Under the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) component, the national Medicaid program requires all state Medicaid agencies to provide certain hearing-related coverage for Medicaid beneficiaries younger than 21 years old. This EPSDT-mandated coverage for children at risk of hearing impairment includes audiological assessments, hearing aid evaluation and medically necessary hearing aids and related services and accessories.
Although federal Medicaid rules do not require individual states to cover hearing products and services for adult beneficiaries who are deaf or hard of hearing, many states choose to provide some form of coverage. In states that do provide hearing coverage for adults, certain limitations generally apply. At minimum, any services must be deemed medically necessary and prescribed by a physician or licensed practitioner.
Some states have very specific rules and guidelines, including:
- A minimum extent of hearing loss to qualify for coverage eligibility.
- Prior authorization for hearing aid purchases and repairs.
- Limited options for hearing aid products.
- Annual limits on covered products or services, such as hearing aid evaluations or batteries.
- Warranty-related rules and restrictions.
- A limited range of acceptable hearing aid vendors.
Other restrictions may apply. Below is a list of U.S. states and some of the hearing aid products and related services that each state currently covers for Medicaid beneficiaries. The services listed are not exhaustive, and states often change their Medicaid benefits, so interested candidates may wish to check with the state Medicaid agency.
|Alaska||Audiology, hearing aids, hearing item repairs, diagnostic testing, hearing therapy and rehabilitative therapy|
|California||Hearing aids, hearing exams, hearing aid repairs, hearing aid part replacements, ear molds, cochlear implant services|
|District of Columbia||Not covered|
|Florida||Cochlear implant services, hearing aids, hearing evaluations, hearing aid repairs and accessories, hearing aid fitting and dispensing, diagnostic audiological testing|
|Hawaii||Hearing aid examination and selection, hearing aid check, hearing aids, hearing aid repairs not covered by warranty|
|Idaho||Doctor-ordered exam and testing, hearing aids and hearing services for children younger than 21|
|Illinois||Basic and advanced hearing tests, hearing aid testing and evaluation, hearing aid fitting, hearing aid part replacement, hearing aid repairs, hearing aid accessories|
|Indiana||Purchase, repair and replacement of hearing aids|
|Iowa||Hearing evaluation, hearing aid selection and purchase, ear molds, hearing aid maintenance, hearing aid replacement|
|Kansas||Trial hearing aid rental, hearing aid batteries, cochlear implant batteries, audiological testing, ear examinations, hearing aid repair|
|Massachusetts||Hearing aids, replacements and repairs covered by some plans|
|Michigan||Not covered, unless authorized before 06/30/2009|
|Minnesota||Hearing aids, ear molds, hearing aid checks, hearing aid repairs, batteries, hearing aid part replacements|
|Missouri||Hearing aids and related services for pregnant beneficiaries, blind beneficiaries and beneficiaries who are residents of nursing homes|
|Montana||Audiology services, hearing aids and hearing aid repairs|
|Nebraska||Hearing aids, hearing aid repairs, hearing aid rentals, assistive listening devices|
|Nevada||Hearing aids, hearing aid batteries, audiological testing, replacement hearing aids, hearing aid supplies and accessories, ear molds, hearing aid fittings, some services for cochlear implants|
|New Hampshire||Hearing aid evaluation and consultation, ear molds, hearing aids, hearing aid fitting, audiogram, hearing aid batteries, hearing aid replacement and repair|
|New Jersey||Hearing exams, hearing aids, hearing aid repairs and replacements, hearing aid batteries (services covered under certain plans only)|
|New Mexico||Audiology screening and services, hearing aids purchase, hearing aid rentals, hearing aid repairs and replacements, hearing aid accessories, hearing aid insurance|
|New York||Hearing exams, hearing aid repair and replacements, ear molds|
|North Carolina||Not covered|
|North Dakota||Hearing aids, replacements, ear molds, batteries|
|Ohio||Conventional hearing aids, replacements, ear molds, batteries|
|Oregon||Audiologic assessment, hearing aid evaluation and selection, electroacoustic evaluation for hearing aid, repair of hearing aids|
|Rhode Island||Hearing aids and replacements|
|South Carolina||Not covered|
|South Dakota||Hearing aids and replacements, ear mold, hearing aid fitting and cleaning|
|Texas||Audiology and audiometry services, hearing aids, hearing aid accessories and repairs, ear impressions and ear molds, hearing aid batteries, cochlear implants, auditory brainstem implants, bone anchored hearing devices|
|Vermont||Audiological examinations, hearing aids, hearing screening and assessments, hearing aid replacements and repairs, ear molds, hearing aid checks|
|Washington||Audiology exams, medical ear treatments|
|West Virginia||Not covered|
|Wisconsin||Certain types of hearing aids|
|Wyoming||Audiologic assessment, hearing aid evaluation, hearing aids, hearing aid replacement and repair|