Hearing Aid Insurance Mandates: Ensuring Access to Sound One State at a Time
By Anna Karkovska McGlew
Access to sound right from the start is critical for children who are deaf or hard of hearing to develop listening and spoken language. Yet, many families struggle to afford the cost of hearing aids. In states across the nation, professionals and parents have joined forces to pass laws requiring coverage for hearing aids.
There are now 20 states that have passed mandates for hearing aid coverage. All of these states require health benefit plans to cover hearing aids for children. Only three states—Arkansas, New Hampshire, and Rhode Island—require coverage for both children and adults. One (Wisconsin) also requires coverage for cochlear implants for children. State mandates vary with regard to the amount of coverage, benefit period and provider qualifications. The American Speech-Language-Hearing Association maintains a website with brief descriptions and links to each statute: http://www.asha.org/advocacy/state/issues/ha_reimbursement/.
The following states have efforts underway to pass hearing aid insurance legislation. In the Perspectives on Our Profession section, Marilyn Neualt, Ph.D., CCC-A, shares the value and rewards for professional involvement in these initiatives.
Massachusetts is the most recent state to pass a hearing aid law for children, which went into effect in January 2013. The Massachusetts Hearing Aids for Children Coalition (MassHAFCC), a statewide network of families of children who are deaf and hard of hearing and professionals, secured passage of the legislation last fall that requires hearing aid coverage for children.
The new law requires that health insurers cover hearing aids for children who are 21 years of age or younger, up to $2,000 per hearing aid per ear in each 36-month period.
Lisa Adams, mother of twin boys with hearing loss and founder of MassHAFCC, shared the story of ensuring passage of the law from the impetus for the initiative to its passage and implementation.
“Our twin sons were diagnosed with hearing loss at birth and began wearing hearing aids as infants. From the time that we purchased their first set of hearing aids, it bothered me that insurance did not cover such an important and, for insurers, a low-cost device that was essential for speech and language development for so many children with hearing loss.”
In 2005, when her sons were 1 year old, Adams contacted her state senator and asked him to file legislation that would mandate insurance coverage for children in Massachusetts. This effort did not succeed and, in 2009, Adams asked her state representative, Sean Garballey, to file similar legislation. Adams advertised a meeting and found other mothers of children with hearing loss who were interested in advocating for the passage of hearing aid legislation. MassHAFCC was born. After rewriting and renaming the bill, it garnered 22 co-sponsors and made it through committee before it was put to study at the end of the legislative session that year.
Organized Around a Common Goal
Without a budget, MassHAFCC worked to increase awareness among legislators by educating them about the importance of providing early access to hearing aids upon diagnosis of hearing loss and clarifying the cost-benefit of hearing aids use on overall educational and medical costs. The group engaged in an extensive public relations campaign through marketing, media and social media outlets and set up countless face-to-face with legislators and their staff.
“We worked together with professionals around the state, including doctors and audiologists from the Massachusetts Eye and Ear Infirmary and Children’s Hospital Boston, several of whom testified at the legislative hearing for the bill,” Adams recalls. “Our goal was to keep the bill on the forefront of everyone’s awareness during the session as a bill that must pass.” Their efforts paid off: the bill passed with bi-partisan support and had 71 co-sponsors.
Adams emphasized the importance of professionals and parents working together, staying connected virtually and through face-to-face meetings, and having constituents in every part of the state to repeatedly contact legislators at crucial moments throughout the legislative process. MassHAFCC continuously identified and grew its base of supporters and maintained a strong presence at the State House with their children to keep the bill at the forefront of legislators’ minds. Evan Brunell, AG Bell board member and president of the Massachusetts chapter of AG Bell, wrote a letter of support for the law that MassHAFCC members presented to legislators at the State House, along with letters from a number of local and national organizations.
Since the law has been implemented, the coalition has continued to follow coverage under the law. It has provided answers to some of the most commonly asked questions about the new law on its blog, including information on where to go for help to advocate for coverage or to report unwarranted denial of coverage.
“The challenge during the first year of implementation is to keep everyone—patients, providers and insurers—on the same page with respect to coverage under the law and to make sure that the intended coverage does not get reduced by misinterpretation of the law’s provisions,” said Adams.
