The following summarizes the coverage of hearing aids and related services available to eligible Medicaid beneficiaries in each state. Because states often review the scope of their Medicaid benefits, beneficiaries are advised to check their state's Medicaid offices to see if there is up-to-date coverage. Requires insurance providers to cover hearing aids for children under 18 when medically necessary. Coverage should include a new hearing aid every five years, a new hearing aid when changes to the existing hearing aid cannot meet the child's needs, and services and supplies, such as initial evaluation, adaptation, adjustments and hearing training.
Do you have questions about renewing your Medi-Cal? Check out our FAQs. See how we support the vision that everyone has fair and equal opportunities to be as healthy as possible. Care Health Plan representatives are available 24 hours a day, 7 days a week, including holidays, to help you. Read your Member Handbook for a full description of coverage, benefits and limitations.
You can find your member handbook in the resources section of this page. If you have questions about what's covered or not, call L, A. Outpatient audiology is limited to two services per month, in combination with acupuncture, chiropractic, occupational therapy and speech therapy services. Care staff can pre-approve (pre-authorize) additional services as medically necessary.
Care covers acupuncture services to prevent, modify, or alleviate the perception of severe and persistent chronic pain as a result of a generally recognized medical condition. Outpatient acupuncture services (with or without electrical needle stimulation) are limited to two services per month, in combination with audiology, chiropractic, occupational therapy and speech therapy services when provided by a doctor, dentist, podiatrist, or acupuncturist. Behavioral health treatment (BHT) includes treatment services and programs, such as applied behavioral analysis and evidence-based behavioral intervention programs that develop or restore, to the greatest extent possible, a person's functioning. BHT services teach skills by observing and reinforcing behavior, or through prompts to teach each step of a specific behavior.
BHT services are based on reliable evidence and are not experimental. Examples of BHT services include behavioral interventions, cognitive-behavioral intervention packages, comprehensive behavioral treatment, and applied behavioral analysis. BHT services must be medically necessary, prescribed by a licensed doctor or psychologist, and approved by L, A. Care, and is provided in a way that follows the approved treatment plan.
Care covers chiropractic services, limited to treatment of the spine through manual manipulation. Chiropractic services are limited to two services per month in combination with acupuncture, audiology, occupational therapy and speech therapy services. Care may pre-approve other services as medically necessary. Care covers health services that are provided in your home, when prescribed by your doctor and are considered to be medically necessary.
Care includes palliative care and palliative care for children and adults, which help reduce physical, emotional, social and spiritual discomfort. Adults may not receive palliative care and palliative care at the same time. Palliative care is a benefit that provides services to terminally ill members. Hospice care requires the member to have a life expectancy of 6 months or less.
It is an intervention that focuses mainly on the treatment of pain and symptoms, rather than on a cure to prolong life. Palliative care is patient- and family-centered care that improves quality of life by anticipating, preventing, and treating suffering. Palliative care does not require the member to have a life expectancy of 6 months or less. Palliative care can be provided at the same time as curative care.
Care covers laboratory and X-ray services for outpatients and inpatients when medically necessary. A number of advanced diagnostic imaging procedures, such as CT scans, MRIs and positron emission tomography, are covered depending on medical needs. Care encompasses occupational therapy services, including occupational therapy evaluation, treatment planning, instruction, and consultation services. Occupational therapy services are limited to two services per month in combination with acupuncture, audiology, chiropractic and speech therapy services.
Care may pre-approve (prior authorization) additional services as medically necessary. Care encompasses physical therapy services, including physical therapy evaluation, treatment planning, treatment services, instruction and consultation, and the application of topical medications. Care encompasses podiatry services as medically necessary for the diagnosis and medical, surgical, mechanical, manipulative, and electrical treatment of the human foot. This includes the ankle and tendons that are inserted into the foot and the non-surgical treatment of the muscles and tendons in the leg that control the functions of the foot.
