Diaper Fact Sheet

Family Voices of Illinois

The Arc of Illinois

Family to Family Health Information Center

www.familyvoicesillinois.org

familytofamily@thearcofil.org

708-560-6703 (voice)   866-931-1110 (toll free for Illinois families)

 

Diaper Fact Sheet


Some children and youth with special needs may require diapers for a much longer time than what is considered to be typical. Others may need diapers throughout their lives. This fact sheet has information that families may find helpful in coping with this expense.

 

  1. The correct medical term for diapers is “disposable incontinent supplies”.

 

  1. Medical documentation: Two documents from physician are needed. In general, third party payment (or income tax deduction) can only be considered when a child with special needs is older than the “typical” age for potty training.  As of July 1, 2012, children age 4 and older who are covered by All Kids will be eligible to receive incontinence products with the following:
    1. Letter of medical necessity from physician. The letter must include child’s age, diagnosis and/or medical justification of why disposable incontinent supplies are needed. The quantity of incontinent supplies needed per day should also be included.
    2. Prescription from physician.

 

  1. Determine whether there is a third party payor:
    1. Private insurance
    2. All Kids/Medicaid
    3. Division of Specialized Care for Children (DSCC)
    4. Other
    5. Some combination of a-d above

 

  1. Find a provider that can provide incontinent supplies and is also willing to bill your third party payor(s). You cannot go into a retail store and pay for incontinent supplies with a Medicaid card or an insurance card. You may be able to do this in a medical supply store that accepts your third party payor. You will need to ask about this specifically.
    1. Ask your physician.
    2. Search online via the internet.
    3. Check phone book for medical suppliers.
    4. Ask friends, providers, support group members for names of vendors.

 

  1. Providers online can ship directly to you. Before ordering online, check to see if the online provider can bill your third party payor. If not, make sure you can submit the billing to your third party payor to receive reimbursement.  Reminder: if you have Medicaid or All Kids insurance, it is not possible to receive reimbursement. You must use providers who accept and bill Medicaid. Helpful websites include:
    1. Able Data: Incontinence Page: http://www.abledata.com/abledata.cfm?pageid=19327&top=12570&deep=2&trail=22,11860
    2. Family Village: Incontinence Products and Information: http://www.familyvillage.wisc.edu/at/incontinence.html
    3. Rush University Medical Center – Resources For children who are too big for standard children’s diapers and too small for adult-size diapers:
  1.                                                               i.      http://www.rush.edu/rumc/page-1245962431455.html

 

  1. Follow the rules established by your third party payor:
    1. If you have private insurance plus Medicaid, try to find providers who accept both forms of payment.
    2. You must get a denial from private coverage first before All Kids/Medicaid will pay the claim if you have both forms of coverage (same rules apply if you have a Medicaid waiver as with “regular” Medicaid). Provider may need to contact All Kids/Medicaid regarding correct billing procedures.
    3. You can only obtain supplies per the frequency and amount prescribed by your physician. If you have All Kids or Medicaid, effective July 1, 2012, you will be limited to a maximum of 200 diapers per month.
    4. If private insurance only, coverage may not be an included benefit. If not, discuss with your physician and obtain the medical justification and send a formal appeal to your third party payor for reconsideration.
    5. You can deduct “incontinent supplies” from income taxes, if you qualify. See F2F Income Tax Facts for more information: http://www.thearcofil.org/familytofamily/documents/documentdetails.asp?did=722
    6. If your child participates in Division of Specialized Care for Children (DSCC), contact your DSCC consultant for more information. http://www.uic.edu/hsc/dscc/

 

  1. If you have no coverage, or limited coverage, see our “When Insurance Won’t Pay” fact sheet for other ideas: http://www.thearcofil.org/familytofamily/documents/documentdetails.asp?did=1250

 

  1. Ask friends and family to save coupons for you and watch for sales on incontinent supplies (a/k/a diapers).
    1. How to Find Diaper Coupons Online: http://www.ehow.com/how_4849256_diaper-coupons-online.html
    2. The Simon Foundation for Continence: Incontinence Solutions: http://www.simonfoundation.org/Incontinence_Solutions.html

 

  1. If you do not have third party coverage for disposable incontinent supplies, and your child is three years of age or older, you may be able to deduct the cost from your income tax return as a qualified medical expense. Please consult our booklet “Income Tax Facts” for more information and instructions. For some families, claiming incontinent supplies as an income tax deduction is the only option.

