Coverage by State

Click on a state to view coverage.

WA OR ID NV MT WY UT AZ NM CO ND SD NE KS TX OK MN IA MO AR LA WI IL MI IN KY TN MS AL GA FL SC NC VA WV OH MD PA NJ DE NY MA CT RI VT NH ME HI AK CA

Alabama

Mandated Insurance Coverage
No
Medicaid Coverage
Individual consideration-case-by-case
Other State Programs
Children’s Rehab Services
334-281-8780
State Medicaid Contact Information
800-362-1504

x

Visit Medicaid Website

Alaska

Mandated Insurance Coverage
Yes, PKU only
Medicaid Coverage
Limited
Other State Programs
Center for Children W/ Special Needs
866-987-2500
206-884-5735
State Medicaid Contact Information
907-269-6529

x

Visit Medicaid Website

Arizona

Mandated Insurance Coverage
Yes, select inborn errors of metabolism
Medicaid Coverage
Yes
Other State Programs
Children w/Special Healthcare Needs
State Department of Health
602-542-1860
State Medicaid Contact Information
800-352-8401
602-542-9935

x

Visit Medicaid Website

Arkansas

Mandated Insurance Coverage
Yes, select inborn errors of metabolism
Medicaid Coverage
N/A
Other State Programs
Children’s Medical Service
870-612-5223
State Medicaid Contact Information
800-482-5850 ext 22277

x

Visit Medicaid Website

California

Mandated Insurance Coverage
Yes, PKU only
Other State Programs
California Children’s Services-GHPP
800-639-0597
State Medicaid Contact Information
916-440-7400

x

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Colorado

Mandated Insurance Coverage
Yes, all inborn errors of metabolism
Medicaid Coverage
Yes
Other State Programs
HCD-Healthcare Program for Children w/Special Needs & Child Health Plus
303-692-2370
State Medicaid Contact Information
303-866-5700

x

Visit Medicaid Website

Connecticut

Mandated Insurance Coverage
Yes, all inborn errors of metabolism
Medicaid Coverage
Yes
Other State Programs
Family Health Service Division (BCH)
860-509-8074
State Medicaid Contact Information
800-842-1508

x

Visit Medicaid Website

Delaware

Mandated Insurance Coverage
Yes, all inborn errors of metabolism
Medicaid Coverage
Yes
Other State Programs
Children w/ Special Healthcare Needs (CSHCN)
State Medicaid Contact Information
800-372-2022

x

Visit Medicaid Website

District of Columbia

Mandated Private Insurance Coverage
No
Insurance Coverage of Formula and Limits
None
Insurance Coverage of Low Protein Foods and Limits
None
Metabolic Conditions Covered by Insurance
None
WIC Coverage
Yes
Medicaid Coverage
Enteral not oral
Other State Programs
Health Services for Children W/ Special Needs
State Medicaid Contact Information
202-442-5999

x

Visit Medicaid Website

Florida

Mandated Insurance Coverage
Yes, all inborn errors of metabolism
Medicaid Coverage
Yes-PKU
Other State Programs
Children’s Medical Service
850-245-4209
State Medicaid Contact Information
850-412-4000

x

Visit Medicaid Website

Georgia

Mandated Insurance Coverage
No Mandated Coverage
Medicaid Coverage
Enteral not oral
Other State Programs
Emory State Program;
Children’s Medical Services
404-657-4855
State Medicaid Contact Information
404-656-4507

x

Visit Medicaid Website

Hawaii

Mandated Insurance Coverage
Yes, select inborn errors of metabolism
Medicaid Coverage
Yes
Other State Programs
Children w/Special Healthcare Needs (CSHNB)
State Medicaid Contact Information
800-316-8005

x

Visit Medicaid Website

Idaho

Mandated Private Insurance Coverage
No
Medicaid Coverage
Enteral not oral
Other State Programs
Children’s Special Health Program
877-887-3075
State Medicaid Contact Information
208-334-5747

x

Visit Medicaid Website

Illinois

Mandated Private Insurance Coverage
No
Medicaid Coverage
Yes
Other State Programs
May be considered upon by request
State Medicaid Contact Information
800-843-6154

