Introduction

For Florida residents enrolled in Medicaid, getting home medical equipment can be far more affordable — often at little to no cost. But Medicaid comes with its own rules, approvals, and paperwork, which can feel confusing if you’re new to the program.

If you’re wondering questions like “Will Medicaid pay for my wheelchair or hospital bed?” or “How do I get approval?” — you’re not alone.

The good news is that Florida Medicaid covers a wide range of durable medical equipment (DME), from mobility aids to Incontinence Products, when medical necessity is properly documented. The process usually involves prior authorization and coordination between your doctor, your Medicaid plan, and a DME supplier.

In this guide, we’ll walk through:

• What Florida Medicaid typically covers
• How managed care plans (MCOs) handle approvals
• The step-by-step process to get equipment
• How Medicaid compares to Medicare

No complex jargon — just the essentials you need to confidently use your Florida Medicaid benefits for home medical equipment.

What DME Does Florida Medicaid Cover?

Florida Medicaid offers broad coverage for medically necessary DME — and in many cases, it covers items that Medicare does not. When your doctor documents medical need, Medicaid can often approve the following:

Mobility Equipment

Florida Medicaid covers:

• Standard Manual Wheelchairs
• Group 1 Power Wheelchairs and higher
• Standard Walkers and Rollator Walkers
• Canes and crutches

More complex mobility equipment, such as custom power wheelchairs with seating systems, may require evaluations by an Assistive Technology Professional (ATP) and often fall under Medicaid waiver programs or enhanced authorization pathways.

Home Hospital Equipment & Support Surfaces

Items such as:

• Hospital Beds (Total Electric)
• Patient lifts
• Shower and commode chairs
• Pressure-reducing mattresses and overlays (e.g., Foam Pressure-Reducing Mattress or Gel Overlay Pad (Pressure Relief Surface))

These are commonly approved when required for safety, positioning, wound prevention, or caregiver support.

Respiratory Equipment

Florida Medicaid covers respiratory equipment including:

• Oxygen equipment
• Ventilators
• Nebulizer systems (e.g., Nebulizer Compressor + Administration Set)
• CPAP machines
• Suction machines

Prior authorization is often required for higher-cost items, but essential respiratory equipment is rarely denied when documentation meets criteria.

Prosthetics & Orthotics

Medicaid covers many braces and support devices, such as:

• Wrap-around hinged knee braces
• Ankle-foot orthoses
• Pediatric orthotics for children with developmental conditions

These typically require a prescription and, in some cases, evaluation by an orthotics provider.

Disposable Medical Supplies

This is where Medicaid provides significant relief compared to Medicare.

Florida Medicaid covers many consumable supplies, including:

• Straight Tip Urine Catheters and related catheter supplies
• Ostomy products
• Wound care dressings
• Diabetic testing supplies
• Incontinence Products (adult diapers, briefs, pull-ups)

Coverage usually requires a diagnosis and documented daily usage. Medicaid often sets quantity limits (for example, a monthly maximum), but approvals are common when medical necessity is clearly stated.

Special Medicaid Waiver Programs

If you’re enrolled in a Medicaid waiver program (such as iBudget or long-term care waivers), additional equipment or services may be available — including items not covered under standard Medicaid. Your case manager can help determine eligibility.

In short: If your doctor documents that equipment is medically necessary to manage a condition or support daily living at home, Florida Medicaid often provides a pathway to coverage.

The Role of Managed Care Organizations (MCOs)

Most Florida Medicaid members receive benefits through Managed Care Organizations (MCOs) such as Sunshine Health, Simply Healthcare, Humana Healthy Horizons, Molina, and others.

While these plans must follow Medicaid coverage rules, they handle approvals and provider networks.

Here’s what that means for you:

Know Your Plan

If you’re enrolled in an MCO, you must use in-network DME suppliers. Member services can help you confirm coverage and approved vendors.

Prior Authorization Is the Norm

Most Medicaid DME requires prior authorization. Your doctor or DME supplier submits a request showing medical necessity before equipment is delivered.

Routine items may be approved quickly. More complex equipment — such as Group 3 Power Wheelchairs — may require therapy evaluations and additional review.

Quantity Limits and Guidelines

Plans follow Medicaid rules for frequency and quantity. For example:

• Incontinence supplies may have daily limits
• Braces may only be covered once every few years unless size or condition changes

If a request exceeds guidelines, additional justification may be required.

Coordination Is Key

Your role is mostly to ensure your doctor and supplier are working together. If the plan requests more information, quick follow-up helps prevent delays. Denials can often be appealed with additional documentation.

Steps to Getting Equipment Through Florida Medicaid

Here’s a typical example using a Hospital Bed (Total Electric):

1. Doctor’s Evaluation
   Your physician evaluates your needs and documents why the bed is medically necessary.
2. Choose a Medicaid-Enrolled Supplier
   Select a DME provider that accepts your Medicaid plan. The supplier gathers your insurance details and prescription.
3. Authorization Submission
   The supplier submits a prior authorization request, including medical records and equipment codes.
4. Plan Review
   The plan reviews the request and may ask clarifying questions before approval.
5. Delivery
   Once approved, the supplier delivers and sets up the equipment. Medicaid typically covers the full cost.
6. Ongoing Support
   Supplies, maintenance, and renewals are handled according to Medicaid guidelines. Some items require periodic reauthorization.

Florida Medicaid vs. Medicare and Other Insurance

For individuals with both Medicare and Medicaid:

• Medicare is billed first
• Medicaid often covers coinsurance or items Medicare denies

Examples:

• Medicare covers a wheelchair → Medicaid pays the 20%
• Medicare denies incontinence supplies → Medicaid may cover them

If you only have Medicaid, your MCO is your primary coordinator. If you have private insurance plus Medicaid, private insurance is billed first, Medicaid second.

Always disclose all insurance coverage to your DME supplier to ensure proper coordination.

Documentation & Prescription Tips

Strong documentation speeds approvals:

• Detailed prescriptions matter — vague orders can delay approval
• Signed and dated forms are required
• Supporting medical notes strengthen requests
• Follow up if approvals seem delayed

Being proactive helps prevent lapses in coverage.

Conclusion

Florida Medicaid is a powerful resource for obtaining necessary medical equipment without financial strain — when the process is followed correctly. Doctor involvement, prior authorization, and working with in-network suppliers are key.

While approvals may take time, most patients ultimately receive what they need. And if Medicare doesn’t cover an item, Medicaid often fills the gap.

With the right guidance and coordination, Florida Medicaid can be a strong partner in helping you stay safe, supported, and independent at home.