Unfortunately, only a handful of states fully cover Gelmix and Purathick under their Medicaid programs. Click here to check if coverage is favorable in your state.
Most state Medicaid programs reimburse suppliers based on the weight of thickener (~.40/ounce of thickener) rather than how much it thickens. These rates were set decades ago, and based on bulky non-preferred corn starch based thickeners. Gum based thickeners are now preferred, but they weigh considerably less and the reimbursement rate is too low to properly reimburse DME suppliers for their costs.
Some states have updated their reimbursement rates to correct the issue to cover preferred gum based thickeners. States with favorable coverage typically have cost-plus reimbursement rates, rather than weight based. These reimburse the DME supplier properly and enables the patient to choose which thickener best suits their individual needs. Gelmix and Purathick are typically covered in states with cost-plus reimbursement rates.
Some states have no coverage of thickeners. In these states, thickeners are not considered a medical necessity by the state Medicaid program and no reimbursement rate is given.