x

Visit Medicaid Website

Indiana

Mandated Private Insurance Coverage
Yes, select inborn errors of metabolism
Medicaid Coverage
Yes
Other State Programs
Riley Children’s Hospital
317-233-1351
State Medicaid Contact Information
317-233-4455

x

Visit Medicaid Website

Iowa

Mandated Private Insurance Coverage
No
Medicaid Coverage
Yes
Other State Programs
Children’s Special Health Care Services (CSHCS)
State Medicaid Contact Information
800-972-2017

x

Visit Medicaid Website

Kansas

Mandated Private Insurance Coverage
Yes, select inborn errors of metabolism
Medicaid Coverage
Individual consideration-case-by-case
Other State Programs
Services For Children W/ Special Healthcare Needs
800-332-6262
State Medicaid Contact Information
800-766-9012

x

Visit Medicaid Website

Kentucky

Mandated Private Insurance Coverage
Yes, select inborn errors of metabolism
Medicaid Coverage
May be considered upon by request
Other State Programs
Commission for Children w/Special Healthcare Needs
502-429-4430
State Medicaid Contact Information
502-564-3232

x

Visit Medicaid Website

Louisiana

Mandated Private Insurance Coverage
Yes, select inborn errors of metabolism
Medicaid Coverage
Yes
Other State Programs
Children’s Special Health Services (CSHS)
504-565-5055
State Medicaid Contact Information
225-342-9500

x

Visit Medicaid Website

Maine

Not currently available. Check back soon!

x

Visit Medicaid Website

Maryland

Mandated Private Insurance Coverage
Yes, all inborn errors of metabolism
Medicaid Coverage
Yes
Other State Programs
Office of Genetics & Children’s Special Health Needs:
Children’s Medical Services (CMS)
410-767-5585
State Medicaid Contact Information
410-767-5800

x

Visit Medicaid Website

Massachusetts

Mandated Insurance Coverage
Yes, select inborn errors of metabolism
Medicaid Coverage
Individual consideration-case-by-case
Other State Programs
Bureau of Family and Community Health
State Medicaid Contact Information
888-665-9993

x

Visit Medicaid Website

Michigan

Mandated Insurance Coverage
No
Medicaid Coverage
Individual consideration-case-by-case
Other State Programs
Children with Special Health Needs
800-359-3722
State Medicaid Contact Information
517-373-3740

x

Visit Medicaid Website

Minnesota

Mandated Insurance Coverage
Yes, select inborn errors of metabolism
Medicaid Coverage
Individual consideration-case-by-case after 30 days unless, PKU, MSUD, Hyperlysinemia w/tube
Other State Programs
MN Children w/Special Health Needs
800-728-5420
State Medicaid Contact Information
651-431-2000

x

Visit Medicaid Website

Mississippi

Mandated Insurance Coverage
No
Medicaid Coverage
Individual consideration-case-by-case
Other State Programs
Children’s Medical Program;
State Formulary
601-713-3457
State Medicaid Contact Information
651-431-2000

x

Visit Medicaid Website

Missouri

Mandated Insurance Coverage
Yes
Insurance Coverage of Formula and Limits
> 6 yrs. Old; up to $5K
Insurance Coverage of Low Protein Foods and Limits
> 6 yrs. Old; up to $5K
Metabolic Conditions Covered by Insurance
All Inborn Errors of Metabolism
WIC Coverage
PKU, MSUD
Medicaid Coverage
Yes
Other State Programs
State Formulary & BR
800-844-0898
State Medicaid Contact Information
573-751-4815

x

Visit Medicaid Website

Montana

Mandated Insurance Coverage
Yes, all inborn errors of metabolism
Medicaid Coverage
Yes
Other State Programs
State Medicaid Contact Information
406-444-4540

x

Visit Medicaid Website

Nebraska

Mandated Insurance Coverage
Yes, select inborn errors of metabolism
Medicaid Coverage
Yes
Other State Programs
Newborn Screening Grant
402-559-3660
State Medicaid Contact Information
402-471-6035

x

Visit Medicaid Website

Nevada

Mandated Insurance Coverage
Yes, all inborn errors of metabolism
Medicaid Coverage
Enteral not oral
Other State Programs
Children w/ Special Health Care Needs (CSHCN)
State Medicaid Contact Information
775-684-3676

