Understanding Medicaid Coverage for Nutritional Supplement Drinks

"Does Medicaid cover Ensure? What about Boost?"

That’s one of the biggest questions we get when it comes to pediatric supplement drinks. Parents like you may not realize you don’t have to pay for these essential supplies out of pocket. Medicaid will cover pediatric supplement drinks for children who qualify.

But navigating the system can be tricky, especially if you’ve never dealt with Medicaid before. Below, we’ll walk you through the process and explain everything you need to know about getting your supplies covered.

Let’s get started.

Does Medicaid Cover Ensure or Boost? Here's What You Need to Know

Your first question is probably, “How do I know if my child is eligible?” Let’s look at the requirements.

Medicaid generally covers pediatric nutritional products if your child has been diagnosed with a condition that requires supplemental nutrition. These include:

• Failure to thrive
• Metabolic disorders
• Severe food allergies
• Chronic conditions affecting growth and development
• Other specific medical conditions where standard food intake is insufficient

Types of Pediatric Nutritional Drinks Covered

Medicaid can cover a variety of nutritional products, including specialized formulas, high-calorie nutritional drinks like Boost or Ensure, and thickeners for children with swallowing difficulties. The specific product covered depends on your child's medical needs as documented by their physician.

Next, let’s look at how the process should go and the snags you could run into along the way.

The Ideal Process for Getting Nutritional Supplements Covered by Medicaid

Ideally, securing Medicaid coverage for your child's nutritional supplements would be straightforward and hassle-free. After their healthcare provider determines that nutritional support is necessary, the process should unfold smoothly, so your child gets the supplements they need without delay.

Here’s how it should work:

• It typically begins in your doctor's office. After diagnosing your child with a condition that requires nutritional supplements, the doctor will write a prescription for the necessary products — whether it's a specific formula, high-calorie drink like Boost or Ensure, or a thickener.
• This prescription will include all the essential details, such as the type of product, the daily dosage, and how often it should be used.
• Once the prescription is ready, the doctor’s office will fax it directly to a supply company. Along with the prescription, the doctor will also include other required documentation, such as the most recent well-child exam and, in some cases, a detailed letter outlining the medical necessity.
• For states like Arkansas, the prescription must include the child’s caloric intake and the number of times per day the supplement is needed. In Texas, a Title 19 form will be filled out, which includes specific billing codes, units, and pricing information.
• After receiving the prescription, the supply company (in this case, TMS) will verify your insurance coverage, particularly your Medicaid plan. If everything checks out, you’ll get a call from us to discuss the available products, including flavor options. (After all, if your child isn’t gaining weight because of food aversions, sticking him with a flavor he hates won’t help.)

"As a mom who has a child on Boost Kids Essentials, my child only likes vanilla, but I love that he's able to pick his favorites. If one day I want to try chocolate, we can certainly do that... A parent could certainly do that just to see if that's something that they would like so that way they're not having to waste product that a child may not drink."

— Angelica Johnson, TMS

• Once you’ve finalized the product details, TMS handles the rest. We’ll make sure all paperwork is in order, submit any necessary forms to Medicaid, and coordinate with your healthcare provider if any additional information is needed. The goal is to ensure there’s no delay in getting the supplements your child needs.
• The supplements will then be discreetly shipped to your home, typically within a few business days (because your child’s medical conditions are no one else’s business).
• Prescriptions usually expire every six months. We’ll re-verify your insurance and prescription before it lapses, so you don’t have to worry about service interruptions. We’ll also check in with you monthly to confirm that everything is on track, from your address to the amount of product you have on hand.

Common Roadblocks to Getting Pediatric Drinks Covered

Now that we know how things should go, let’s look at where things could go wrong and how TMS ensures they don’t.

 Roadblock No. 1: Prescription Issues

One common problem we see is missing or incomplete information on the prescription. Medicare requires precise details, including the doctor’s signature and specific nutritional needs. So, we’ll double-check the prescription before we submit paperwork to stop delays before they happen.

Roadblock No. 2: Insurance Verification

Each state has unique Medicaid requirements for covering nutritional drinks. In Arkansas and Texas, our primary coverage areas, the documentation and coverage rules are completely different. And it can be challenging to know exactly what’s needed. Fortunately, when you partner with TMS, we handle the documentation for you, so you don't have to worry about it.

What to Do If Coverage Is Denied

If Medicare denies coverage at first, don’t worry. Often, Medicaid will automatically deny claims if documentation is missing or incorrect.

But if Medicaid doesn’t think a signature matches a doctor’s name or loses a piece of documentation, we’ve got your back. We’ll do everything we can to correct the issue, so you don’t have to. You’ve got enough on your plate as it is.

Another potential snag might happen even before Medicaid gets involved. Most doctors understand the importance of pediatric nutritional supplements, but others might not. If your doctor doesn’t understand why the drinks are medically necessary, they might not prescribe them.

In that case, we’ll contact the doctor and explain why they’re needed. In most cases, this works. But if your doctor still declines to prescribe them, it might be time to find an alternate primary care physician who understands your child’s condition. If you do switch doctors, let us know, so we can update Medicaid.

"Sometimes doctors may not approve it because they don't deem it medically necessary. They think, ‘Oh, serve them an extra serving of mashed potatoes, give them a little bit more of this and see if we can try to help them gain weight.’ Some parents and some doctors don't understand the necessity."

— Angelica Johnson, TMS

Getting the pediatric supplement drinks you need doesn’t have to be complicated. But navigating it by yourself certainly can be. Luckily, the right partner can tear down roadblocks, so all you have to do is answer a few phone calls and see the doctor twice a year. The rest of the time, you just get your products shipped right to your door. Because we know you have a lot on your mind as it is. The least we can do is take this off your plate.