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Medicaid Specialty Formula Changes

Learn about upcoming changes to the Medicaid specialty formula process and how to order specialty formula for patients through Children's Home Healthcare.

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 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 completing a WIC Physician Authorization Form (PAF), providers will:

  • Submit an order that includes the name of the formula, the daily amount needed and an appropriate diagnosis.

  • Providers outside of Children's will need to include demographics for the patient, including insurance information.

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

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

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.

Formula Access Guide

Formula Type
View Nebraska WIC Formulary
Coverage Contract Infant Formulas Non-Contract Infant Formulas Exempt Formulas WIC-Eligible Nutritionals
Medicaid WIC WIC DME DME
WIC
(not eligible for Medicaid)
WIC WIC WIC WIC
Commercial Insurance
(not eligible for WIC or Medicaid)
For patients with commercial insurance, coverage is dependent on the patient's insurance plan. If coverage is unavailable, formula may be purchased through retail sources

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.

How to Order Specialty Formula

Providers can download and fax a completed and signed order form, the patient’s demographics and insurance information, along with a relevant clinical note to 402.387.7126 or submit an order through Epic.

Download Formula Order Form View Epic Ordering Tip Sheet

Frequently Asked Questions

Contact Us

If you have questions during this transition, please contact Joe Heck, director, Children’s Home Healthcare; or Kristy Anderson, manager, Clinical Nutrition.