x

Visit Medicaid Website

New Hampshire

Mandated Insurance Coverage
Yes, select inborn errors of metabolism
Medicaid Coverage
Enteral not oral
Other State Programs
Bureau of Special Medical Services
603-271-4595
State Medicaid Contact Information
800-852-3345 ext 5254

x

Visit Medicaid Website

New Jersey

Mandated Insurance Coverage
Yes, all inborn errors of metabolism
Medicaid Coverage
3 Specialty clinics
Other State Programs
Special Child, Adult & Early Intervention Services
609-292-1582
State Medicaid Contact Information
800-356-1561

x

Visit Medicaid Website

New Mexico

Mandated Insurance Coverage
Yes, all inborn errors of metabolism
Medicaid Coverage
Individual consideration-case-by-case if oral
Other State Programs
Children’s Medical Services
505-902-7491
State Medicaid Contact Information
505-827-3100

x

Visit Medicaid Website

New York

Mandated Insurance Coverage
Yes, all inborn errors of metabolism
Medicaid Coverage
Individual consideration-case-by-case
Other State Programs
CSHCN
State Medicaid Contact Information
866-211-1736

x

Visit Medicaid Website

North Carolina

Mandated Insurance Coverage
Yes, select inborn errors of metabolism
Medicaid Coverage
Individual consideration-case-by-case
Other State Programs
Children w/ Special Health Care Needs
800-737-3028
State Medicaid Contact Information
919-707-5762

x

Visit Medicaid Website

North Dakota

Mandated Insurance Coverage
Yes, select inborn errors of metabolism
Medicaid Coverage
Yes
Other State Programs
Children’s Special Health Services (CSHS)
701-328-2436
State Medicaid Contact Information
701-328-2321

x

Visit Medicaid Website

Ohio

Mandated Insurance Coverage
No
Medicaid Coverage
Yes
Other State Programs
State Formulary;
OH Department of Health Metabolic Program;
Bureau for Children w/Medical Handicaps;
601-644-8389
State Medicaid Contact Information
800-324-8680

x

Visit Medicaid Website

Oklahoma

Mandated Insurance Coverage
No
Medicaid Coverage
Individual consideration-case-by-case if not PKU
Other State Programs
Children w/ Special Health Care Needs
State Medicaid Contact Information
800-987-7767

x

Visit Medicaid Website

Oregon

Mandated Private Insurance Coverage
Yes
Insurance Coverage of Formula and Limits
No Limit
Insurance Coverage of Low Protein Foods and Limits
No Limit
Metabolic Conditions Covered by Insurance
All Inborn Errors of Metabolism
WIC Coverage
No
Medicaid Coverage
Yes
Other State Programs
Children w/ Special Health Needs Branch
405-521-3646
State Medicaid Contact Information
503-945-5772

x

Visit Medicaid Website

Pennsylvania

Mandated Private Insurance Coverage
Yes
Insurance Coverage of Formula and Limits
No Limit
Insurance Coverage of Low Protein Foods and Limits
None
Metabolic Conditions Covered by Insurance
PKU, branched-chain Ketonuria, galactosemia, hemocystinuria
WIC Coverage
Limited
Medicaid Coverage
Individual consideration-case-by-case
Other State Programs
Bureau of Family Health; Newborn Screening (NBS)
717-783-8143
State Medicaid Contact Information
800-692-7462

x

Visit Medicaid Website

Rhode Island

Mandated Private Insurance Coverage
No
Insurance Coverage of Formula and Limits
None
Insurance Coverage of Low Protein Foods and Limits
None
Metabolic Conditions Covered by Insurance
None
WIC Coverage
May be considered upon by request
Medicaid Coverage
Individual consideration-case-by-case
Other State Programs
State Formulary;
Office of Children w/ Special Needs
State Medicaid Contact Information
401-462-5300

x

Visit Medicaid Website

South Carolina

Mandated Private Insurance Coverage
No
Insurance Coverage of Formula and Limits
None
Insurance Coverage of Low Protein Foods and Limits
None
Metabolic Conditions Covered by Insurance
None
WIC Coverage
Yes
Medicaid Coverage
Enteral not oral
Other State Programs
State Formulary;
Children’s Rehab Services
State Medicaid Contact Information
800-768-5700

