Medicaid is America's health care program for low-income citizens of all ages. If patients are eligible to receive Medicaid, their benefits may be managed directly through the state program or through a commercial managed care plan that is contracted by the state.
Each state and each managed care plan establishes its own guidelines regarding coverage of nutritional products in the outpatient or homecare setting. Most states and plans will provide coverage for enteral nutrition when there is medical necessity for a feeding tube. Some states and plans will provide coverage for nutritional products when consumed orally as the only source of nutrition or when consumed orally in specific medically necessary situations. Most often prior-authorization must be obtained by a provider like a durable medical equipment company or a pharmacy.
Patients should contact their plan directly to obtain coverage information if they receive benefits through a Medicaid managed care plan. Our Abbott Nutrition Reimbursement HelpLine can offer some general information on traditional state Medicaid policies and provide a general summary of each state's Medicaid policy for enteral nutrition for adults and children. Abbott Nutrition Helpdesk Representatives can be reached by calling 1-800-558-7677 Monday through Friday 8:30AM to 5:00PM, EST.
Enteral nutrition coverage is based on medical necessity determination and policies can change. Therefore, we encourage patients to check with the program or their healthcare professional for specific coverage requirements.
NOTE: Information contained in this section is taken from a variety of sources including, but not limited to, official government documents. Such information is provided for our customers from information correct at the time of publication. Abbott Nutrition and Abbott Laboratories assume no responsibility for omissions, errors, or policy changes contained therein. Additionally, the information provided is meant to be a guide for your information only. Each health care provider office is ultimately responsible for verifying codes, coverage, and payment policies used for individual patients to ensure that they are accurate and appropriate for the services and items provided.