Written and maintained by CASRAI Editorial Board
Last updated
General information for staff and researchers, not medical or coverage advice for any individual. Checked against the sources below on 2026-10-31.
Short answer
Medicaid DME (durable medical equipment) is equipment, appliances and supplies that state Medicaid programs cover under the federal home health benefit in 42 CFR 440.70. Federal rules set a floor: coverage is not limited to the items Medicare treats as DME, a state may not have absolute exclusions, and it must offer a way to request items not on its list. States decide most of the rest, including rates and utilization limits.
Definition and scope
Medicaid has no stand-alone “DME benefit” in the federal regulation. The relevant text sits in the home health definition at 42 CFR 440.70 (eCFR, checked 2026-10-31), paragraph (b)(3): “medical supplies, equipment, and appliances suitable for use in any setting in which normal life activities take place.” Two definitions follow in the same paragraph:
- Supplies are health care related items that are consumable or disposable, or cannot withstand repeated use by more than one individual, and are required to address an individual medical disability, illness or injury (b)(3)(i).
- Equipment and appliances are items primarily and customarily used to serve a medical purpose, generally not useful to a person without a disability, illness or injury, able to withstand repeated use, and reusable or removable (b)(3)(ii).
This is why searches for “Medicaid medical supplies coverage” and “durable medical equipment Medicaid” land on the same rule: supplies and equipment are covered together under (b)(3). The Medicaid and CHIP Payment and Access Commission (MACPAC) describes DME as including “a wide range of medical equipment that is appropriate for use in the home” and reports that state Medicaid programs spent about $7.87 billion on DME in 2017 (issue brief published July 2019).
How the federal rule works in practice
Orders and review
Services are provided on orders from a physician or another licensed practitioner of the healing arts acting within state scope of practice, as part of a written plan of care (440.70(a)(3)). A beneficiary’s need for the supplies, equipment and appliances must be reviewed by a physician or other licensed practitioner at least annually; further review frequency is set case by case by the nature of the item (b)(3)(iii)-(iv).
Face-to-face encounter
No payment may be made unless a practitioner documents a face-to-face encounter with the beneficiary related to the primary reason the equipment is needed. For the initiation of medical equipment, the encounter must occur no more than 6 months before the start of services (f)(2). It may occur through telehealth, as implemented by the State (f)(6). Paragraph (g)(1) applies this to equipment, supplies and appliances to the extent a face-to-face requirement would apply to DME under Medicare. For staff, the practical point is documentation: the ordering practitioner must record who conducted the encounter and its date (f)(5).
Setting
Home health services, including (b)(3) items, cannot be limited to beneficiaries who are homebound, and coverage cannot be contingent on needing nursing or therapy services (440.70(b) and (c)(1)). A beneficiary’s place of residence for this benefit does not include a hospital, nursing facility or intermediate care facility for individuals with intellectual disabilities, with a narrow exception in (c).
Medicaid vs Medicare DME: what the federal text says
The rule itself draws the contrast. Each row below is taken from 42 CFR 440.70 as checked on 2026-10-31.
| Question | What 42 CFR 440.70 says |
|---|---|
| Is Medicaid limited to Medicare’s DME items? | No. State Medicaid coverage of equipment and appliances “is not restricted to the items covered as durable medical equipment in the Medicare program” (b)(3)(ii). |
| Can a state exclude a category outright? | No. States “are prohibited from having absolute exclusions of coverage” on medical equipment, supplies or appliances (b)(3)(v). |
| Can a state keep a list? | Yes, a list of preapproved items “for administrative ease,” but it must have processes and criteria for requesting items not on the list (b)(3)(v). |
| What if a request is denied? | The state must inform the beneficiary of the right to a fair hearing (b)(3)(v). |
| Is the benefit limited to homebound people? | No (c)(1). |
| How often is need reviewed? | At least annually by a physician or other licensed practitioner (b)(3)(iii). |
For how Medicare itself defines and covers DME, see Medicare DME coverage.
Where states differ
MACPAC states that “states have broad flexibility to determine payments for DME,” and its compendium of state fee-for-service DME payment policies (July 2019) documents each state’s policy, including how states set rates and coverage and payment for common equipment categories. Because the compendium is dated 2019, treat it as a map of what to look for, not as current policy. Coverage lists, prior authorization rules, quantity limits and rates come from the individual state program.
How to find a state’s DME manual
- Start at the state Medicaid agency’s website and look for the provider manual, or a DME or “medical supplies” provider chapter.
- Look for the state’s fee schedule and its list of covered or preapproved items.
- Find the process for requesting an item not on the list; 440.70(b)(3)(v) requires one.
- Check whether the program uses managed care organizations, whose own policies may add procedures for the same benefit.
- Compare the state’s text with the 2019 MACPAC compendium to see which policy areas it addresses, then confirm against the current manual.
For the narrower case of one product family, see Medicaid incontinence supplies. Related background: DME HCPCS codes, the DMEPOS fee schedule and types of medical supplies.
Where it matters for clinics and supply decisions
For practice and supplier staff, the rule produces three concrete documentation and process points, each traceable to 440.70: an order within a written plan of care, a documented face-to-face encounter within the 6-month window for equipment, and an annual need review. Which items require prior authorization, and at what rates, is determined by each state and must be read from that state’s manual. Fraud controls for DME are covered separately in DME fraud schemes.
Common misunderstandings
- “Medicaid covers exactly what Medicare covers as DME.” The regulation says Medicaid equipment coverage is not restricted to Medicare’s DME items.
- “Only homebound people qualify.” Home health services, including (b)(3) items, cannot be limited to homebound beneficiaries.
- “If an item is not on the state list, it is excluded.” A list is allowed for administrative ease, but absolute exclusions are prohibited and a request process is required.
- “One national rulebook.” The federal text is a baseline; states set rates and many coverage details.
FAQ
What does Medicaid DME mean?
It means the medical supplies, equipment and appliances a state Medicaid program covers under 42 CFR 440.70(b)(3), suitable for use in any setting where normal life activities take place.
Is Medicaid medical supplies coverage the same in every state?
No. Federal rules set a floor, but MACPAC reports states have broad flexibility in DME payment, and each state publishes its own manual and fee schedule.
Is durable medical equipment under Medicaid limited to Medicare’s list?
No. 42 CFR 440.70(b)(3)(ii) says state Medicaid coverage of equipment and appliances is not restricted to the items covered as DME in Medicare.
Sources
- eCFR, 42 CFR 440.70 Home health services, ecfr.gov, checked 2026-10-31.
- MACPAC, Durable Medical Equipment Fee-for-Service Payment Policy (issue brief, July 2019), macpac.gov, checked 2026-10-31.
- MACPAC, State Medicaid Fee-for-Service Durable Medical Equipment Payment Policies (compendium, July 2019), macpac.gov, checked 2026-10-31.
