Medicaid Specialty Formula Changes

The Nebraska Department of Health and Human Services (DHHS) will require all Medicaid-covered children obtain specialty formula through a Durable Medical Equipment (DME) supplier rather than through WIC. This change goes into effect Sept. 1.

What Is Changing?

Under the new DHHS requirement, providers must use the new DME ordering process for Medicaid-covered children who receive WIC and need specialty formula, replacing the current WIC authorization process. For patients with Medicaid, instead of writing a WIC Physician Authorization Form (PAF), providers will:

• Submit an electronic order that includes the daily amount of formula needed.

• Route electronically via Epic or fax the order to Children's Home Health at 402.387.7126.

• Instruct families to contact their DME supplier each month to schedule home delivery of formula.

• View the tip sheet on how to find and place these orders within Epic.

Although this requirement takes effect Sept. 1, Children’s Nebraska Clinical Nutrition and Children’s Home Healthcare teams are making the transition now to ensure a smooth implementation and minimize delays in formula access.

What Is Not Changing?

Nebraska WIC will continue to provide specialty formula for infants and children not covered by Medicaid.

What Are the Next Steps?

Please begin referring eligible Medicaid patients to Children’s Home Healthcare for specialty formulas (see the formulary) and use the new ordering process as patients become due for formula renewals.

View Ordering Tip Sheet