In this guide, you’ll get answers to the question, does Medicaid cover bathroom equipment? We include a brief overview of the Medicaid coverage of restroom equipment and renovation funding across the states since coverage varies depending on the state.
You’ll learn whether Medicaid covers walk-in tubs, raised toilet seats, grab bars, and more. You’ll find several links to allow you to learn more detailed information specific to your state’s Medicaid and the equipment you require.
Which U.S. States’ Medicaid Covers Bathroom Equipment?
Unlike the federal Medicare program, which doesn’t cover any restroom modifications or equipment other than a portable commode/toilet chair for those who can’t access a bathroom, Medicaid programs in all states provide some type of bathroom equipment and adaptive modification funding. Bathroom equipment and renovations covered for seniors under state Medicaid must be assistive or adaptive in nature.
The money amount and eligibility requirements vary greatly between states. The shared goal though is to help Americans age independently in their homes and put off nursing home care for as long as possible. Medicaid pays 100% for long-term nursing home care for eligible seniors and that is much more expensive than helping Americans age in their homes with the equipment needed for independent living.
State Overview of Medicaid Bathroom Coverage
Since Medicaid is state-run and not federally managed, states have different types of funding management systems for their Medicaid. State-run Medicaid systems are always evolving and may change at any time to be more cost-effective while still providing long-range senior care. Although there can be some overlap, most states currently use a waiver system, with some states employing a managed long-term care approach and a few states enacting a more mixed or unique delivery of benefits.
Generally, the three main types of state Medicaid delivery systems for home modification and bathroom equipment coverage are:
How does Medicaid cover bathroom equipment on a state waiver program? Medicaid waiver programs provide Home and Community-Based Services (HCBS). Basically, waivers allow states flexibility in adjusting programs and services for people in their homes and communities as a less expensive alternative to institutional care.
This Medicaid.gov explanation of HCBS Waivers is a brief and helpful quick read. While cutting health care costs, HCBS Waiver care must be protective of each person’s well-being and follow reasonable standards.
In terms of paying for bathroom equipment for seniors, adaptive and assistive items are typically covered along with restroom modifications. Some states don’t consider additions such as better lighting for coverage while others may severely limit bathroom remodeling coverage or cover the materials and not the labor.
Most states use some variation of HCBS Waiver Medicaid. Presently, these states include:
Managed Care Programs
The benefits in terms of bathroom equipment and remodeling covered in Managed Care Medicaid are like those in waiver programs. The main difference is that service delivery is managed by Medicaid partners called Managed Care Organizations (MCOs).
States that deliver assistive Medicaid senior bathroom equipment and remodeling coverage with MCOs include:
Presently, two states combine methods of delivery for Medicaid bathroom renovation and modification coverage:
The division of Delaware Medicaid called Diamond State Health Plan Plus DSHP-Plus includes coverage of home modification benefits for seniors.
Oregon’s K Plan/Community First Choice program manages HBCS that includes Medicaid coverage of elderly-accessible home modifications. If the senior is eligible for regular Medicaid, K Plan benefits are currently guaranteed without a waitlist.
After the next quick section on what types of restroom equipment is typically covered for seniors by state Medicaid, you’ll find links that allow you to select your state to find contacts for specific bathroom coverage information.
What Types of Bathroom Equipment Does Medicaid Cover?
Does Medicaid cover bathroom equipment of all types for seniors? Not every state will cover every washroom safety item. The focus is for coverage of assistive or adaptive equipment. Walk-in tubs and accessible showers are Medicaid-covered. The same goes for grab bars and raised toilet seats.
Not all states will cover equipment such as brighter lighting, accessible shelving, bidets, non-slip flooring, or easy-use lever handles for showers, tubs, sinks, and cabinets. Also, not all states will pay for installation and labor costs.
Here is the bathroom equipment most likely to be covered by each state:
Where To Find State-Specific Medicaid Bathroom Equipment Coverage Info
We hope you gained resources, advice, and knowledge from our answer to the question does Medicaid cover bathroom equipment for seniors. You should now be better prepared to find the state-specific info you need to move forward with any elderly bathroom remodeling and equipment you require.