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Children with disabilities or special health care needs might need medical equipment or supplies. Both Medicaid and other health insurance often cover some or all of the costs for these items. Navigating insurance and Medicaid is complicated, so understanding as much as you can about durable medical equipment and how to best purchase it is essential.
Durable Medical Equipment (DME) is typically used for 3-5 years, not just once or twice. Examples include:
- Manual and power wheelchairs
- Hospital beds
- Oxygen equipment
- Hearing aids
- An augmentative communication device (that helps children who can’t speak or can’t speak clearly)
Children who use DME may also need medical supplies that are used once and then thrown out on a daily or weekly basis:
- Specialized formulas or food
- Feeding tubes or syringes
- Diapers and wipes (for a child who is 5 years or older).
- Ask your child’s doctor for a prescription. It should clearly describe what equipment or supplies your child needs.
- A therapist or specialist can also help. They can take measurements for a wheelchair or pick which type of communications device is needed. Once you or the therapist gives the doctor the therapist’s report, the doctor can write the prescription.
- Businesses that sell medical supplies and equipment are called DME providers. They’ll also handle your insurance claims. An insurance or Medicaid case manager can also help find an in-network DME provider. Connecting with other parents or asking your doctor or therapist can also be a good source of information.
- Talk with the DME provider about your child’s needs. They’ll want to know your insurance plan, how the equipment will be used, and your child’s specific needs. They can then help you find the right items and tell you what the insurance company must approve before you order it. This is called prior authorization.
- The DME provider will then get the prior authorization and file any paperwork with the insurance company. Once they get approval, the supplies are ordered and delivered to your home or therapist’s office.
DME providers can be an important part of your child’s well-being. They talk with your insurance company on your child’s behalf, and they often advocate for your child to get the right equipment.
Here are a few things you should expect a DME provider to do:
- Check in with you at least once a month.
- Explain the differences in equipment and supplies, pointing out special features or issues with certain products.
- Deliver and set up equipment in your home and teach you how to use and care for it.
- Check on and repair any rented equipment.
- Ask you to sign a form showing you received the equipment and were trained how to use it.
Before signing off on any delivery of equipment or supplies, make sure:
- It fits your child.
- It fits in your home, can make it into your vehicle, and can be used as needed.
- You’ve received all the items listed.
- You know how it works and how to maintain it.
You can switch DME providers at any time if you’re not happy. Just make sure the new one is in your health insurance network and have all the equipment your child needs.
- Medicaid plans and other health insurance typically cover some or most of the cost of DME and supplies, but they must be prescribed by a doctor and deemed medically necessary.
- Many insurance plans have co-payments or other limits on how many supplies they’ll pay for or how often they can replace DME. Medicaid might waive limits on how many supplies and equipment can be replaced for children and teens.
- If your child is 20 years old or younger and on Medicaid, they have the right to receive all the supplies and equipment prescribed by a doctor and considered medically necessary.
- Ask your child’s therapist to be with you for fittings or when new equipment is delivered. You might be able to have equipment delivered to the therapist’s office.
- If your health insurance doesn’t want to pay for the exact equipment or supplies your child needs, don’t give up. Work with your doctor and DME provider to explain to the insurance company why your child needs that specific prescription instead of another one.
- If the equipment arrives and it doesn’t fit your child correctly, don’t sign off on the delivery. If the wrong supplies arrive, don’t sign off on the delivery.
- There’s no need to stockpile medical supplies beyond what your child needs. If you ask the DME provider to reduce the amounts, your child won’t lose their access to supplies. You can always increase the amounts later if needed.
- Choose a DME supplier that advocates for your child and family. They’re an essential part of your child’s care team.
Assistive Technology
Assistive technology is another group of products that can help children with disabilities or other special health care needs. Many of these products can also be prescribed by a doctor, but they’re different than DME.
Learn more about assistive technology and adaptive equipment.
