Medicaid provides medical assistance to certain individuals and families with low incomes and resources. It is jointly funded by the Federal and State governments. Although the federal government establishes national guidelines, each state has the authority to establish its own eligibility standards, determine the type and duration and scope of services, set the rates of payments and administer the program. Eligibility criteria can be found on the Centers for Medicaid and Medicare Services (CMS) website at: http://www.cms.hhs.gov/MedicaidGenInfo/ As part of the plan, the state must offer medical assistance for certain basic services to those living under the poverty level. For adults over the age of 21, the states are not required to provide speech-language pathology and audiology services. To ascertain the coverage in your state, you should contact the state Medicaid agency. The following website will assist you in locating your state agency: http://www.cms.hhs.gov/MedicaidGenInfo/
For children under the age of 21, the Medicaid law requires the states to provide hearing screenings and assessment of communication skills and language development as part of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) service. Based on the findings of this screening, the state must provide services and related devices such as hearing aids and AAC devices to treat or ameliorate the condition. To find out more about EPSDT.
Medicaid recognizes the importance of school-based speech-language pathology and audiology services although it is a medical assistance program. The federal Medicaid program actually encourages states to use their Medicaid programs to help pay for certain health care services delivered in the schools if federal regulations are followed. Contact your local school district to inquire if they participate in the Medicaid program.
Medicare
In 1965, the Social Security Act established both Medicare and Medicaid. Medicare is the federal health insurance program that is designated for those people who are 65+ years of age. Although directed towards a specific age bracket, Medicare plans are also applicable to certain disabled people.Medicare covers most services for assessing and treating speech, language, swallowing, hearing and balance disorders. It covers most hearing examinations but it does not cover hearing aids or tests for hearing aids.
Medicare has two major parts: Part A is hospital insurance and is financed through federal taxes while Part B is supplementary medical insurance and has a monthly premium.
Medicare Part A helps cover hospital stays, limited skilled nursing facility care when daily skilled services are needed, home health care and hospice care. Most services for speech, language, hearing and related disorders such as those effecting swallowing and balance are covered in these settings. Medicare regulations allow rehabilitation services when significant functional progress is expected and/or maintenance care is needed.
Medicare Part B helps cover physician services, audiology testing services, outpatient hospital services, rehabilitation agency services and comprehensive outpatient rehabilitation facility services. Service for speech and related disorders are covered in these settings.
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