Roadmap for Navigating Medicaid Denials
The Medicaid program maintains both federal and state connections. CMS oversees the federal portion of the Medicaid program and sets baseline standards for care provision and coverage, while individual states establish specific coverage policies and administer the programs.
Wheelchairs and select accessories and features are defined as durable medical equipment (DME) in federal legislation, and therefore are covered by state programs (although specific coverage may vary, see specific state policies for details). However, denials may occur for the wheelchair base, accessories, and/or features that the user and clinician deem necessary to the person’s health and function. In that case, a denial by the Medicaid system may be confronted through an appeals process. The following roadmap directs a process that may be taken to overturn a denial. Furthermore, contact the CTF if specific aid is requested.