How Often Will Medicaid Pay for a Wheelchair?

Medicaid is a government-funded program that provides health insurance to individuals and families who can’t afford it. One of its many benefits is coverage for mobility devices such as wheelchairs, power chairs, and scooters. But how often will Medicaid pay for a wheelchair?

The short answer is it depends on a few factors. Find out if Medicaid in California, or Medi-Cal, will cover the cost of your wheelchair here.

Does Medicaid Cover Wheelchairs in California?

To start, yes, Medi-Cal covers durable medical equipment (DME); this includes everything from manual and power wheelchairs to accessories and repairs, as long as they’re medically necessary. It’s important to note that Medicaid coverage for wheelchairs varies by state.

To be eligible for Medi-Cal coverage of a wheelchair, an individual must have a medical condition that causes significant mobility issues. Once you establish medical necessity, Medicaid will generally cover the cost of a wheelchair, partially or fully.

Your doctor must also prescribe the wheelchair, which a Medi-Cal-enrolled DME supplier must provide, but we’ll discuss this more below.

How Often Will Medicaid Pay for a Wheelchair?

The frequency at which Medicaid pays for wheelchairs varies, but as a general guideline Medi-Cal will consider paying for a replacement every five years. This is based on the reasonable useful lifetime (RUL) of a power wheelchair, which is estimated at five years. It is typically more cost effective for Medi-Cal to pay for replacement than to repair the equipment after the RUL has been reached. However, in the event of loss, theft, or irreparable damage to your power wheelchair, you may be eligible for a replacement sooner.

Additionally, Medi-Cal may consider paying for new equipment or modifications to existing equipment if an individual's medical condition changes, even if their power wheelchair is less than five years old. For example, if you or a loved one has a degenerative disease that has progressed and now requires a different type of wheelchair than previously received, a medically necessary replacement is considered a Medi-Cal covered benefit.

What Makes a Wheelchair Medically Necessary?

California considers a wheelchair medically necessary if a licensed healthcare provider prescribes it due to an injury, illness, or disability. Some qualifying diagnoses for a wheelchair typically include:

  • Spinal cord injuries
  • Cerebral palsy
  • Muscular dystrophy
  • Multiple sclerosis (MS)
  • Amputation
  • Severe arthritis
  • And many others

Conditions that cause significant weakness, fatigue, or pain might also require a wheelchair to conserve energy and prevent further injury.

How Do You Get Approved for a Wheelchair?

Obtaining a wheelchair through Medicaid can be complex and time-consuming. In most cases, you’ll need to get a prescription from a healthcare provider, work with a durable medical equipment supplier, and submit a request for coverage from Medicaid.

Our guide to getting a wheelchair through insurance breaks down the steps you’ll need to take, including but not limited to the following:

  • Finding a medical equipment supplier to assist you in the insurance qualification process.
  • Proving your insurance eligibility
  • Receiving a prescription from your doctor
  • Undergoing an in-home evaluation
  • Getting insurance approval

The process can take several weeks or months, depending on the program's specific requirements and the availability of equipment providers.

Need Help Getting a Medicaid-Approved Wheelchair?

If you or a loved one needs a wheelchair and live in California, contact Freedom Mobility today! We have a team of complex rehab technology experts that can help you receive the equipment and support you need to maintain your mobility and independence.

See if you qualify today, and contact us for a free consultation.