Care includes surgery to correct or repair an abnormal body structure in order to improve or create a normal appearance as much as possible. Abnormal body structures are those caused by birth defects, developmental abnormalities, trauma, infections, tumors, diseases, or breast reconstruction after a mastectomy. Some limitations and exceptions may apply. The care covers medically necessary speech therapy.
Speech therapy services are limited to two services per month, in combination with acupuncture, audiology, chiropractic and occupational therapy services. Care covers services for transgender people (gender-affirming services) as a benefit when they are medically necessary or when the services meet the criteria for reconstructive surgery. Some services include medically necessary hormone therapy, preventive screenings, behavioral health evaluations, sex reassignment surgery, and referrals to community resources that respond to cultures. Non-Emergency Medical Transportation (NEMT) You have the right to use non-emergency medical transportation (NEMT) to get to your appointments when it comes to a service covered by Medi-Cal.
If you can't get to your doctor, dental, mental health, substance abuse, or pharmacy appointment by car, bus, train, or taxi, you can ask your doctor to administer NEMT. Your doctor will decide on the correct type of transportation to meet your needs. NEMT is an ambulance, garbage van, wheelchair van, or air transport. NEMT is not a car, bus, or taxi.
Care offers you the most affordable NEMT for your medical needs when you need a ride to your appointment. That means, for example, if it can be physically or medically transported in a wheelchair van, L, A. Care won't pay for an ambulance. You are only entitled to air travel if your medical condition precludes any form of ground transportation.
Before you get approved for mileage reimbursement, you must indicate L, A. Please inform yourself by phone, email, or in person that you tried to obtain all other reasonable transportation options and were unable to obtain any. Care allows the lowest cost type of NMT that meets your medical needs. You can request a printed copy of your Member Handbook in any of the available languages.
The Lighthouse partners with 150 hearing providers from across the state, four hearing aid manufacturers, and many other health organizations to provide these services. Services covered by WYOMING include audiological evaluation, hearing aid evaluation, hearing aids, hearing aid repair and replacement. The insured can purchase a hearing aid at a price higher than the benefit amount and pay the difference in cost. Coverage includes fitting and dispensing services, including providing the hearing molds needed to maintain an optimal fit, provided by an audiologist, hearing aid dispenser, or doctor licensed in New Mexico.
Requires medical insurance and Medicaid coverage for the hearing evaluation of infants, new tests (if needed), audiological evaluation and follow-up, and initial amplification, including hearing aids. The Hearing Loss Association of America (HLAA) is a tax-exempt charitable organization that is eligible to receive tax-deductible contributions under IRS Code 501 (c) (. The insured person can choose a more expensive hearing aid and pay the difference between the price of the hearing aid and the benefit. Requires that any insurer that also offers hearing aid coverage to people 18 years of age or older allows the insured the option of choosing a hearing aid with a price higher than the benefit payable under the policy.
Requires insurers to offer coverage to all insured persons, subject to all applicable copays, coinsurance, deductibles and out-of-pocket limits, for hearing aids once every 12 months, unless there is a significant change in the insured's hearing status. Colorado, Delaware, Georgia, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Minnesota, Missouri, Montana, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Tennessee, Texas and Vermont require that their state's health benefit plans pay for hearing aids for children. The BAHA is an alternative hearing device for recipients who cannot use conventional hearing aids. The National Hearing Aid Project provides hearing aids and hearing health services to people with low incomes.
The first step in obtaining financial assistance resources for hearing aids (and other technologies) is to check with your health insurance provider to find out if they offer coverage for hearing aids. The services covered by OHIO only include conventional hearing aids, including the cost of warranty, testing and evaluation, ear molds, cleaning kit, batteries, up to three hours of counseling, and hearing aid repair. Services covered by VERMONT include audiological exams, hearing exams and evaluations, hearing aids for beneficiaries with minimal (unspecified) hearing loss, repairs, replacements, ear molds, adjustment and revision of hearing aids, and six batteries per month. Requires health insurers, the State Health Benefit Program and NJ FamilyCare to cover the medically necessary expenses for the purchase of a hearing aid for covered children aged 15 and younger.
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