Medicaid is the largest program designed to provide medical and health-related services to people with low incomes and pay for covered medical services. Medicaid may cover a power wheelchair if the patient meets eligibility and coverage requirements. Title 19 of the Social Security Act is a program that provides medical assistance for certain individuals and families with low incomes and resources. The Medicaid program is funded through a cooperative venture between the Federal and State governments. Within broad national guidelines which the Federal government provides, each of the States:
- establishes its own eligibility standards;
- determines the type, amount, duration, and scope of services;
- sets the rate of payment for services; and
- administers its own program.
Assistive technology devices, such as a motorized wheelchair, may be covered as Durable Medical Equipment (DME) under this program.
To qualify for Medicaid, an individual must meet income and resource limits, and be medically needy or fall into an eligibility category specified by your state. Anyone receiving Supplemental Security Income (SSI) benefits is automatically eligible in some states. Medicaid will only pay for a motorized wheelchair if the individual has a medical need for the specific type of electric wheelchair he or she needs. There must also be a doctor’s prescription. Power wheelchairs can be covered as DME under Medicaid; however, coverage varies from state to state. Some of these variations include:
- Coverage for outdoor, vocational use;
- Coverage for skilled nursing homes;
- Coverage for accessories (some states have age limitations for coverage);
- Whether the power wheelchair can be purchased or rented; and
- Some states require physical therapy reports or special forms to be completed
To apply for Medicaid, please visit your local state Medicaid agency.