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Given there are many different sets of rules, generally speaking, Medicaid will pay for medical equipment when it is determined to be medically necessary, cost effective and meet their strict definition of what is durable medical equipment. Instead, there are hundreds of different sets of rules depending on the state and the Medicaid program in which one is enrolled. Therefore, there is not a single set of rules governing Medicaid’s role in paying for durable medical equipment.
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Eligibility rules and benefits are determined at the program or waiver level by each individual state. Within each state, there are multiple Medicaid programs and several Home and Community Based Services Waivers. Medicaid is an insurance program for Americans with low incomes (and usually limited assets), primarily the elderly or disabled but also some adults and children. There is not a single set of rules regarding Medicaid’s role in paying for durable medical equipment, instead there are hundreds of different sets depending on one’s state and Medicaid sub-program.īefore discussing Medicaid’s role in paying for durable medical equipment (DME), it is helpful to briefly explain how Medicaid works.
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