organization
  • Have a current HME license and qualification as pertains to applicable laws
  • Not have any cases of fraud or abuse

There are more qualifications, but these are the main things to look for when choosing a supplier for your equipment.

Coverage Based on Where You Live

Generally, Medicaid does not provide coverage for older adults in institutional settings. Some examples of places where they will offer coverage include:

  • the patient’s home
  • the family home of the patient
  • a group home
  • an assisted living facility
  • a custodial care facility

Medicaid Compared With Medicare

Depending on the age of the patient, they might also qualify for Medicare coverage. If this is the case, they will be benefiting from Medicare Part B, which covers equipment. The main difference between Florida Medicaid and Medicare is that Medicare requires devices to have an expected lifetime of more than three years of use. Additionally, you’ll have to pay 20 percent of the amount that Medicare is paying and choose a doctor and supplier that is part of the Medicare system.

Because Medicaid rules can be so fickle, the best rule of thumb is to always double-check and see if your specific durable medical equipment will be covered before making a purchase.

If you need any help with this, feel free to contact Comfort N Mobility for assistance. We have years of experience providing people from Florida with the powerchairs and scooters they need to maintain an active and healthy lifestyle.

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