Augmentative and alternative communication (AAC) describes a variety of approaches used to support, enhance, or augment the communication of individuals who are not independent verbal communicators in all settings. AAC includes both low-tech systems, such as sign language and communication notebooks, as well as high-tech systems, such as voice output computer-based communication devices. Many individuals may use both a low-tech communication approach and a high-tech device to communicate across various settings.
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
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.
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"?
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.
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.
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.
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.
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
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.
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!
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.
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.
What is assistive technology?
Assistive technology is any kind of technology and/or tool that can be used to enhance the functional independence of a person with a disability. Often, for people with disabilities, accomplishing daily tasks such as communicating with others, going to school or work, or participating in activities can be a challenge. Assistive Technology (AT) devices are tools to help overcome those challenges and enable people living with disabilities to enhance and have access to a quality of life, that may otherwise not be known, and lead more independent lives.