Medicaid Mobility Equipment Coverage by State: How It Works and Where to Look

Every state Medicaid program must cover medical equipment, because 42 CFR 440.70 makes “medical supplies, equipment, and appliances” a required part of the home health benefit, and no state may impose an absolute exclusion on an item. What varies by state is the prior authorization threshold, the fee schedule, the preferred-item list, and whether a managed care plan or the state agency makes the decision.

The federal framework

Home health is mandatory, and equipment rides with it. Medicaid.gov’s list of mandatory benefits includes “Home health services (1905(a)(7), 42 CFR 440.70 and 42 CFR 441.15).” The regulation at 440.70(b) names three required components: part-time nursing, home health aide service, and “medical supplies, equipment, and appliances suitable for use in any setting in which normal life activities take place.” Coverage of equipment “cannot be contingent upon the beneficiary needing nursing or therapy services,” and home health services “cannot be limited to services furnished to beneficiaries who are homebound.”

The definition is broader than Medicare’s. Under 440.70(b)(3)(ii), equipment and appliances are items “primarily and customarily used to serve a medical purpose, generally are not useful to an individual in the absence of a disability, illness or injury, can withstand repeated use, and can be reusable or removable.” The rule then states: “State Medicaid coverage of equipment and appliances is not restricted to the items covered as durable medical equipment in the Medicare program.”

Lists are allowed; exclusions are not. 440.70(b)(3)(v) lets states keep “a list of preapproved medical equipment supplies and appliances for administrative ease,” but states “are prohibited from having absolute exclusions of coverage.” Each state must have a process, using “reasonable and specific criteria,” for requesting items not on its list, and must tell a beneficiary of the right to a fair hearing when it denies a request. A practitioner must review the need for equipment at least annually.

Face-to-face encounter. 440.70(f) and (g) require a documented face-to-face encounter for medical equipment that would carry a face-to-face requirement under Medicare. For equipment the encounter must occur no more than 6 months before the start of services, may be performed by a physician, nurse practitioner, clinical nurse specialist, physician assistant or other licensed practitioner within state scope of practice, and may occur by telehealth as the state implements it.

Prosthetics are optional. Medicaid.gov lists “Prosthetics (1905(a)(12), 42 CFR 440.120(c))” among optional benefits, so braces and artificial limbs for adults depend on the state plan, while wheelchairs, walkers and hospital beds fall under the mandatory home health benefit.

EPSDT for children

For enrollees under 21, the Early and Periodic Screening, Diagnostic and Treatment benefit overrides state plan limits. Medicaid.gov states that states “are required to furnish all 1905(a) Medicaid coverable, appropriate, and medically necessary services” to correct or ameliorate a child’s condition, “regardless of whether the service is covered in a state’s Medicaid plan.” Medical necessity is decided case by case. In practice, a mobility device a state limits for adults can still be required for a child when it is medically necessary.

Prior authorization and managed care

Nearly every state requires prior authorization for higher-cost equipment, but the trigger differs: a dollar threshold (Pennsylvania, New Jersey), a code-level flag in the fee schedule or code database (Florida, Michigan), a certificate of medical necessity (Ohio), or a service authorization contractor (Virginia). Authorization is a medical-necessity review and, as Virginia’s manual puts it, “does not guarantee payment.”

Most states deliver Medicaid through managed care organizations. Medicaid.gov describes managed care as “contracted arrangements between state Medicaid agencies and managed care organizations (MCOs)” paid a “set per member per month (capitation) payment.” The MCO then applies its own authorization process and provider network, within the state’s coverage rules. Florida lists DME among the “minimum covered services for all Managed Medical Assistance and Long-Term Care plans”; New Jersey’s Comptroller training notes that MCO authorization runs through “MCO-specific form and/or provider portal” and that requirements vary by item and dollar amount. Fee-for-service rules still govern people outside managed care and, in several states, carved-out items.

Dual eligibility with Medicare

Medicaid.gov reports about 12 million people enrolled in both Medicare and Medicaid, more than 15 percent of Medicaid enrollees. For services both programs cover, “services covered by both programs are first paid by Medicare” with Medicaid “filling in the difference up to the state’s payment limit.” Medicare Part B covers durable medical equipment, so a dual-eligible person’s wheelchair claim goes to the Medicare DME MAC first. New York’s DMEPOS policy spells out the consequence: Medicaid prior approval “is not required when claiming the Medicare co-insurance and deductible,” and when Medicare denies an item, the Medicaid prior approval request must include the Medicare denial and the denied reconsideration, with exceptions for items Medicare treats as non-covered. Medicare Savings Programs can cover Part B premiums and cost sharing; for 2026 the Qualified Medicare Beneficiary income limit is $1,350 a month for an individual and $1,824 for a couple.

