Adult services may include audiological services and hearing aids limited to certain models. Includes batteries and repairs. Speech therapy may also be included. Children are covered under EPSDT.
Restrictions
Dependent on medical necessity as determined by audiological exam.
Pregnant women, children up to age 19, individuals 65 & over, blind, disabled, TANF families, individuals requiring nursing home care, breast and cervical cancer patients, foster children, refugees, families with an unemployed parent.
Services Available
Not a covered service for adults. Children covered under EPSDT (these benefits are subject to prior approval and benefit limit).
SSI/SSP recipients, individuals currently in CalWorks program, refugees, children in foster care, individuals 65 & over, blind, disabled, children under 21, pregnant women, women diagnosed with breast or cervical cancer, individuals in a skilled or intermediate care facility, parents or care takers of children under 21, parent who is primary wage earner is unemployed or underemployed.
Services Available
Adult services may include hearing evaluations, hearing aids, one set of batteries, and repairs. Children covered under EPSDT.
Restrictions
Must be prescribed by a otolaryngologist, audiologist, or if none available, a physician. Must meet medical necessity requirements in hearing exam. May be subject to prior authorization or treatment authorization requests (TAR).
Contact Numbers: 1-800-896-2512(TTY) and 1-800-952-5253(V)
Colorado
Eligibility Requirements
Individuals currently in ColoradoWorks program, pregnant women, children, parents of adopted children, recipients of SSI or Colorado Old Age Pension, individual 65 & over, disabled, blind, long term care recipients, HIV/AIDS patients.
Services Available
Not a covered service for adults. Children covered under EPSDT up to age 18 (may be subject to benefit limit).
Individuals 65 & over, blind, disabled, families with dependent children, those who meet needs for TANF or SSI, medically needy (medical expenses total certain percentage of income), pregnant women, children under the age of 21.
Services Available
Adults services may include hearing evaluations and hearing aids of various types depending on need. Ear molds and batteries covered.
Restrictions
Conformity evaluation required (appropriate testing to determine need).
Individuals 65 & over, disabled, blind, children under 21, SSI recipients, low income children & families referred by Department of Human Services.
Services Available
Adult services many include diagnostic testing, hearing aids, hearing aid fitting & dispensing. Repairs & accessories may be included. Children are covered under EPSDT and may be eligible for cochlear implant.
Restrictions
Limited to one per prescription every 3 years, some prior authorization required, no repairs until manufacturer's warranty has expired, no routine maintenance, batteries, cord or wire replacements, or cleanings. Medical need documentation required.
Individuals receiving TANF or GA aid, pregnant women, children up to age 19, foster children, individuals who have lost employer sponsored coverage because of unemployment within 45 days of applying for Medicaid program.
Services Available
Adult services may include hearing exams, hearing aids, and repairs. Children are covered under EPSDT.
Restrictions
Individuals covered under aged, blind, and disabled plans are covered under fee for service. All other eligible individuals are covered under managed care and benefits are at least what is listed to the left, possibly more. Replacements are possible once every two years with need. All in the ear and miniaturized models are not covered. Other special needs require documentation and prior approval. Accessories are not covered.
Disabled, low income working families, pregnant women, and children.
Services Available
Adult services may include one aid in the course of a lifetime including hearing screening & repairs. Children covered for aids with certain restrictions under EPSDT up to age 21.
TANF recipients, children, caretakers, pregnant women, disabled, blind, individuals 65 & over, foster care & adoption, repatriates, refugees in resettlement.
Services Available
Adult services may include comprehensive
testing, hearing & speech evaluation, hearing aids,
and speech therapy. Repairs and replacements for
monaural and binaural aids based on need. Children
are covered under EPSDT.
Restrictions
Dependent on medical necessity as determined by audiological exam.
Adults services may include hearing aids when deemed medically necessary. Ear molds, batteries, and additional supplies may be included. Children are covered under EPSDT.
Individuals receiving SSI, blind, disabled, families with dependent children, pregnant women, foster children & individuals in subsidized adoption.
Services Available
Adult services may include hearing aids, batteries, & repairs. Replacements are possible once every 4 years. Children are covered under EPSDT.
Restrictions
Must be referred by a physician to an audiologist. Tests must indicate need. Prior authorization needed for aids costing more than $650 for monaural & $1300 for binaural. Prior authorization also required for replacements.
TANF recipients, cervical or breast cancer patients, pregnant women, disabled, blind, refugees, individuals 65 & over.
