Does Medicaid Cover Formula?

Many states offer Medicaid enrollment for pregnant women who meet the income limits of the program. These benefits continue for some time after the child is born in order to ensure good access to health services for children. Find out if Medicaid covers infant formula and what the process is.

Does Medicaid Cover Formula?

Medicaid covers formula for newborns in two ways: in coordination with the Women, Infants and Children benefit (WIC) nutritional supplement program, and by direct payment for special formulas prescribed by your doctor. As a rule, people who meet the income and asset eligibility criteria to participate in the Medicaid program also qualify for participation in WIC, which streamlines the application and approval process for both programs.

What Formula Does WIC Cover?

WIC vouchers are limited to specific brands of formula, whose manufacturers have entered into a rebate agreement with the WIC program to provide low-cost product for beneficiaries. Your WIC vouchers cannot generally be used for brands of formula made by non-enrolled manufacturers, and which brands and formulas are covered varies by state.

Special Circumstances and Prescription Infant Formula

Every baby's needs are different, and some children have allergies or special nutritional needs that off-the-shelf infant formula doesn't address. It sometimes happens that a baby needs formula that WIC doesn't pay for. If there is a medical need for gluten-free, hypoallergenic or other special varieties of formula, it is possible that none of the commercially available brands in your area are provided for under the WIC benefit. In that case, you might be able to get the formula you need directly from a pharmacy. 

If your baby's doctor agrees that your child has a medical need for special formula, you can ask for a prescription that can be filled at the pharmacy. Like any prescription written by a doctor, this is a covered benefit under your Medicaid plan. 

How Can I Get Free Formula?

In addition to WIC, Medicaid enrollees are also typically eligible to participate in the Supplemental Nutrition Assistance Program (SNAP), formerly known as food stamps. SNAP benefits act as cash for most food purchases and may be used for grocery purchases at most retail stores. Infant formula, being a qualifying food item, is nearly always included in EBT-eligible purchases. In many states, people who meet the enrollment standards for Medicaid participation are automatically enrolled in SNAP or other assistance programs. 

You may also be able to get free samples of formula for your doctor or the hospital where you gave birth. High-value coupons are also sometimes available, and while these won't make the formula free, they can offset the out-of-pocket cost drastically.