Kelly Jenkins, a parent and co-founder of Let Georgia Hear— a parent-led initiative working towards the goal of securing insurance coverage for children’s hearing aids in Georgia—provided an update on legislative efforts in her state.
The group has been working on passing this legislation for a year and a half and was recently granted a public hearing this session, which was covered by CNN as well as local media. Local listening and spoken language professionals lent their support to the effort: Shelley Carr, LSLS Cert. AVEd, coordinator for the Atlanta Speech School organized a caravan of listening and spoken language professionals to come to the hearing. “Media coverage has been instrumental in keeping this legislation moving along,” added Jenkins.
Currently, the bill has been assigned to the Special Advisory Commission for Health Insurance Mandates, which is charged with reviewing all insurance mandates to ensure that they make social, medical and fiscal sense for the state. Let Georgia Hear hopes to keep the momentum going. A video about the Let Georgia Hear effort is available at www.letgeorgiahear.org/video.
The Utah legislature recently passed a bill, which creates a two-year pilot program to provide hearing aids to qualifying children with hearing loss. To that end, the legislation establishes a fund of $100,000 placed in a restricted account for fiscal year 2014. Further, the law asks the Health and Human Services Interim Committee of Utah to evaluate the program and potentially recommend it for conversion to an ongoing program within the Utah Department of Health. Betsy Sutherland, M.Ed., AG Bell member and director of the listening and spoken language program at the Utah Schools for the Deaf and the Blind, said that Utah legislators are currently not considering introducing more comprehensive legislation until the pilot program’s impact and benefit have been evaluated.
Rachel Arfa, AG Bell board member, provided an overview of efforts in Illinois. Two bills, SB 38 and HB 1231, have been introduced in the Illinois legislature to ensure that private health insurance would cover hearing aids for those who need them of all ages, for up to $2,500 per ear every three years. A version of these bills has been introduced almost yearly over the past 20 years. However, the effort is currently stalled due to upcoming changes as part of the Affordable Care Act (ACA).
Under the ACA, states are to create health insurance exchanges, or a marketplace in which those without health insurance can shop for a plan. In Illinois, this exchange will open for enrollment on October 1, 2013 and become effective in 2014. As part of this process, the state of Illinois created a set of Essential Health Benefits (EHB), which need to be covered under any health insurance plan offered through the marketplace. However, Illinois did not include coverage of hearing aids in the EHB, leaving the decision at the discretion of individual private plans.
More importantly, “if the state of Illinois decides through legislative process or as state policy to impose a mandate for coverage of benefits that are not in the EHB, that would require the state, not private insurers, to cover the difference in cost. This means that if SB 38 and HB 1231 passed, the state would have to pay for all hearing aids for those who buy insurance on the marketplace,” said Arfa. The bills are currently stalled due to a lack of funding.
Stakeholders in Illinois are considering their options. One is to work directly at the federal level with the U.S. Department of Health and Human Services (HHS) to include insurance coverage for hearing aids nationwide. The other is work at the state level to amend or modify the EHB standards to add hearing aids.
If you live in Illinois, please consider contacting the governor’s office as well as your state representative and senator to let them know you care about this issue.
Jocelyn Ross, parent of a child with hearing loss, founded Let South Carolina Hear (LSCH) to secure hearing aid insurance legislation. LSCH has worked with members of the South Carolina state legislature to introduce two companion bills— S.65 and H.3240 – during the last two legislative sessions.
The legislation seeks to provide hearing aid coverage (initial and replacement aids) for children under 22 years of age with hearing loss with a minimum coverage benefit of $1,500 every 36 months. The proposed legislation would allow the option of choosing a hearing aid that exceeds the coverage amount and paying the difference in cost with no penalties.
LSCH has collected hundreds of petition signatures in support of this legislation across the state. The group encourages professionals and other stakeholders to write their legislators to encourage sponsorship of the bill. “The last couple of years have been great building years, especially considering this is a health coverage bill in the midst of states working out their plans for the Essential Health Package pursuant to the Affordable Care Act,” said Ross.