There are a variety of potential funding sources for communication services and supports. Deciding which one(s) should be approached may be based on the person’s age, disability, or other factors (e.g. income; interest in employment).
Under federal law, states offer early intervention services for children under 3 years with disabilities, but eligibility and operational rules vary from state to state. In many cases, children from birth to 3 years of age and their families can access a wide variety of services and supports, including assessment, treatment, and equipment, at little or no cost. Many states, however, require families to exhaust their private insurance, Medicaid, and self-pay options before the early intervention program will assume any of the costs of services or augmentative and alternative communication (AAC) devices. For specific information on birth-to-3 services available in each state, contact the state's Parent Training and Information Center or go to the Centers for Disease Control and Prevention's (CDC) page with Early Intervention Contact Information by State.
AAC devices and services are deemed educationally necessary when they are needed for the student to benefit from a free, appropriate public education in the least restrictive environment. The Individuals with Disabilities Education Act of 2004 (IDEA 2004) specifies that special education and related services should enable students to access, participate in, and demonstrate progress with respect to the general education curriculum. Communication services can be represented on the Individualized Education Program (IEP) as special education, related services, or supplementary aids and services. Assistive technology is specifically mentioned and defined in IDEA as any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of a child with a disability. This includes AAC devices – from “low tech” such as picture communication cards to “high tech” speech generating devices (SGDs). IEP teams are obliged to consider assistive technology, AAC devices and services when a child's communication limitations impact the child's access to, and potential to benefit from, the general curriculum.
A school cannot compel a family to use its private health insurance to acquire AAC devices, but families may find it beneficial to cooperate with the school to fund or co-fund assistive technology equipment. For example, if the school purchases the technology, it belongs to the school, but if private health insurance pays, it belongs to the beneficiary.
Medicaid may cover (see your state’s guidelines) AAC devices/services for eligible children as long as they are medically necessary (even though they may be educationally necessary as well). But even when there are alternative or complementary funding sources, the school's obligation is to see that the student receives what is specified in the IEP in a timely manner. It is not permissible to delay access to needed technology pending approval from other funding sources. In such cases, schools may need to explore temporary access solutions (such as a district's equipment inventory, an equipment loan program, or short-term rental) while waiting for more permanent funding solutions.
Currently, adults with disabilities in the United States do not have an entitlement to free therapeutic services or assistive technology. Options for funding communication services and supports for adults may include state-administered programs like Medicaid, Home and Community-based Medicaid Waivers, Vocational Rehabilitation, or health insurance programs like Medicare or private health insurance. The state Assistive Technology Act program will have information on these programs in each state and other mechanisms for acquiring devices including cash loans, rent-to-own, or ways to obtain previously owned devices.
When seeking payment for AAC devices/services through public or private health insurance, it is important to know these programs are driven by the ability to justify the services and supports as “medically necessary.” Services/devices address the medical condition by attempting to restore lost function, forestall further functional decline, or provide an alternative means of performing the affected function. It is important to understand, however, that health insurers define medical necessity in different ways. Some have very narrow definitions, while others have more expansive definitions. Knowing the precise wording of each insurer's definition can be important in wording the justification accordingly. Insurers most often will only fund AAC devices that qualify as “durable medical equipment” – that is, AAC devices that withstand repeated use (often a lifespan of 5 years) and are medical in nature (would not be useful to someone without a disability).
There are many dimensions to a comprehensive evaluation and treatment plan, and, although the individual with communication needs is the focus of the services, there are some activities that do not occur in the context of a direct patient contact. Some of these include training of communication partners, conducting an environmental inventory to identify needed vocabulary, and programming an AAC device. These types of services ensure that the communication services and supports are appropriately tailored to the needs of the individual and that the person's communication partners are sufficiently educated and empowered to promote communication all the time. Although these services are critical, they may not be covered.
Medicare may cover such services as device programming and training. Medicaid reimbursement depends on the Medicaid coverage guidelines in effect in each state (see your state’s guidelines.) An enabling policy might define the scope of AAC services as "diagnostic, screening, preventative, and corrective services provided by or under the direction of a speech-language pathologist. Such activities include evaluation for, recommendation of, design, set-up, customization, programming, and training related to the use of AAC devices."
The availability of private insurance reimbursement depends on the scope of a particular policy's coverage, although more and more private insurers are following Medicare's lead. Consult the private health insurer's policy manual for clarification of coverage parameters.
It is the ethical and professional responsibility of members of the interprofesssional team to pursue funding for communication services and supports. When seeking coverage for AAC devices and services, it is essential the documentation clearly justify the need for specified devices and services. Payment for communication services involves individualized decisions and may require advocacy; review appropriate policies for coverage information. When it is unclear what is covered, don’t be afraid to ask! Creativity and persistence is key in procuring services and supports through a variety of possible sources.