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The Buck Starts Here... > Durable Medical Equipment (DME) Program
Durable Medical Equipment (DME) Program
Division of Hospitals and Provider Operations, Department of Medicaid Services
Overview:
Many types of assistive technology can be purchased as Durable Medical Equipment (DME) under this program. Durable
Medical Equipment is defined as equipment that withstands repeated use and is used primarily to serve a definite medical
purpose. It is not generally useful to a person in the absence of an illness or injury. Medicaid covers DME such as
wheelchairs, hospital beds, orthodontic appliances (braces), prosthetic devices (artificial limbs) etc., and disposable
medical equipment ordered by an accepted prescriber that is medically necessary and suitable for use in the home. Some
items require prior authorization by the supplier. The Kentucky Medicaid Program makes payment for covered services provided
by health care providers. It does not reimburse the recipient directly for medical expenses incurred. In recent
years, augmentative communication devices have been added to the list of DME covered by Medicaid.
Eligibility Requirements:
Individuals or families with dependent children may be eligible for Medicaid if they meet the following requirements:
- A pregnant woman;
- A dependent child under age 19. (The child does not have to live with a parent or close relative in order to
receive Medicaid);
- Parent(s) (one or both) of the dependent child if one parent has left the home, cannot work due to sickness or
disability, or has died;
- Parents (both) living with the dependent child, if the parent who earned the most income in the last 24 months is
unemployed.
AT Services Provided/Covered:
AT Devices Provided/Covered:
- Daily Living
- Speech Communication
- Mobility, Seating and Positioning
- Vision/Hearing Equipment
Application Process:
An application for Medicaid may be filed at your local Department for Community Based Services Office. At the time of
application, an individual or family should be advised to bring proof of:
- Social Security Number;
- Proof of Identity (Drivers License);
- Proof of Citizenship (Birth Certificate);
- Health Insurance;
- Pregnancy (Doctor statement verifying pregnancy and expected date of delivery), if applicable;
- Income
- Non-pregnant parents should bring proof of resources (last three months bank statements, checking or savings
account, life insurance polices, stocks and bonds), if they want Medicaid Coverage for themselves.
Contact Information:
Department for Medicaid Services
275 E. Main St. 6 C-B
Frankfort, KY 40621
(502) 564-6511
Email: dmsweb@ky.gov
Website: http://chfs.ky.gov/dms/dme
Bridges & Potholes:
Bridges
- Once Medicaid purchases a device for an individual, the device belongs to the individual. It does not remain the
property of Medicaid.
- Medicaid payment is payment in full. Providers may not bill both the individual and Medicaid.
- Medicaid is the payer of last resort on equipment purchases. If the individual is eligible for Medicare, Medicaid
will only pay the remainder of the cost after Medicare has paid within the limits of the fee schedules. If an
individual has health insurance, Medicaid pays only after the health insurance.
Potholes
- Not all devices are allowable for purchasing under Medicaid. There must be a medical need for a piece of assistive
equipment and this need must be clearly demonstrated. Equipment must be prior authorized by the Department for Medicaid
Services to determine medical necessity.