MedicaidCoverageMedium impact
2024.33 - Provider Bulletin - Coverage of OTC Formula & Nutritional Supplements for Clients with WIC & Medicaid PDF
Connecticut Medicaid (HUSKY Health)·CT · Pediatrics, Family Medicine, Internal Medicine·Provider Bulletin
Effective date
Dec 1, 2021
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid is now the primary payer for specialty/prescription formulas and medical foods for patients enrolled in both WIC and Medicaid programs, effective since December 1, 2021. Standard Abbott formulas remain covered by WIC, but specialty formulas require prescriptions and will be reimbursed by Medicaid.
Action Required
Immediately: Billing team must ensure all specialty formulas and medical foods for WIC/Medicaid dual-enrolled patients are billed to Medicaid as primary payer with valid prescriptions. Verify diagnosis codes for enteral nutritional products using the official diagnosis code list at ctdssmap.com. Document medical necessity on all prescriptions for nutritional supplements.