Tennessee becomes 1st state to roll out free diapers under Medicaid

Lauren Barca believes fighting health inequality often comes down to something simple—and, frankly, messy: diapers.

“Diapers have been the overlooked, silent epidemic of families in need,” she told Healthcare Brew.

Barca, VP of quality at 86Borders, a member relationship management company that works with vulnerable Medicare and Medicaid beneficiaries, led the charge to make Tennessee the first state to cover diapers under Medicaid. The program works by covering disposable diapers for babies and toddlers up to two years old enrolled in Medicaid and the Children’s Health Insurance Program. It began in August and provides parents and caregivers up to 100 diapers a month under a section 1115 demonstration waiver. Parents must show their child’s pharmacy ID card at a participating pharmacy like they would to pick up a prescription medication.

“Hopefully, that will drive people to also pick up other important medications for their family [and] get those necessary flu vaccines or other recommended vaccinations,” Barca said.

As of November 8, the program has served 30,321 Medicaid members.

The need for clean

To get the coverage approved, Barca said she first had to convince people about the importance of baby diapers.

Diapers, she said, have been overlooked as a “female problem” by the traditionally male-dominated field of medicine. But they’re important for the physical and mental health of children and families, she said.

Among other health issues, insufficient access to diapers leads to more clinical appointments for pediatric urinary tract infections (UTIs) and diaper dermatitis, according to a 2022 study from the University of California, Los Angeles and Yale University.

Lack of diapers also hurts the mental health of children and their caretakers.

About 70% of parents and caregivers in need of diapers said last year that they were stressed or anxious about access, according to a 2023 study from advocacy and research group the National Diaper Bank Network (NDBN). Increased stress and depression among parents due to lack of diapers can lead to developmental challenges among children, according to Helping Mamas, a nonprofit that runs a diaper and baby supply bank for moms in Georgia and Knoxville, Tennessee.

“From an emotional standpoint, clean diapers lead to safety and security for that infant who is beginning to develop so many of those emotional responses,” Barca added.

Diapers are often also required to send children to daycare, and one-quarter of parent and caregiver respondents said that they missed work or school due to lack of diapers, the NDBN reported last year. For a parent making the $7.25 per hour federal minimum wage, the study found that missed work represented $296 lost per month.

“It’s really a huge systemic issue for our entire health and financial ecosystem,” Barca said.

Medicaid already covers diapers for adults and for children who are unable to use the bathroom independently. But baby diapers aren’t typically covered by any public or private plans.

This leaves most families paying out of pocket. And with babies needing up to 12 diapers each day, according to NDBN, this can cost between $80 and $100 per month per child.

Cleaning up the mess

Part of the reason that diapers have been left undercovered, Barca said, is because it would be difficult to provide them to every family in need.

Medicaid has long been used to cover existing medical issues rather than preventive care, Barca said. But there’s been a shift in healthcare generally in recent years, especially as value-based care trends upward, to help patients avoid getting sick in the first place.

A Tennessee native, Barca took her passion for diaper access, combined it with her healthcare expertise and connections, and began advocating for coverage in November 2019. She emphasized to legislators and TennCare officials, the state’s Medicaid plan, how diapers can lead to other physical and mental health issues for children and caregivers, which ends up costing health plans anyway. According to Barca, there needs to be a mindset shift among lawmakers and the healthcare industry to understand that diapers are a need that many families struggle with.

While she’s celebrating the success in Tennessee, there are still millions of families who require diapers every day across the country, according to NDBN. Barca said the state is still in its “experimental phase” and will track if increased access leads to a drop in diaper rash and UTI visits.

“Then I think other payers might get on board,” she said.

Delaware also implemented a pilot program for free diapers under the 1115 waiver in May. The program covers beneficiaries for up to 12 weeks postpartum and also provides food and baby wipes.

The Centers for Medicare and Medicaid Services approved both Tennessee and Delaware’s programs in May.