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05.22.17

Arkansas Medicaid Could Pay for Your Child’s Formula

If your child is tube-fed or drinks nutritional formula, Arkansas Medicaid may cover the costs. If approved, a child can get formula from WIC from birth to their 5th birthday. This applies to children who are tube-fed or who drink formula or eat formula puddings. Arkansas Medicaid will cover these nutritional drinks and formulas if your child is 5 years to 21 years old.

The covered formulas include many brands. Formulas come as powders, liquids, or puddings for eating or drinking. Doctors treat these as snacks, meal replacements, or nutritional supplements. Specialty formulas exist for various allergies or digestive problems. Your child’s doctor may prescribe them to add vitamins and nutrients to your child’s diet. Only your child’s pediatrician will know what kind of supplement or formula your child needs.

To receive formula, your child must have either full Arkansas Medicaid or ARKids First (also known as ARKids B). Their Primary Care Physician, (PCP), must write a prescription with an appropriate medical diagnosis. Your child must also have either a feeding tube or an EPSDT explaining need.

An EPSDT is also known as a well child exam. This exam explains a child’s physical, emotional, and mental growth. It is a medical record showing need for formula. If your child has a feeding tube, an EPSDT is not necessary. Medicaid does need a PA (Prior Authorization) every 6 months, as well as annual medical records from the doctor. An EPSDT is only required if your child takes the formula by mouth and is not required every year.

There is no dollar limit to how much formula your child may eat. The doctor must state the caloric need on the prescription, as well as frequency of feedings, quantity per feeding, and a reasonable medical diagnosis. The most formula a child may receive is 30 units per day or 3,000 calories per day. Finnegan Health Services will work with the PCP and the dietitian to ensure your child is getting what they need.

Arkansas Medicaid accepts many diagnoses for needing nutritional formulas. Diagnoses such as Failure to Thrive, Anorexia, Nutritional Deficiency, and many others are acceptable. Arkansas Medicaid will cover your child’s formula if the PCP has signed off on a prescription for oral or tube-fed formula.

Su-Lauren Wilson

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