Children with cerebral palsy, cognitive impairment, brain injury, and autism may benefit from the use of augmentative communication. Research has shown there are no prerequisite skills which must be demonstrated before augmentative communication is appropriate. Early intervention with AAC facilitates language development. Intervention often begins by introducing picture symbol systems. As children grow they may transition to a combination of systems, including high-tech devices. Studies have shown that the use of AAC does not interfere with the acquisition of natural speech.
An high end device may be chosen to be the best system for a child, however they can be very expensive. When this is the direction a team decides to go, looking for funding is the next step.
AAC Device Funding
The funding of speech generating devices varies, depending upon the laws and policies of the state in which you reside. It is best to try to get funding that allows the device to belong to the person planning to use it so that it can then be with them, becoming a part of their life in every aspect. With this in mind, Alternative Augmentative Communication device funding options include private insurance, Medicaid/MediCal, various organizations such as Regional Centers (they must be the payer of last resort) or service clubs, grants and private pay.
Most AAC companies have a funding department that will help you through the funding process. Start by talking to them and gaining their support.
Private Insurance - How can communication services, including AAC devices, be documented as "medically necessary"?
Insurance companies generally will pay only for a dedicated communication system. (Dedicated AAC systems are those that were developed for the sole purpose of being an AAC device.) The funding process requires a prescription, letter of medical necessity, and evaluation documenting the need for and efficacy of the chosen device. Most medical insurance companies will consider replacing a communication device every five years so you will want to make sure you have a device in mind that will meet the child's needs for at least 5 years.
For each case, the starting point is a review of the insurer's definition of medical necessity. These definitions can vary considerably from one insurer to the next. Typically, medical necessity is tied to an identified condition or diagnosis that limits the child's functioning in some way. In the case of communication, treatment would be medically necessary when the diagnosed condition (for example, cerebral palsy, brain injury, apraxia, ALS) impairs the individual's ability to communicate effectively. Services/devices address the medical necessity by attempting to restore lost function, forestall further functional decline, or provide an alternative means of performing the function. It is actually difficult to imagine a situation in which communication services, including AAC supports, are not medically necessary, as most instances of significant communication limitations are associated with diagnosed conditions. The key is however that this must be discussed.
This is usually a pretty easy process but it will take time and a commitment from everyone as there are a lot of i's to be dotted and t's to be crossed. The specifics of what is needed (e.g., multidisciplinary report, prescription, invoice) will depend on your particular policy coverage. Your policy handbook should be your guide to understanding your covered services. It is likely that your private insurance company will be unfamiliar with AAC so you may need to help to educate the person on the other end of the line. Be sure to discuss the needs as they apply to medical concerns.
Each private insurer has their own policies regarding funding AAC but most involve a co-payment, which can be anywhere from 50%-100% of the total cost of the device. The policyholder is responsible for the co-payment.
Contact your insurance company to find out about applying for an AAC device as part of their DME – Durable Medical Equipment. There will be special forms and processes unique to your Insurance plan, the insurance company can direct you to. Often the first step is to have your Speech and Language Specialist (SLP) write a letter to your doctor describing the need along with their recommendation. Be sure to start the communication process with your SLP and doctor to get their support.
Letters of Necessity
Many Insurance and Medicaid filings required 3 letters of recommendation, one each from primary care pediatrician, the speech pathologist who performed the AAC evaluation and provides ongoing therapy and State Medicaid asked for a letter from behaviorist or psychologist. Best to send all three along with a cover letter in your request.
Most AAC companies will provide you with an example of a letter of necessity. There are also many provided on the Internet that you can find through a search. Below are sample letters you can model when applying for Private insurance or Medicaid to cover an AAC device. The following are links to letters written by concerned organizations to the government agency in support of AAC device funding.
There are several sites that focus on the funding process. Do your research!
Medicaid
If you have both private insurance and Medicaid (or Medi-Cal), you MUST apply to your private insurance and be denied before you can apply to Medicaid because Medicaid is always payer of last resort.
If you only have Medicaid, you will likely only be required to provide letters of necessity from your Medicaid provider speech and primary care physicians. Your Medicaid caseworker can walk you through the process of applying for a AAC device under Durable Medical Equipment (DME).
It's a process but the end result is a voice for a child! Don't give up, it is well worth the journey. In the meantime, continue developing skills that will slide into AAC use, collecting vocabulary that you feel the child will need and keep your fingers on the pulse of where everyone is in doing their part.
*FYI: For funding purposes, the phrases: Speech Generating Devices (SGDs), Augmentative and Alternative Communication (AAC) Devices, and Voice Output Communication Aids (VOCA) all refer to the same things. SGD or AAC devices can be used interchangeably in documents and conversations related to funding (VOCA is an historic phrase that rarely is used today).
For more funding ideas, Carolann Cormier has developed a Pinterest page of funding resources.