Services Available
Adult services may include hearing aids, repairs with cost restriction, one month rental of hearing aid, 6 hearing aid batteries (monaural) and 12 batteries (binaural). Replacements possible once every 4 years. Speech therapy also available. Children are covered under EPSDT cochlear implant information is also available.
Restrictions
Must have proper hearing exam within 6 months of dispensing. Medical documentation by either a physician or an audiologist.
Contact Numbers: 1-800-766-9012(V) and 1-800-792-4292(TTY)
Kentucky
Eligibility Requirements
Families with dependent children if one parent is missing or unemployed, children under 19, pregnant women, individuals in nursing homes, disabled, blind, individuals 65 & over.
Services Available
Not a covered service for adults. Children up to 21 covered under EPSDT.
Individuals under 21 or over 65, individuals between these ages must have a dependent child, disabled, pregnant women, breast and cervical cancer patients.
*Program beginning October 1st, 2002 covering individuals between the ages of 21 & 65 without children or a disability.
Services Available
Not a covered service for adults. Children covered under EPSDT & with prior authorization under Medicaid itself.
SSI recipients, individuals 65 & over, disabled, blind, children under 21, an individual caring for a related child in the home, pregnant women, parents of unmarried children.
Services Available
Not a covered service for adults. Children are covered under EPSDT up to age 21.
Families with children under 19, children under 19, pregnant women, long term unemployed individuals, individuals 65 & over, blind, disabled, adults who work for a qualified employer, individuals who are HIV positive.
Services Available
Adult services may include analog hearing aids of basic models. Replacements are possible once every 7 years. Repairs are covered as well. Speech is also available. Children are covered under EPSDT.
Restrictions
Must have proper hearing exam to prove medical necessity. Prior approval is required. Only behind the ear models are covered, not in the ear.
Children, pregnant women, SSI recipients, care taker relatives, individuals 65 & over, blind, disabled, low income families.
Services Available
Adult services may include hearing aids. Replacements are possible once every 3 years. Children are covered under EPSDT.
Restrictions
Must show medical necessity. If individual meets criteria for medical necessity, prior authorization is not required. Digital and programmable aids are not covered without prior authorization and are usually only approved for children.
Contact Numbers: 1-800-642-3195(V) and 1-800-292-2550(TTY)
Minnesota
Eligibility Requirements
Low income families, children, pregnant women, people 65 & over, disabled, blind.
Services Available
Adult services may include programmable, analog aids. Available models include behind the ear, in the ear, full shell, half shell, discrete, and low profile. Replacements are possible once every 3 years. Medically necessary changes and updates and repairs are covered. Batteries are covered. Children are covered under EPSDT.
Restrictions
Must show medical necessity. Accessories are not covered.
Individuals 65 & over, disabled, blind, nursing home or long term care hospital patients, medically needy, children, pregnant women, TANF families, foster children.
Services Available
Adult services may include hearing evaluations and hearing aids of certain types and models. Children are covered under EPSDT.
Restrictions
Prior authorization for binaural hearing aids or more than one aid per year. Medical necessity must be shown.
Disabled, children, individual in nursing homes, blind, refugees, pregnant women, children in foster care, individuals 65 & over.
Services Available
Adult services may include hearing exams and hearing aids. Repairs, post-fitting adjustments may be available. Replacement of one aid every 4 years is possible. Replacement of ear molds due to changes in ear canal or shape may also be available. Children are covered under EPSDT.
Restrictions
All aids and related services require prior authorization. Routine testing of aids is not covered. Hearing aids must be dispensed by an audiologist, physician, or hearing instrument specialist licensed under Title XIX Hearing Aid Participation Agreement. Repairs and post fitting adjustments are limited to 3 per year. New aids will not be purchased within 6 months of previous dispensing.
Adult services may include hearing aids, repairs, and related items ordered by a doctor. Speech therapy may also be included. Children are covered under EPSDT.
Restrictions
These services are approved only if provided by a licensed audiologist and ordered by your doctor or mid-level practitioner. Must show medical need on audiogram. Services require prior approval. Basic Medicaid does not cover hearing aid exams.
Individuals 65 & over, disabled, children, SSI recipients, TANF families, refugees, individuals in nursing home care, foster children in transition to Independent Living, foreign citizens, adpotive parents, & Katie Beckett children.