x

Visit Medicaid Website

South Dakota

Mandated Private Insurance Coverage
Yes
Insurance Coverage of Formula and Limits
No Limit
Insurance Coverage of Low Protein Foods and Limits
None
Metabolic Conditions Covered by Insurance
PKU
WIC Coverage
PKU
Medicaid Coverage
Enteral not oral
Other State Programs
Children’s Special Health Services
State Medicaid Contact Information
605-773-2944

x

Visit Medicaid Website

Tennessee

Mandated Private Insurance Coverage
Yes
Insurance Coverage of Formula and Limits
No Limit
Insurance Coverage of Low Protein Foods and Limits
None
Metabolic Conditions Covered by Insurance
PKU
WIC Coverage
Yes
Medicaid Coverage
Yes
Other State Programs
Children’s Special Services
State Medicaid Contact Information
866-311-4287

x

Visit Medicaid Website

Texas

Mandated Private Insurance Coverage
Yes
Insurance Coverage of Formula and Limits
No Limit
Insurance Coverage of Low Protein Foods and Limits
None
Metabolic Conditions Covered by Insurance
Inborn errors of amino acid or urea organic acid metabolism
WIC Coverage
Yes
Medicaid Coverage
Individual consideration-case-by-case
Other State Programs
Children w/ Special Needs
800-252-8023
State Medicaid Contact Information
800-252-8263

x

Visit Medicaid Website

Utah

Mandated Private Insurance Coverage
Yes
Insurance Coverage of Formula and Limits
No Limit
Insurance Coverage of Low Protein Foods and Limits
No Limit
Metabolic Conditions Covered by Insurance
Inborn errors of amino acid or urea cycle metabolism
WIC Coverage
May be considered upon by request
Medicaid Coverage
Individual consideration-case-by-case
Other State Programs
Children w/Special Health Care Needs (CSHCN)
State Medicaid Contact Information
800-662-9651

x

Visit Medicaid Website

Vermont

Mandated Private Insurance Coverage
Mandated Coverage
Insurance Coverage of Formula and Limits
No Limit
Insurance Coverage of Low Protein Foods and Limits
$2500 Low-Pro foods
Metabolic Conditions Covered by Insurance
All Inborn Errors of Metabolism
WIC Coverage
May be considered upon by request
Medicaid Coverage
Yes
Other State Programs
Department of Children & Families;
Children w/Special Health Needs
802-847-4463
State Medicaid Contact Information
802-879-5900

x

Visit Medicaid Website

Virginia

Mandated Private Insurance Coverage
No Mandated Coverage
Insurance Coverage of Formula and Limits
None
Insurance Coverage of Low Protein Foods and Limits
None
Metabolic Conditions Covered by Insurance
None
WIC Coverage
Yes
Medicaid Coverage
Tube
Other State Programs
Department of Health;
CSHCN
State Medicaid Contact Information
804-225-2773

x

Visit Medicaid Website

West Virginia

Mandated Private Insurance Coverage
No
Insurance Coverage of Formula and Limits
None
Insurance Coverage of Low Protein Foods and Limits
None
Metabolic Conditions Covered by Insurance
None
WIC Coverage
Referred to WV metabolic program
Medicaid Coverage
Referred to WV metabolic program
Other State Programs
Department of Family Health-Newborn Services (NBS)
State Medicaid Contact Information
888-483-0797

x

Visit Medicaid Website

Wisconsin

Mandated Private Insurance Coverage
No
Insurance Coverage of Formula and Limits
None
Insurance Coverage of Low Protein Foods and Limits
None
Metabolic Conditions Covered by Insurance
None
WIC Coverage
No
Medicaid Coverage
Yes
Other State Programs
State Formulary;
Department of Health-Newborn Services (NBS)
State Medicaid Contact Information
608-266-1865

x

Visit Medicaid Website

Wyoming

Mandated Private Insurance Coverage
No
Insurance Coverage of Formula and Limits
None
Insurance Coverage of Low Protein Foods and Limits
None
Metabolic Conditions Covered by Insurance
None
WIC Coverage
Yes
Medicaid Coverage
Yes
Other State Programs
Genetic and Metabolic Clinic;
SCHIP
State Medicaid Contact Information
307-777-5775

x

Visit Medicaid Website