How often will Medicaid pay for a wheelchair? It’s probably a question that’s come up more than once if you have Medicaid and a severe mobility issue.
Unfortunately, there’s not a simple answer to that question because one thing many people don’t realize is that Medicaid isn’t a singular program.
Although the Federal Government funds it, the government gives the money to the states, and each state administers its Medicaid program as they see fit. Thus, the specific coverage provisions vary from one state to the next, as do the conditions under which Medicaid will pay for DME (Durable Medical Equipment), and the frequency with which they’ll do so.
To make matters even more confusing, Medicaid rules often vary depending on whether you live in your own home, or if you live in a nursing home or other long-term care facility. The one way to get a specific answer to this question is to call your state Medicaid office and find out direct.
On the other hand, if the question is, how often will Medicare pay for a wheelchair, the answer is thankfully a good bit more straightforward, although there are still a couple of wrinkles to consider.
The short answer to the question is that you can theoretically get your wheelchair replaced after five years, but there are a few additional conditions that must also apply. You must:
Have had the DME in your possession for the entire time you have owned it
It must have either naturally reached the end of its useful life, or have become damaged or broken (Medicare isn’t going to replace the wheelchair just because you want a new model, even if it’s been five years)
And your replacement will be identical or as nearly identical to the original device as possible.
If you started with a manual wheelchair and after some years, you want to upgrade to a powered one, it’s possible that Medicare or Medicaid will help pay for it. Still, you’ll need to essentially start the acquisition process from scratch, and you’ll need documentation from your doctor that you need a powered chair (and that a manual one will simply no longer work for you).
The long and the short of it is that, whether you’ve got Medicaid or Medicare, both programs have at least some provisions for helping you get a wheelchair if you need one.