Services Available
Adult services may include hearing aids including in the ear, behind the ear and body aids, repairs, necessary batteries, assistive listening devices, and specific supplies. Ear molds and rental are covered. Speech therapy may also be available. Children are covered under EPSDT.
Restrictions
Must show medical necessity. A maximum of $656.76 per aid is approved unless otherwise noted on prior authorization. Canal aids and accessories are not included.
Pregnant women, TANF families, children, SSI recipients, nursing facility residents, disabled, individuals 65 & over, non-citizens with immediate medical needs.
Services Available
Adults and children may receive basic models of aids based on medical necessity, exams, ear molds, and batteries are covered. Repairs and replacements are available every 2 years. Some accessories may also be covered.
Restrictions
Must show medical necessity, showing specific decibel loss. A physicians order and an audiogram are required.
Children 18 and under, pregnant women, low income families with children, blind, refugees, individuals 65 & over, disabled,
Services Available
Adult services may include hearing exams, hearing aids, repairs, and replacements once every 2 years. Children are covered under ESPDT.
Restrictions
Must show specific loss. Some prior authorization is required including fixes and programmable aids. Replacements are covered only if aids cannot be fixed or if needs change.
Families with children up to age 18, individuals 65 & over, disabled, pregnant women, children, blind.
Services Available
Adult services may include hearing exams, hearing aids, repairs, replacements as needed, and batteries. Children are covered under EPSDT.
Restrictions
Medical necessity must be shown. Adults who are working may receive two aids, non-working adults may only receive one. Replacements are covered if hearing aid is no longer under warranty.
SSI recipients, children in foster care, children, refugees, disabled, breast or cervical cancer patients, pregnant women, blind, individuals 65 & over.
Services Available
Adult services may include hearing exams, hearing aids, repairs, replacements once every 4 years, and batteries. Children are covered under EPSDT.
Restrictions
Medical need must be shown. Adults who are going to school or working may receive two aids, non-working adults may only receive one.
Adult services may include hearing exams, hearing aids of certain makes and models, ear molds, repair, and replacements as indicated by need. Children are covered under EPSDT.
Must be evaluated by primary care physician and referred to ENT for specific loss testing. If recommendation is made for an aid the dispenser would write up the cost and submit for prior authorization. There is not time limit on replacement, the norm is usually 3 years.
Contact Numbers: 1-800-505-5678(NYC) and 1-800-367-6557(all other areas)
North Carolina
Eligibility Requirements
Individuals 65 & over, blind, disabled, nursing care patients with medical expenses, pregnant women, children up to age 21, SSI recipients, Work First and TANF families, medically needy.
Services Available
Not a covered service for adults. Individuals may be referred to another agency. Children covered under EPSDT and Medicaid. May receive auditory training, speech reading, aural rehabilitation such as FM systems or cochlear implant. Monaural and binaural aids may be approved once every 4 years.
TANF families, individuals 65 & over, low income families, the elderly in mental institutions, children 21 & under in mental institutions, adopted children, pregnant women, children up to age 18, disabled, blind.
Services Available
Adults and children may receive aids of certain types and batteries. Adults are eligible for replacement once every four years. Children are eligible for exam and replacement once every 2 years. Ear molds are also covered.
Restrictions
Binaural aids require medical necessity and are not covered for adults unless a prior binaural user. Canal and digital aids are not covered. Must provide documentation of need in audiogram and ENT report.
Children, TANF families, pregnant women, individual 65 & over, blind, disabled, low income families that are not TANF eligible (with some requirements), women with breast or cervical cancer.
Services Available
Adult services may include comprehensive testing, hearing aids, cleaning kit, ear molds, I months supply of batteries, shipping & handling for aids if sent to customer, fittings, 3 hours of counseling, I year warranty covering all repairs. Replacements may be available once every 4 years. Children are covered under EPSDT.
Restrictions
Prescription of physician must show medical necessity and individual must have a certain db loss. Binaural aids not typically covered but can submit a claim based on need. Services require prior authorization. Must have aids periodically rechecked.
TANF families, pregnant women, children under 18, individuals 65 & over in long term care, blind, disabled, individuals 65 & over, certain individuals with TB, foster children, individuals 65& over in mental health institutions, individuals requiring long term care, individuals experiencing catastrophic illness, families with an unemployed parent.
Services Available
Adults and children are proved at minimum hearing services including hearing evaluation once every 12 months, hearing aid evaluation if indicated, and the purchase of a hearing aid when prescribed. Interperiodic exams are allowed if hearing condition if expected. Children are also covered under ESPDT. Speech and hearing services may also be covered for children only.
