Gov. Jim Doyle (second from left)
celebrates the new law with the Neilson family (from left)--Larry, 14-year-old Peyton, and Laurie. Peyton offered testimony in support of the bill.
In May, Wisconsin became one of the first states to require insurance companies to cover the cost of cochlear implants (CIs) for children 18 years old or younger. The new law also covers children's hearing aids as well as the related professional services and aural rehabilitation needed to benefit from these devices.
Kentucky also requires health plans to cover CIs, and insurers in 13 other states must cover the cost of hearing aids for children, according to the National Conference of State Legislatures.
The Wisconsin law (S.B. 27/A.B. 16) was designed to be broad, according to Laura Feldhake, vice president for audiology services of the Wisconsin Speech-Language Pathology and Audiology Professional Association (WSHA-P). Children may receive up to two hearing aids every three years. Also covered are surgically implanted auditory devices, including cochlear implants, bone-anchored hearing aids, middle-ear implantable hearing aids, auditory brainstem implants, and future hearing implants. Bilateral implantation is also covered if an audiologist or surgeon determines it is medically necessary.
Before the law takes effect on Jan. 1, 2010, a rulemaking process may establish a specific coverage limit for the cost of hearing aids, Feldhake noted. "We will advocate so that the ceiling will not be set too low."
Feldhake sees her advocacy for the law as an extension of her efforts to promote the passage of early hearing detection and intervention legislation in Wisconsin, efforts that were commended by the governor in the late 1990s. "A lot of the families I work with were at the signing of the bill," said Feldhake, whose private practice includes pediatric patients.
"We are thrilled the hearing aid/cochlear legislation passed into law this legislative session," said Laurie Nelson, whose 14-year-old daughter, Peyton, testified in support of the law. "We were devastated to have to pay out of pocket for her hearing aids every four to five years."
The cost of hearing aids is a problem for many families, Feldhake said. "You wind up choosing amplification that will save them money, or the family will delay replacement with newer technology. Some families put the entire cost on their credit card or take out a second mortgage."
According to a survey by the Wisconsin chapter of Hands and Voices, about 200 babies are born with hearing loss in Wisconsin each year, and more than half of their families do not have insurance that covers hearing aids. The new law would cover those who have group or individual plans, although the measure does not extend to self-insured plans of private employers.
Audiology Client Plays Key Role
The law was set into motion four years ago by a conversation between an adult with hearing loss and his audiologist about the cost of hearing aids and the lack of insurance coverage. This prompted the consumer to contact his state legislator, Rep. Martin Schneider. Schneider introduced the bill, which did not pass out of committee. That bill was reintroduced last session and passed in the Senate; the legislative session ended before the bill could be passed in the House.
"I knocked on a lot of legislators' doors and did as much advocacy as I could without actually being a lobbyist," Feldhake said. During each legislative session, Feldhake met with lawmakers and stressed the need for insurance coverage for children's cochlear implants and hearing aids. A letter-writing campaign reinforced the message with legislators.
In summer 2008, Rep. Schneider and Sen. Julie Lassa gave the bill a final push. In a meeting with stakeholders, including WSHA-P, parents, representatives of the state chapter of the Hearing Loss Association of America, and the state's disability rights group, new legislative language was hammered out. Legislators agreed to increase the age limit from age 11 to age 18, after Feldhake explained that these young adults could then receive funding for hearing technology from
the department of vocational rehabilitation services. The final bill was sponsored by Sen. Lassa and Rep. David Cullen.
Gov. Jim Doyle signed the bill into law on May 21.
Small business representatives, concerned that the mandate would drive up insurance costs, lobbied against the bill, but a fiscal-impact study by the Office of the Commissioner of Insurance to the Legislature determined that the directive would add less than $2 per month to an insurance policy.
Advocates for the Deaf community also presented testimony opposing the bill's coverage of cochlear implants and circulated a petition that gathered 500 signatures in a last-minute battle to urge Gov. Doyle not to sign the bill. They argued that CIs are expensive and threaten their language and cultural identity. Deafness is not a medical disorder that needs to be fixed, according to the petition.
Although the new law will give parents insurance coverage for a technological approach to assist with their child's hearing loss, all communication options should be discussed with parents so they can make an informed choice, Feldhake said.
"It's important for parents to research options and to reach the decision of whether or not to implant early," she said. "When I broach the topic of a cochlear implant with parents, I tell them that it's their decision."