If you have Medicaid and a severe mobility problem, this is probably a question you’ve heard more than once.
Unfortunately, there is no clear response to that issue because many individuals are unaware that Medicaid is not a single program.
Medicaid is a large program that provides medical and health-related services to low-income people.
If the patient meets the eligibility conditions, Medicaid may cover a complex rehab electric wheelchair or a mobility scooter.
Thus, you can technically replace your wheelchair after five years, but there are a few more conditions that must be met.
Whether you have Medicaid or Medicare, both programs offer options for assisting you in obtaining a wheelchair if you require one.
Let’s look more closely at the answer to this question.
Take a look into Medicare and Medicaid
Medicare and Medicaid cover more than 100 million people in the United States.
Both of them are government-funded health insurance programs, but the people they cover have different qualifications.
Medicare normally covers persons over the age of 65, as well as people under the age of 65 who have disabilities.
Medicare covers everyone, regardless of financial level.
Anyone who uses Medicare as their health insurance coverage contributes to the cost of medical services by paying monthly premiums and deductibles.
Medicaid, on the other hand, is only available to individuals or families with extremely low incomes.
This program’s participants frequently pay no charges for covered medical treatments and often only a small co-payment for many other services.
While both systems are relatively similar in terms of what they will and will not cover in terms of medical bills, it is important to remember that coverage and eligibility can vary depending on where you live.
What qualifies you for a wheelchair?
The Medicaid program is funded by a partnership between the federal and state governments.
Within broad national parameters provided by the federal government, each state:
- Establishes its own eligibility rules;
- Determines the kind, amount, length, and extent of services;
- Sets the rate of payment for services; and
- Administers its own program
Individuals must meet income and resource limits, be medically needy, or fall into an eligibility category designated by your state in order to qualify for Medicaid.
Anyone who receives Supplemental Security Income (SSI) is automatically eligible.
Medicaid will only cover the cost of a motorized wheelchair if the individual has a medical need for it.
A doctor’s prescription for the patient and the type of motorized wheelchair he or she requires is also needed.
Power wheelchairs are eligible for Medicaid coverage as Durable Medical Equipment (DME); however, conditions vary by state.
Among these variances are:
- Coverage for outdoor and vocational use;
- Coverage for skilled nursing facilities;
- Coverage for accessories (some states have age restrictions on coverage);
- Whether the powered equipment can be purchased or rented; and
- Some states require therapy reports or additional paperwork to be completed.
Individuals who qualify for both Medicare and Medicaid may be eligible for Medicaid to cover a portion of the cost of a powered chair that is not covered by Medicare.
Medicaid will consider paying for power adjustable seat height on a case-by-case basis if it can be proven that it is necessary for transfers, reach, access, safety, communication, and/or to support defined vocational and educational goals.
You are not obligated to do anything.
If your doctor orders a wheelchair for you, your Durable Medical Equipment (DME) provider will usually submit an informed consent request and the necessary documents to Medicare on your behalf.
Medicare will analyze the information to ensure that you are qualified for power wheelchair coverage and that you meet all of the requirements.
Your Medicare advantage and coverage will remain unaffected, and you should not suffer any delays in receiving the materials you require.
Frequently Asked Questions
What durable medical equipment does Medicaid cover?
Mobility aids including canes, crutches, walkers, and wheelchairs.
Orthopedic footwear, orthotic, and prosthetic devices. ostomy and urological supplies.
Respiratory equipment and supplies including nebulizers and oxygen.
What does Medicaid include?
Medicaid provides a broad level of health insurance coverage, including doctor visits, hospital expenses, nursing care, home health care, and the like.
Prescription drugs are not covered by Medicaid.
Will Medicaid pay for a wheelchair van?
Government funded health insurance programs are used to cover many medical needs, but wheelchair vans and conversions are not commonly covered under medicare or medicaid (which generally follows medicare rules).
Will Medicare pay for bathroom modifications?
Unfortunately, Medicare typically does not pay for the cost of house modifications.
In some rare instances, Medicare will pay for bathroom modifications and walk-in tubs.
Does Medicaid cover gym membership?
Medicaid coverage is different from state to state, so whether gym membership is provided will depend on where you live.
According to federal guidelines, a gym membership isn’t a benefit that must be provided by Medicaid, and in most states, it’s not included.