Medicaid and hearing aides, implications for work requirements

Screenshot 2017-08-09 16.55.00In this month’s Health Affairs Michelle Arnold, Kathryn Hyer, and Theresa Chisolm examined hearing aide coverage among states. They found that nearly half of states do not offer hearing aides for age-related hearing loss. This optional benefit is offered in 28 states and is not offered uniformly across states that do offer the benefit. For example, if you are unable to hear conversations at normal volume or in other states, you are unable to hear a vacuum cleaner may qualify you for hearing aides. In another state a more severe level of hearing loss is required, equivalent to not being able to hear a car horn. And in many states even this level of hearing loss does not allow the coverage of hearing aides.

According to the authors, age related hearing loss affects more than 26 million adults in the US. Loss of hearing is associated with other health impacts such as mental health problems, falls, and increased cognitive decline. Age related hearing loss can be caused by environmental factors such as loud noise or medications. The only treatment for hearing loss at this time is hearing aides or implants.

While this condition primarily affects older adults, one in three people by the age of 65 have the condition. This means that people approaching Medicare eligibility, or many people made newly eligible for Medicaid through the expansion, have high rates of age related hearing loss. With the increase in earbuds and other loud devices, the age at which people start to experience hearing loss is getting younger. It is becoming more common for children to experience age related hearing loss. Medicaid is a primary insurer of health insurance for children, although the EPSDT program will often cover hearing aides because of the mandate to treat eligible children. Therefore, only coverage for people over the age of 21 was examined for this study.

One major limitation to this study is that Medicaid managed care plans are not analyzed. Most Medicaid beneficiaries are covered by managed care plans and these plans may decide to cover hearing aides. However, if a state has not explicitly required this benefit for Medicaid enrollees, the coverage of hearing aides is at the discretion of the managed care plan.

With the recent 1115 waiver requests to require that Medicaid beneficiaries meet work requirements (currently pending approval or completed application from Arkansas, Arizona, Indiana, Maine, Kentucky, and Wisconsin) it is important to remember that hearing loss does not qualify as a disability. Therefore, states that begin to take up work requirements will begin requiring people who cannot hear to work in order to maintain their health care coverage. Yet, that health care coverage may not cover a device that would allow you to get to work and hold most jobs. In many parts of the country one needs to drive to get to a job and hearing is a key aspect of traffic safety.

Hearing loss is one of many conditions that are not considered disabilities that would inhibit people from working. Yet. this and other conditions such as chronic pain, severe diabetes, or heart conditions can impede a person’s ability to hold a job. While the coverage of hearing loss is not uniform across states, there are many parts of the country including all of the states proposing work requirements with the exception of Wisconsin and Indiana, where a low-income person would not be eligible for hearing assistance and then expected to work.

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