Medical Coverage for Disposable Diapers

Disposable diapers are considered to be a non-covered service by NH Medicaid.  However, under the provisions of the Early and Periodic Screening Diagnosis and Treatment Program (EPSDT), also known as the Child Health Assurance Program (CHAP), disposable diapers can be considered for coverage under the medical necessity provisions for children over 2 and under age 21.

You may bill for this service without requesting authorizations if the following requirements are met:

You must have a letter of medical necessity (a prescription is not sufficient) on file and signed by a physician or ARNP which addresses the following and which supports the medical necessity of the disposable diapers:

Ø    Recipient diagnosis and whether a pre-existing or presenting condition exists

Ø    Medical need for the item prescribed

Ø    Expected outcome and recommended timetable of the prescribed treatment

Ø    Historical medical data, if applicable, of any treatment plans which may or may not have been successful to treat the current diagnosis

Ø    Assurance that the prescribed service is the least restrictive, most cost effective service available to meet the child's needs

Ø    Number of diapers required per day (limited to 7) and the medical reason why reusable diapers cannot be used

Examples of medical necessity that are acceptable include (a) the situation in which a child attends school and the school will not allow cloth diapers due to the threat of spread of a communicable disease, or (b) the child tried cloth diapers in the past and has had problems with skin breakdown. Disposable diapers are NOT covered for children who would be in diapers regardless of medical conditions ( ages0 through 2 years).  Disposable diapers are not covered for reasons of convenience (for example, if the parent does not own a washer and has to use the Laundromat, or if the parent cannot keep up with the wash. )

If you have any questions, please contact the Communications Unit at 1-800-423-8303.

Source information from Gail D

NH Family Voices, a family to family health information and resource

Project supported by Special Medical Services, NHDHHS

Information researched and guidelines provided by Martha Jean Madison.

Martha and husband Rob Madison are foster parents licensed by Portsmouth

DO.