What if my insurance does not cover hearing aids or assistive technology for my child?
There is a federal law that requires Pennsylvania to pay for all medically necessary health care for children under 21 that is not covered by another insurance. Part of the services required for children includes seeking out and screening children under 21 to detect health issues and to pursue providing the needed treatment. The screening is usually done by schools and doctor’s offices. If a child is found to have a hearing loss that requires a hearing aid or other assistive technology, and the child cannot get the cost covered by another insurance, such as a private company like Blue Cross, then Medical Assistance will pay for it, regardless of the parents income. Repairs for a hearing aid that is provided through Medical Assistance will also be covered, as long as the invoice has an itemized list of the repairs with it.
The federal law known as the Social Security Act establishes the joint federal-state Medicaid program. In Pennsylvania, the Medicaid program is known as Medical Assistance or MA. MA is designed to ensure the provision of medical care to low income persons and persons with disabilities. States are not required to participate in the MA program, but, if they choose to do so, they must adopt a “state plan” that lists the standards for deter¬mining eligi¬bility and identifies the MA services to be provided. Under the federal law there are a limited number of services that a state must provide to adults and some services that the state can choose to provide to adults.
The same federal MA law that establishes the medical services for adults has a part that establishes services for children. That part of the law is called “Early and Periodic, Screening, Diagnostic and Treatment” mandate, or EPSDT for short. So EPSDT is not a separate program, it is a part of the MA program that applies to children.
If you need MA coverage for your child’s hearing aid or for other assistive technology and your child is not already in the MA program, you should contact your local County Assistance Office or go to:
in order to apply for MA coverage for your child, no matter what your income is.
Prepared by the Disability Rights Network of PA, 3/2009
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