Restrictions
Must show medical necessity. Provider must hold a certificate of clinical competence from ASHA or have completed all course work for the certificate, or hold a contract with OCHA to perform such services.
Adult services may include comprehensive hearing evaluation, hearing aids, repairs, replacements are possible once every five years. 60 batteries per calendar year are covered. Assistive devices may be approved for individuals 21 & over who cannot wear or benefit from the use of a hearing aid. Children are covered under EPSDT.
Restrictions
Hearing aids, repairs, dispensing and fittings, and assistive devices require prior approval. Binaural hearing aids are approved for adults with significant vision problems. Must show medical necessity.
Contact Numbers: 1-800-359-9517(V) and 1-800-621-5260(TTY)
Pennsylvania
Eligibility Requirements
Children, pregnant women, individuals 65 & over, disabled, blind, TANF families, GA recipients, an individual who is a nursing home patient for 30 days or more, juvenile detention residents after 35 consecutive days, individuals who are ventilator dependent and hospitalized for 30 days, uninsured breast and cervical cancer patients.
Services Available
Not a covered service for adults. Children are covered under EPSDT and may receive any type of hearing aid including digital models. Dispensing fees, ear molds updated as frequently as necessary, replacements and up to 8 batteries a month are covered.
Restrictions
Must have an unaided and aided audiogram showing need and use of any devices. Hearing aids of any model are only covered up to $280. Any further cost may be covered under a waiver. FM systems are not covered. Children in need of one for school purposes must go through the school district.
Contact Numbers: 1-800-692-7462(V) and 1-800-451-4886(TTY)
Rhode Island
Eligibility Requirements
Individuals 65 & over, blind, disabled, children, parents with children 19 and under, long term care recipients, pregnant women.
Services Available
Categorically needy adults may be provided hearing aids of types and models determined by individual need including monaural & binaural (with restrictions). Adults may be provided replacements once every 3 years. Rentals and repairs beyond warranty are also covered. Children are covered under ESPDT and may receive monaural, binaural, analog, or digital aids based on need. Replacements and repairs are not restricted but based on medical necessity for children.
Restrictions
Adults must show that hearing loss impairs daily activities. Adults requiring binaural hearing aids must have used two aids in the past or show that they are employed or will be employed. Both children and adults must show medical necessity. Aids must be dispensed by a licensed dealer and must be guaranteed for one year.
Blind, disabled, individuals 65 & over, TANF families, individuals in long term nursing home care, SSI recipients, foster children, Katie Beckett children, children under 1 living with special arrangements, specified low income individuals, pregnant women, children.
Services Available
Not a covered service for adults. Children covered under EPSDT and Children's Rehabilitative Services.
Families, children, SSI recipients, long term care recipients, refugees, pregnant women, uninsured breast and cervical cancer patients, individuals 65 & over, blind, disabled.
Services Available
Adult services may include hearing aids, ear molds, fittings, follow-up services, and cleanings. Replacements may be available once every 3 years. Also includes services covered under the warranty of the hearing aid prescribed. Children are covered under EPSDT.
Restrictions
Must be prescribed by a physician or certified audiologist, specific decibel loss required.
Families First (TANF program), low income women and children up to age 17, SSI recipients, the medically needy, uninsured breast and cervical cancer patients.
Services Available
Not a covered service for adults. Children are covered under EPSDT and receive one hearing evaluation per year, one hearing aid or aid. Replacements and repairs are also available.
Restrictions
Must show medical necessity. Replacement of lost or stolen aids requires prior authorization.
Contact: 1-800-669-1851(V) and 1-800-772-7647(TTY)
Texas
Eligibility Requirements
TANF families, children 19 and under, pregnant women, care takers and second parents of children who meet the definition of deprived children, emergency care for undocumented aliens, individuals who meet TANF guidelines except citizenship, youth aging out of foster care ages 18-20, refugees, repartition program participants, nursing home residents, SSI recipients, blind, disabled, and individuals 65 & over.
Services Available
Adults are provided only one hearing aid once every 6 years. Only basic models are available. Repairs and replacements are covered as well as ear molds. Children through the age of 20 are covered under EPSDT and are provided at minimum the coverage provided above. Cochlear implants are also available for children.
Children under the age of 18, children in foster care, special needs children, parents of children under 18, pregnant women, uninsured breast or cervical cancer patients, nursing home patients, refugees, non-citizen emergency care, blind, disabled, individuals 60 & over, adults who have special medical needs.
