Pediatric Wheelchair Medicaid Coverage

Medicaid is the largest program that provides medical and health-related services to those who qualify. Funded through cooperative efforts between the federal and state governments, each state is responsible for administering its own Medicaid program, while remaining within the national guidelines enforced by the federal government. Each state sets eligibility standards and determines the amount and type of services offered, as well as the scope of services, and how long the services are provided. In addition, individual states set the rate of payment for services received.

An individual or family must meet resource and income limits set by their state in order to qualify for Medicaid services. Is your child receiving Supplementary Security Income (SSI)? If so, he or she automatically qualifies for Medicaid services. An individual or child must have a medical need or fall into a specified eligibility category. Is your child living with a serious medical condition, such as muscular dystrophy, spina bifida or cerebral palsy? Your child may qualify for Medicaid coverage of a pediatric wheelchair. A pediatric power wheelchair can give your child greater mobility and independence. Read on to get more information on Medicaid wheelchair coverage guidelines and how a pediatric power wheelchair can change your son or daughter’s life!

Medicaid Pediatric Wheelchair Coverage

For your child to qualify for pediatric wheelchair Medicaid coverage, your child must have a medical need for a specified pediatric wheelchair. A doctor’s prescription is required in writing and the prescription must state the type of pediatric power wheelchair your child needs. Pediatric wheelchairs may be covered as Durable Medical Equipment (DME) under Medicaid, however, circumstances of coverage can vary from state to state. Such variations include:

  • Coverage for vocational or outdoor use
  • Coverage for skilled nursing homes
  • Coverage for pediatric wheelchair accessories (some states have age limits on coverage)
  • Whether pediatric wheelchairs can be rented or purchased
  • Some states may require physical therapy reports or additional forms to be completed

If your child qualifies for both Medicare and Medicaid, Medicaid may cover a portion of the cost of a pediatric power wheelchair that is not covered by Medicare.

Edge 3 Stretto™ Pediatric Power Wheelchair

Edge 3 Stretto with iLevel

Once you know that your child qualifies for a pediatric wheelchair, it’s time to pick the best wheelchair to meet their needs. The Edge 3 Stretto™ is the ultimate pediatric power chair! With an overall width of 20.75 inches with 12.5-inch drive wheels, the Stretto is a narrower wheelchair that is designed to fit in pediatric-sized spaces! It is equipped with independent SRS (Smooth Ride Suspension) for a smooth, more comfortable ride with increased shock absorption. The Stretto pediatric power wheelchair comes standard with a USB charger port and front and rear LED fender lights.

Want to further boost your child’s independence? The Edge 3 Stretto is available with optional iLevel® technology. iLevel raises the wheelchair’s seat up to 12 inches while driving at speeds up to 3.5 mph. Medicaid may cover the cost of a power elevating seating system on a pediatric wheelchair, like iLevel, on a case-by-case basis. It must be demonstrated that iLevel is essential for Mobility Related Activities of Daily Living (MRADLs), such as reach, transfers, access, safety, communication, and/or supports the educational goals of your son or daughter.

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