ASHA is helping state associations respond to an erroneous characterization by Kathleen Sebelius, U.S. secretary of health and human services, who informed all 50 state governors that "speech therapy" is "optional" under Medicaid.
In a Feb. 3 letter, Sebelius stated that "While some benefits, such as hospital and physician services, are required to be provided by state Medicaid programs, many services, such as prescription drugs, dental services, and speech therapy, are optional."
Under Medicaid, however, speech-language and hearing services (and speech-generating devices and hearing aids) for children up to age 21 are required under the federally mandated Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program.
An attachment to the Sebelius letter, "Medicaid Cost-Savings Opportunities," includes a Medicaid benefits table. The EPSDT program is clearly part of the mandatory services, but the letter lists "speech, hearing and language disorder services" under the optional services category.
Sebelius sent the letter to outline ways in which cash-strapped states can save money through flexible interpretation of Medicaid rules. Medicaid is an entitlement program funded by federal and state money that provides health insurance for individuals who meet certain eligibility requirements. States establish their own standards and guideline interpretations.
ASHA has developed a two-pronged approach to combat the misinformation. ASHA President Paul Rao has sent a letter to Sebelius clarifying the requirements of EPSDT as they relate to speech-language hearing services and assistive devices, recommending that she ensure that those services are not placed in jeopardy for Medicaid-eligible children and urging that she remind governors that EPSDT services are mandated. The letter to Sebelius also includes a rationale for coverage of speech, language, and hearing services and devices for adults.
In addition, ASHA is helping individual state associations organize and prepare information to be sent [PDF] to their governors. In a letter to state association presidents, Rao urges them to contact the governor's office and the state Medicaid agency to remind the officials that speech-language pathology services, audiology services, and related assistive devices are part of the mandatory EPSDT program.
Included in the letter to state association presidents is a sample letter [PDF] to governors that outlines the misinformation in the Sebelius letter. The sample letter also specifies the services and devices mandated under EPSDT, and encourages provision of speech-language and hearing services and devices for adults. State associations can personalize the letter to meet individual needs.