Services Available
Not a covered service for adults. Children up to age 21 are covered under EPSDT and may be provided hearing exams, hearings aids, repairs, and replacements once every five years. Those with monaural aids are provided 6 batteries a month; with binaural aids receive 12.
Restrictions
Must have proper exam by an audiologist. Any further examinations must document need. Replacements may occur once every 5 years unless prior authorization approves another service.
Services for individuals of all ages include comprehensive audiological exams, analog hearing aids for any individual, digital hearing aids for children 21 and under, repairs and replacements of both types may be covered. Fittings, orientation, and checking of aids as well as ear molds are covered, 6 batteries per month are provided.
Restrictions
Must have a specific decibel loss, prior authorization is required for more than one aid repair in excess of $100. Unless authorized non medical items such as canal aids and maintenance items are not covered. Rental and trial periods are not covered. Digital aids are for children 21 and under only.
Pregnant women, children 19 and under, low income families with children, children under 21 who are in foster care, SSI recipients, individuals 65 & over, blind, disabled, individuals receiving long term care services, auxiliary grant recipients, terminally ill individuals in hospice care, refugees, uninsured breast or cervical cancer patients.
Services Available
Not a covered service for adults. Children covered under EPSDT.
Work First (TANF) families, medically needy, SSI recipients, low-income pregnant women, uninsured breast and cervical cancer patients, children, children living with guardians low income immigrant children, refugees and aliens, and long term care recipients.
Services Available
Adult services may include one new, unrefurbished hearing aid once every five years, prefitting evaluations, ear molds, a minimum of 3 post fitting consultations, Repairs are covered with some restrictions, and ear molds may be replaced once a year if soft in type, once every three years if hard in type. Rentals for up to 2 months while client's aid is being repaired are covered. Children are covered for the same services although replacements are possible on a medically necessary basis, with no minimum yearly standard. Some restrictions may differ.
Restrictions
Adults displaying need for monaural aids must show that inability to hear has caused difficulty in job performance, inability to perform in school, or that they are also legally blind. Individuals with need for binaural aids must try for up to 6 months to adapt with only once aid and must have specific decibel loss in both ears while also showing that inability to hear has caused significant difficulty in school or job performance, or that the individual is legally blind. Batteries, ear trumpets, tinnitus maskers, digital aids, programmable aids, and FM systems are not covered. Children must present be 17 or under, present a MAID card, have prior authorization, and show medical necessity. Computer aided devices used in schools, digital and programmable aids provided based on individual circumstances, batteries, ear trumpets, and tinnitus maskers are not covered.
TANF families, qualified women and children, SSI recipients, individuals 65 & over, blind, disabled.
Services Available
Not a covered service for adults. Children are provided coverage up to age 20. Hearing aids, dispensing and fittings, repairs, and replacements once every 5 years. Certain programmable, digital aids will be covered of certain types. Batteries and ear molds may also be covered. Cochlear implants may also be covered. Children are covered under EPSDT.
Restrictions
Must show medical necessity and must have prior authorization. Children must qualify through Children with Special Health Needs or must be referred by HealthCheck.
Relative or care taker of a "deprived child"(see index), pregnant women, children under the age of 19, individuals 65 & over, blind, disabled.
Services Available
Services for individuals of all ages may include hearing exams, hearing aids, ear molds, repairs, recasings, and replacements, once every three years. Batteries are also covered. Digital aids may be covered on a case-by-case basis. Children are covered under EPSDT.
Restrictions
Services are based on medical necessity. Exams must be performed by a licensed audiologist, and prescription must be written.
Low income families, children up to age 19, foster children, individuals aging out of foster care up to age 21, uninsured breast or cervical cancer patients, long term care recipients, pregnant women, emergency services for non-citizens, individuals in nursing homes, blind, disabled, and individuals 65 & over.
Services Available
Services for individuals of all ages may include hearing exams, hearing aids, dispensing fees, fitting, orientation, counseling, 2 return visits, and insurance for loss or damage beyond repair. Replacements are available based on medical necessity. Children are covered under EPSDT.
Restrictions
Evaluations must be ordered by a licensed audiologist, including: minimum speech discrimination tests, a speech reception threshold, pure tone air threshold, pure bone threshold, a tympanogram, and acoustic reflex testing. Must demonstrate a specific decibel loss.
