Frequently Asked Questions

Medicaid covers wheelchairs when certain requirements are met. Recipients may be approved for one wheelchair every seven years based on medical necessity. Motorized wheelchairs may be approved when documentation verifies that a manual wheelchair cannot meet the individual's medical needs and a motorized chair is needed for six months or longer. Home, environmental and vehicle adaptations, equipment and modifications are not covered. Repairs or replacement of parts must be approved in advance unless otherwise specified by Medicaid. Within the seven year period, Medicaid will not repair or replace equipment that is lost or damaged as the result of misuse, neglect, loss or wrongful disposition by the recipient, the provider or the recipient's caregiver(s). More specific information is available in the Medicaid Provider Billing Manual, Chapter 14.

CPAP machines are covered for children up to age 21 through the EPSDT program with a current EPSDT screening and prior authorization from the primary care provider.

Breast pumps are covered through the Alabama Department of Public Health (ADPH) through its WIC program. Please contact your nearest county health department. Here is link for those locations from the ADPH website: https://www.alabamapublichealth.gov/about/locations.html.

Medicaid will consider payment of disposable diapers when referred as medically necessary with an EPSDT screen and Prior Authorization (PA) for recipients ages 3–20 only.

For wheelchair repair, please use the link below for the list of Alabama DME Wheelchair Repair list of providers. http://www.medicaid.alabama.gov/documents/4.0_Programs/4.3_Pharmacy-DME/4.3.12_DME/4.3.12_DME_Wheelchair_Repair_List_10-24-13.pdf. Repairs and replacement of parts for wheelchairs will require prior authorization and coverage by Alabama Medicaid.

Alabama Medicaid will reimburse covered diabetic supplies for Medicaid recipients.

Insulin pumps may be approved for patients under age 21 when certain conditions are met. Recipients must have insulin-dependent diabetes mellitus (IDDM, Type 1), must have been in a program of multiple daily injections for at least six months, and must have documentation of glucose self-testing at least four times a day in the three months prior to use of a insulin pump. The patient or caregiver must be able to operate the pump and to comply with diet, exercise and glucose testing at least four times a day, among other requirements. Specific guidelines may be found in Medicaid Provider Billing Manual, Chapter 14.

No. A recipient does not have to be a home health care recipient in order to receive services of the DME program.

If the prescription or order to be paid by Medicaid goes over the maximum benefit limit that Medicaid has set up, the provider can ask for an override or approval for the extra items. If the request is not approved, any items above the maximum is not covered and the recipient may be charged as a cash recipient for the item(s) in excess of Medicaid's maximum benefit limit.