State by state

Each entry links to the state’s DME page or manual. Specifics are listed only where we opened the source; the rest say “see state page.”

California (Medi-Cal). See state page: Medi-Cal provider manuals. We could not open the DME manual sections on 2026-10-30.

Texas (Texas Medicaid, HHSC). Texas HHS says the Texas Medicaid & Healthcare Partnership (TMHP) “processes claims for Medicaid services delivered under the traditional, fee-for-service system” and “does not process claims for services provided by Medicaid managed care organizations,” so a DME claim’s path depends on whether the member is in managed care (HHS claims page). The DME, medical supplies and nutritional products handbook sits in the Texas Medicaid Provider Procedures Manual on tmhp.com, which we could not open on 2026-10-30; see state page for its prior authorization rules.

Florida (Florida Medicaid, AHCA). AHCA’s coverage page says Medicaid “reimburses for durable medical equipment (DME) and medical supplies appropriate for use in the recipient’s home,” that DME “may be rented, purchased or rented-to-purchase,” and that mobility aids “including canes, crutches, walkers, and wheelchairs” are covered for all recipients who meet medical necessity. The DME and Medical Supply Services Provider Fee Schedule dated July 1, 2026 carries a maximum fee per HCPCS code, a rental-only flag, monthly and daily rental amounts, unit limits and a prior authorization column; PA codes “require prior authorization by the Agency’s fee-for-service delivery system Quality Improvement Organization (QIO) vendor,” including requests to exceed limits or for E1399 items. Coverage policies are split by category, including “Wheelchairs, Hospital Beds, and Ambulatory Aids.” State page.

New York (NY Medicaid, eMedNY). The DMEPOS Policy Guidelines, effective July 1, 2026, require prior approval for codes underlined in the Procedure Code Manual and for any DME or supply not listed there; prior approvals are valid for 6 months. The dual-eligible rules above come from this document. Prior approval questions go to the Bureau of Medical Review at (800) 342-3005. The eMedNY DME manual page also posts the DMEPOS fee schedule, procedure codes and coverage guidelines, and prior approval guidelines.

Pennsylvania (Medical Assistance). 55 Pa. Code 1123.60 limits payment for DME and surgical supplies to a maximum of $600 unless the item is prior authorized, and limits rental to 6 months before prior authorization is needed (or a shorter period if the fee schedule says so). The Office of Medical Assistance Programs issues item-specific prior authorization guidelines as bulletins; 2026 titles on the What’s New at OMAP page include wheelchair cushions and accessories (01-26-57, July 1, 2026), standers (01-26-55, July 16, 2026) and manual hospital beds and accessories (01-26-43, January 29, 2026), plus the 2026 HCPCS updates and fee adjustments bulletin 99-26-04 (July 10, 2026).

Illinois (HFS Medical Programs). See state page: HFS Durable Medical Equipment. The HFS site did not resolve from our network on 2026-10-30.

Ohio (Ohio Medicaid). OAC rule 5160-10-01, effective January 1, 2026, sets the general DMEPOS coverage and payment policy. It defines a certificate of medical necessity (default form ODM 01913), sets a “frequency limit” as the average expected useful life of an item that “may be exceeded with medical justification,” and describes “need verification” for items exceeding the cost threshold or frequency guideline. The Schedules and Rates page posts the DMEPOS payment schedule (XLSX) with sections for DME and supplies, orthoses and prostheses, wheelchairs, oxygen, and prior authorization assignment groups.

Georgia (Georgia Medicaid, DCH). The Department of Community Health runs DME prior authorization and a 30-day supply allowance for DME supplies, per its March 26, 2020 provider notice (the only DCH DME document we could open); DME questions go to dme.ops@dch.ga.gov. The current Durable Medical Equipment Services manual is posted under Provider Manuals on the Georgia Medicaid MMIS portal; see state page for current prior authorization rules.

North Carolina (NC Medicaid). The NC Medicaid DME page (last modified February 18, 2026) sorts DME into Medicare-style categories: inexpensive or routinely purchased items, capped rental or purchased equipment, equipment requiring frequent and substantial servicing, oxygen, supplies, service and repair, and individually priced items. Coverage rules sit in three clinical coverage policies: 5A-1 Physical Rehabilitation Equipment and Supplies, 5A-2 Respiratory Equipment and Supplies, and 5A-3 Nursing Equipment and Supplies. The page links fee schedules, a face-to-face encounter Q&A and the NCTracks contact center (800-688-6696).

