Following CMS approval of its 1115 demonstration amendment earlier this year, Tennessee is set to begin covering diapers as a Medicaid benefit on August 7th. All children under age two enrolled in Medicaid and CHIP (known as TennCare and CoverKids, respectively) will be eligible to receive up to 100 diapers per month as a covered benefit.
In preparation for the launch, the state has published new resources to help stakeholders assist families who may be eligible for the new diaper benefit and answer questions about how the policy will be implemented. Here are some of the key details which the state addresses:
- What types of diapers will be covered? Disposable diapers are covered, including pull-ups and trainer diapers. For the initial launch, four major diaper brands (Huggies, Cuties, Pampers, and Luvs) will be covered, but the state says it expects to cover more brands and sizes within the next few weeks. Availability of diaper brands and sizes may vary by pharmacy since each pharmacy will choose what diaper options to carry. Eligible families will only be permitted one brand of diapers per month; however, different brands and sizes can be selected in subsequent months.
- How will the diapers be provided? The benefit will be operated through the TennCare pharmacy benefit. (The state has published separate resources targeted to pharmacists who will be responsible for supplying diapers). Diapers will not count against a child’s or mother’s monthly prescription limit.
- Are there prescription or cost obligations? No prescription will be required and there will be no copayment for diapers. For newborns, the mother’s prescription ID number or social security number can be used to process claims until the newborn receives their own.
- How will the coverage limit on diapers each month be operationalized? Families can receive up to 100 diapers per month or up to 200 diapers for 60 days. This is to account for packages of diapers with quantities larger than the monthly limit. Because of the odd quantity sizes offered in standard packages of diapers (for example, a large package of size 1 diapers from one brand comes with 174 diapers), families may receive less than 200 diapers every 60 days depending on the package sizes chosen. Pharmacists will not be permitted to break down packages of diapers to achieve even quantities of diapers.
- What are the requirements for pharmacies? Participating providers will be responsible for the purchasing and stocking of covered diaper brands. Pharmacies may also have to update their claims software to account for sales tax, since diapers are taxable in Tennessee. Pharmacists will verify eligibility for Medicaid or CHIP and affix a prescription label to the diapers provided to eligible families. A list of participating pharmacies can be found on the diaper resources page on the state website, which will be updated weekly.
In addition to the resources that address questions about implementation and accessing the new diaper benefit, Tennessee also created outreach materials for pharmacies and stakeholders to provide to families. One of the materials is a flyer that highlights some of the issues outlined above (e.g. how many diapers provided, whether a prescription is need, cost to families) and even includes a reminder about well-child visits(!); this flyer is available in English, Spanish, and Arabic. There is also a communications toolkit for stakeholders that includes template messages and social media posts to share with eligible beneficiaries. All resources note where beneficiaries can to find information on participating pharmacies and covered diaper brands. The state has also posted slides from webinars conducted with stakeholders and pharmacies, explaining the new program and key details to help outreach and implantation efforts.
The launch of the diaper benefit in Tennessee is a noteworthy “first” for Medicaid, which has historically only covered diapers for infants based on medical necessity for incontinence issues. Diaper need is an increasingly prevalent issue which can result in children going longer than recommended between changes (leading to diaper rash and other diaper-related health conditions) and can affect a parent’s ability to work given many child care program’s requirements to have an adequate supply of diapers. The beginning of Tennessee’s diaper benefit next week will offer a new example of the important support Medicaid provides to low-income families.
[Editors Note: this blog was updated with new information on the diaper benefit and available resources on August 8. 2024.]
