Smiling child

Wisconsin passes comprehensive legislation requiring insurance to cover hearing aids and cochlear implants for children

Senate Bill 27 requires health insurance policies and plans to cover the cost of hearing aids, which include any externally wearable instruments or devices designed to enhance hearing, and cochlear implants, which include any implantable instruments or devices designed to enhance hearing, that are prescribed by a physician or audiologist in accordance with accepted professional medical or audiological standards, for any child under 18 years of age who has coverage under the policy or plan and who is certified as deaf or hearing impaired by a physician or an audiologist. Treatment (defined as services, diagnoses, procedures, surgery, and therapy provided by a health care professional) for such a child that is related to hearing aids and cochlear implants is also required to be covered.

Coverage for hearing aids is not required to exceed the cost of one hearing aid per ear per child more often than once every three years. The coverage requirement applies to both individual and group health insurance policies and plans, including defined network plans and cooperative sickness care associations; to health care plans offered by the state to its employees, including a self−insured plan; and to self−insured health plans of counties, cities, towns, villages, and school districts. The requirement specifically does not apply to limited−scope benefit plans, Medicare replacement or supplement policies, long−term care policies, or policies covering only certain specified diseases. The required coverage may be subject to any limitations, cost−sharing provisions, or exclusions, other than a preexisting condition exclusion, if these limitations apply generally under the policy or plan.

Hearing aids and cochlear implants are already covered under all BadgerCare plans except for the BadgerCare Benchmark Plan. This bill does not apply to children covered under the BadgerCare Benchmark Plan. Also, although this bill covers self-insured plans of the state, counties, municipalities and school districts, the state does not have the authority to regulate private self-insured plans. Therefore, this bill does not apply to children insured under private self-insurance plans.

There are approximately 200 babies born each year in the state of Wisconsin who are deaf and hard of hearing. According to a survey conducted by the Wisconsin Families for Hands & Voices, 54% of the parents surveyed did not have insurance that covered any of the cost of hearing aids or cochlear implants. Research shows that early intervention through hearing aids or cochlear implants can allow a child to maximize their language and speech and that it can provide a savings of between $5,000 to $10,000 per child per year in reduced or eliminated special education services. And over a lifetime, early intervention can reach a savings of about 1 million dollars per person .

Wisconsin joins 13 other states in passing legislation requiring coverage of hearing aids for children who are hard of hearing; however each state differs in the scope and strength of the law. These states include Colorado, Connecticut, Delaware, Kentucky, Louisiana, Maine, Maryland, Minnesota, Missouri, New Jersey, New Mexico Oklahoma, and Rhode Island. Kentucky is the only other state to mandate the coverage of cochlear implants. Wisconsin’s law is broad in that it covers both hearing aids and cochlear implants, it covers children up to 18 years old, and it does not limit the coverage of hearing aids to a specific dollar amount.

Disability Rights Wisconsin worked in conjunction with legislators and hundreds of families, children, professionals, and adults affected by hearing loss across the state to get this bill passed. It was a strong and well organized grassroots movement. Organizations involved in advocating for this bill include the Wisconsin Families for Hands & Voices, The Hearing Loss Association of America – WI, Wisconsin Speech-Language Pathology and Audiology Professional Association, Board for People with Developmental Disabilities, LetKidsHear.org, Center for Deaf and Hard of Hearing, Wisconsin Association of School Boards, Marshfield Clinic, Wisconsin Council of Children and Families, Wisconsin Association of Independent Living Centers, and the Wisconsin Primary Health Care Association to name a few. The Department of Pubic Instruction, Office of the Commissioner of Insurance and the Department of Health Services were also supportive of the bill.

Senate Bill 27 was signed into law by Governor Doyle on May 21st, 2009 as 2009 Wisconsin Act 14 and goes into effect on January 1, 2010.

If you have questions or would like additional information, contact Alicia Boehme at Disability Rights Wisconsin at 608/267-0214 or aliciab@drwi.org.