Michigan (Michigan Medicaid, MDHHS). The medical suppliers and DME dealers page posts a quarterly DMEPOS database (October 2026 is current) and says codes not on the list “may be considered for medical necessity on a case-by-case basis through prior authorization.” Prior authorization flags, documentation requirements and rates live in the Medicaid Code and Rate Reference tool inside CHAMPS. The page also links a DME face-to-face list, a complex rehabilitation technology code list and a wheelchair repair and labor guide. Provider Inquiry: 800-292-2550.

New Jersey (NJ FamilyCare, DMAHS). The State Comptroller’s June 24, 2025 DME provider training, presented with DMAHS, states that fee-for-service prior authorization is required for DME items over $300 and supplies over $100, obtained from the Medical Assistance Customer Center except for specialized wheelchairs, hospital beds, ventilators, parenteral nutrition, augmentative communication systems and facility requests, which go to the DMAHS Office of the Medical Director. Under N.J.A.C. 10:59-1.5 the prescription must describe the type and style of equipment (“wheelchair” alone is insufficient), and billing follows the fee schedule in N.J.A.C. 10:59-1.8. Five MCOs hold DMAHS contracts: Aetna Better Health, Wellpoint, Horizon NJ Health, UnitedHealthcare Community Plan and Fidelis Care.

Virginia (Virginia Medicaid, DMAS). The DME and Supplies Manual, Appendix D, revised September 12, 2025, explains service authorization: it “is the process to review specific service requests … prior to service delivery and reimbursement,” validates medical necessity against DMAS criteria, “does not guarantee payment,” and is specific to an individual, provider, service code, quantity and dates. Fee-for-service requests go through the Acentra Health/DMAS portal; MCO members follow their plan’s process, with transition-of-care rules when members move between the two.

Washington (Apple Health, HCA). The Medical Equipment and Supplies Billing Guide effective January 1, 2025 supersedes earlier DME guides and is governed by chapter 182-543 WAC. The 2025 edition added a hospital bed definition, medical necessity guidelines for patient lifts and other equipment categories, and a note that some equipment “may require a shorter timeline between prescription signature and PA submission.” Prosthetics and orthotics are billed under a separate guide, and claims and authorizations run through ProviderOne.

Arizona (AHCCCS). AMPM Policy 310-P, effective October 1, 2026, covers medical equipment “under the home health services benefit, as specified in this policy and 42 CFR 440.70,” when ordered by a physician or non-physician practitioner as part of a plan of care reviewed annually and authorized by AHCCCS or the contractor. It repeats the federal rules: coverage is not restricted to Medicare DME, cannot be limited to homebound members, and absolute exclusions are prohibited. Fee-for-service prior authorization follows AMPM Policy 820, and equipment may be purchased or rented “only when there are no reasonable alternative resources” to obtain it at no cost.

Massachusetts (MassHealth). See state page: 130 CMR 409.000 Durable Medical Equipment. Mass.gov blocked our requests on 2026-10-30.

What changed recently

• October 1, 2026. Arizona’s revised AMPM 310-P took effect (approved May 14, 2026).
• July 1, 2026. New York’s DMEPOS Policy Guidelines effective date; Florida’s July 1, 2026 DME fee schedule took effect; Pennsylvania issued prior authorization guidelines for wheelchair cushions and accessories (bulletin 01-26-57).
• February 18, 2026. NC Medicaid last modified its DME program page.
• January 1, 2026. Ohio’s amended OAC 5160-10-01 took effect.
• September 12, 2025. Virginia DMAS revised Appendix D (service authorization) of its DME manual.
• June 24, 2025. New Jersey’s Office of the State Comptroller and DMAHS presented the fee-for-service DME prior authorization thresholds ($300 equipment, $100 supplies) in provider training.

Where to check

• 42 CFR 440.70 on eCFR for the federal home health and equipment rules.
• Medicaid.gov EPSDT and mandatory and optional benefits.
• Medicaid.gov dual eligibles for Medicare Savings Program limits.
• The state links in the list above, and for managed care members, the plan’s provider manual and prior authorization portal.

Coverage decisions are made by the state agency or managed care plan on the clinician’s documentation. Readers should confirm current rules with the state Medicaid program, the plan, or the supplier.