Medicaid can cover diabetic shoes, but coverage depends entirely on which state you live in. Unlike Medicare, which has a specific federal benefit for therapeutic footwear for people with diabetes, Medicaid leaves this category up to individual states. Some state Medicaid programs cover therapeutic shoes as a standard benefit, others cover them only with prior authorization, and a few don’t cover them at all.
Why Coverage Varies by State
Medicaid is jointly funded by the federal government and individual states, but states have wide latitude in deciding which optional services to include. Podiatric care, including diabetic footwear, falls into that optional category. A national survey of Medicaid programs found that 82% of jurisdictions covered podiatric services for all classes of Medicaid beneficiaries, but the specific rules, restrictions, and limitations differed significantly from state to state.
Some states cover routine foot care only when it’s medically necessary or when a qualifying condition (like diabetes) is present. Eight jurisdictions didn’t cover routine foot care at all. Twenty-eight states required prior authorization before podiatric services would be reimbursed. So even in states where diabetic shoes are theoretically covered, you may need approval before purchasing them.
The fastest way to find out what your state covers is to call the number on the back of your Medicaid card or check your state Medicaid agency’s website. Ask specifically about “therapeutic footwear” or “diabetic shoes,” since coverage for shoes may be listed separately from general podiatry visits.
Medicare’s Diabetic Shoe Benefit
If you have both Medicare and Medicaid (sometimes called “dual eligible”), Medicare has a clear, federally standardized benefit worth knowing about. Under the Therapeutic Shoes for Individuals with Diabetes benefit, Medicare covers one of two options each calendar year:
- One pair of custom-molded shoes (or inserts), plus 2 additional pairs of inserts
- One pair of extra-depth shoes, plus 3 pairs of inserts
Custom-molded shoes are built from a cast or model of your foot and are typically reserved for people whose foot deformities can’t be accommodated by standard extra-depth shoes. Extra-depth shoes have additional room inside to fit custom or prefabricated inserts comfortably. Most people start with extra-depth shoes, which come with one more pair of inserts per year than the custom option.
This benefit resets every calendar year, so you’re eligible for a new pair of shoes and new inserts each January.
Who Qualifies
Whether you’re going through Medicaid or Medicare, therapeutic shoes aren’t covered simply because you have a diabetes diagnosis. You generally need to meet medical necessity criteria, which means your doctor must certify that you have diabetes and at least one foot-related complication that puts you at risk. Common qualifying conditions include:
- Previous foot ulceration on either foot
- Peripheral neuropathy (nerve damage causing numbness or tingling)
- Poor circulation in the feet
- Foot deformities such as bunions, hammertoes, or Charcot foot
- History of amputation of part of the foot
- Calluses that could lead to ulcers
Your treating physician, typically a primary care doctor or endocrinologist managing your diabetes, needs to provide a written statement confirming both the diabetes diagnosis and the foot condition. A podiatrist or other qualified provider then writes the specific prescription for the type of shoe and inserts you need.
How to Get Diabetic Shoes Through Medicaid
The process generally follows these steps, though your state may add or remove requirements:
First, talk to the doctor who manages your diabetes. They’ll evaluate your feet and determine whether you have a qualifying complication. If you do, they’ll provide a certification statement, sometimes called a Statement of Certifying Physician, documenting your diagnosis and the medical reason you need therapeutic footwear.
Next, a podiatrist, orthotist, or other qualified provider will write a prescription specifying whether you need extra-depth shoes, custom-molded shoes, or shoe modifications. They’ll also determine what type of inserts you need. In many states, this is the stage where prior authorization gets submitted to Medicaid.
Finally, you’ll be fitted by an approved supplier. The shoes and inserts need to come from a provider who is enrolled in your state’s Medicaid program (or Medicare, if that’s the benefit you’re using). Not every shoe store or medical supply company qualifies, so confirm enrollment before your fitting appointment.
What If Your State Doesn’t Cover Them
If your state Medicaid program doesn’t include therapeutic footwear, you still have options. Dual-eligible beneficiaries can use their Medicare benefit instead. If you only have Medicaid, ask your doctor about filing an exception or appeal. Some states will approve coverage on a case-by-case basis if your provider can demonstrate that the shoes are medically necessary to prevent a more expensive outcome, like a foot ulcer or amputation.
Some nonprofit organizations and diabetes advocacy groups also offer free or reduced-cost diabetic shoes. Community health centers may be able to connect you with local resources. If cost is a barrier, a social worker at your clinic or hospital can help you navigate these alternatives.
Why Diabetic Shoes Matter
Therapeutic shoes aren’t a luxury item for people with diabetes. Foot ulcers are one of the most common and costly complications of the disease, and they’re the leading cause of non-traumatic lower limb amputations. Properly fitted therapeutic shoes reduce pressure on vulnerable areas of the foot, accommodate deformities without creating friction, and provide space for custom inserts that redistribute your weight more evenly.
If you’ve already had a foot ulcer, the risk of developing another one is high. Wearing appropriate footwear daily is one of the most effective preventive measures available, which is why both Medicare and many state Medicaid programs consider it a covered benefit rather than a convenience.