If you're caring for someone on New York Medicaid or a Medicaid Managed Long Term Care (MLTC) plan, incontinence supplies are covered, but the process has specific rules that trip people up.

What's Covered

New York Medicaid covers medically necessary incontinence supplies, including adult briefs, protective underwear, underpads, and liners. Coverage runs through either straight Medicaid (billed through eMedNY) or, more commonly today, an MLTC plan if the individual is enrolled in one.

What You Need Before Ordering

• A prescription or order from a physician or nurse practitioner stating medical necessity
• Documentation of the specific diagnosis causing incontinence
• Active Medicaid or MLTC enrollment, verified before supplies ship

Quantity Limits

Plans set monthly quantity limits based on product type. Going over the limit typically requires updated documentation from the prescriber. If your loved one's needs have changed, ask their provider to update the order rather than assuming more will simply be approved.

Common Reasons Orders Get Delayed

• Prescription missing a specific diagnosis code
• Managed care plan not yet updated with new enrollment
• Product requested doesn't match what's authorized on file

Working With a Supplier

A DME supplier that already holds contracts with your specific MLTC plan can usually resolve these issues faster than starting from scratch, since eligibility and authorization are checked on their end before the order ships. If you're not sure whether your plan is in network with a given supplier, it's worth asking directly before placing an order.

Have questions about your specific plan or diagnosis? Contact us and we can check coverage before you order.