Ensuring that patients have appropriate access to insurance coverage is a key organizational priority. All 50 states and Washington, DC cover children under Medicaid, but the nature of coverage as well as the payment amount varies greatly. We have surveyed CI clinics and found that there are access to care issues created by state regulations that limit sound process replacements, numbers of batteries allowed, and sufficient coverage of therapy. We believe that these regulations interfere with Congressional intent on ensuring appropriate services for Medicaid covered children under federal law. We will be discussing the findings with appropriate Federal policy-makers in the Fall 2018.
CI coverage of adults under Medicaid is optional under Federal law; whether and how adults are covered is determined by the individual states. An estimated 60% of states cover eligible adults for cochlear implants under Medicaid. ACI Alliance was contacted by Disability Rights Maryland (DRM), an organization that advocates for the legal rights of Maryland residents with disabilities. DRM was interested in pursuing CI coverage for adults under Maryland Medicaid. ACI Alliance provided information and supported the effort. The State of Maryland made the decision to cover cochlear implants for adults under Medicaid starting in July 2018. Read our comments on the proposed rule HERE.
As part of our ongoing advocacy and education efforts on Medicaid, the ACI Alliance visited with staff at Centers for Medicare & Medicaid Services (CMS) as well as with the Majority and Minority staff for the House Energy and Commerce Committee and Senate Finance Committee. We shared information on cochlear implants and the life-changing benefits that they provide for children and adults. In addition, we discussed ongoing access issues Medicaid patients and providers face including reimbursement, replacement policies for sound processors and other equipment, caps on rehabilitative therapies, and MCOs. We encourage our members to contact Nichole Westin (firstname.lastname@example.org) or Donna Sorkin (email@example.com) to add to our collective knowledge on how Medicaid is serving children and adults who have or need cochlear implants.