 

  1. You will need to provide the diapers and other needed supplies at school and at other places/programs in which your child participates. Arranging for adequate supplies in all of your child’s environments is important.

 

  1. It is also essential to disclose or to share information about your child’s toileting needs up front with any caregivers. Consult our booklet “Tools for School” for more information about this topic: http://www.thearcofil.org/familytofamily/documents/documentdetails.asp?did=1305

 

  1. Remember that in order to protect your child/family member, disposable gloves must be worn by caregivers and other staff during toileting and diaper changing.
    1. The family is usually responsible for providing the gloves (except for medical facilities, school settings, group homes and other residential facilities).
    2. Disposable gloves are not typically covered by third party payors. They can, however, be included as a deductible income tax expense.
    3. Remember that you do not necessarily need to purchase “medical” gloves. Disposable gloves can often be found at lower prices at big-box home improvement stores, beauty supply stores, dollar stores and other discount outlets.

 

  1. If your family member is allergic to latex, you will need to make sure that only latex-free gloves are used. It’s a good idea to get a doctor’s order documenting the need for latex-free precautions and make sure that this information is shared with anyone providing personal care for your child/family member.

 

  1. Children and adults who use incontinent supplies may have related skin conditions which require topical medications (barrier creams, diaper rash ointments, for example) and/or specialized cleaning products (wipes).  These items may also be covered by a third party payor if prescribed by a doctor for the treatment of a specific condition. If not, discuss with your physician and obtain the medical justification for the medications and send a formal appeal to your third party payor for reconsideration.

 

Additional resources that may provide useful information on incontinence and incontinence supplies:

National Association for Continence – www.nafc.org

Incontinence Support Center – www.incontinentsupport.org

Incontinence Resource Center – www.incontinencesupport.info

Complex Child E-Magazine article -Diaper and Incontinence Product Coverage Through Medicaid and Insurancehttp://www.articles.complexchild.com/jan2012/00356.html

 

The following Information is important for people age 19 and older who have Medicaid insurance and are enrolled in the Illinois Medicaid Integrated Care Plan. This applies currently to individuals living in suburban Cook, DuPage, Kane, Kankakee, Lake, and Will Counties.

 

Disposable incontinent supplies are still a covered benefit. However, the way to get them changes due to enrollment in one of the two managed care organizations (MCOs).

 

For those enrolled in Aetna Better Health:

 

  • The Member Handbook provides a summary overview of covered services as listing all categories of supplies, services and/or treatments would be too lengthy to cover in the handbook.  The process for obtaining disposable incontinent supplies is the same as other DME supplies as outlined below. 

 

  • The Aetna Better Health Prior Authorization Department and Provider Services Department work closely with providers to educate them on how to access a full list of supplies, services, and treatments via the plan’s web-portal.  When a prescribing provider is giving the consumer a referral or prescription for a supply, service, and/or treatment the provider will also inform the consumer whether or not prior authorization is required.  When prior authorization is not required the consumer will take their referral, order or prescription to an Aetna Better Health contracted supplier that is most convenient for him/her.  If the supply, service, and/or treatment require authorization, the prescribing provider will coordinate the request with Aetna Better Health’s Prior Authorization department via secure fax (855) 320-8445, secure web-portal, or directly by calling (866)212-2851 and following the prompts.

 

For those enrolled in IlliniCare Health Plan:

 

  • IlliniCare does not require Prior Approval for incontinent supplies. Requests surpassing the benefit limit will be reviewed individually for medical necessity. If members have difficulty finding providers, they can contact one of IlliniCare’s Care Coordinators 866 329 4701 and ask to speak to a Care Coordinator. Providers can contact IlliniCare Prior Approval line866 329 4701 for anything exceeding the benefit limit.

 

 

This document was developed with funding from the Health Resources and Services Administration (HRSA)/Maternal and Child Health Bureau (MCHB)/Division of Services for Children with Special Health Needs (DSCSHN), through grant H84MC06873.