Title: 'Impacting Medicaid Policy at the State Level'
Track: 9-Policy, Advocacy, and Legislative Issues
Keyword(s): Medicaid, access to care, auditory implants
Learning Objectives: At the end of the session, participants will be able to assess and consider the impact of Medicaid policies on appropriate access to care for children in their state. At the end of the session, participants will be able initiate Medicaid advocacy efforts in their own states.


State budget shortfalls continue to plague states around the country due to high levels of unemployment, declines in consumer spending, and reductions in real estate value from years past. Medicaid in many states has become the fastest growing category of cost. States are coping with the spiraling cost of Medicaid by narrowing coverage for services, eliminating some services entirely, and reducing payment rates to providers. Cochlear and bone anchored implants have not been exempt from such cost cutting efforts at the state level. Pediatric patients receiving cochlear implants with straight Medicaid varies by state ranging from 15% to 50%. At present, children are covered for implant surgery in all 50 states because of Early Periodic Screening Diagnosis and Treatment (EPSDT), the child health component of Medicaid. But since implants are an optional service and states are now seeking changes in Medicaid policy from the Federal government, it is safe to assume that nothing is exempt from cost-cutting. While surgery for cochlear implants is currently covered, follow up services by states are quite variable. For example, some states provide no Medicaid coverage for equipment upgrades and consequently children are using outdated technology held together with duct tape. There is rationing of follow-up services including the setting of unrealistic limits on the number of therapy sessions covered for children by Medicaid and the number of batteries issued to a child in a given timeframe. Parents, early intervention professionals and clinicians in several states have formed coalitions with the purpose of mitigating Medicaid changes by working within their state’s political system. Such initiatives can be successful in ameliorating or reversing actions by states regarding coverage of, or reimbursement for, auditory implants and/or the provision of related services such as audiology, auditory therapy, or purchase of external equipment.
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