(0227) Implementation of Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment Across the United States for Pediatric Hearing Services

Introduction: The Early and Periodic Screening, Diagnosis, and Treatment benefit (EPSDT) within Medicaid promises comprehensive healthcare services for children with hearing loss from low-income families. In this study, we analyzed how individual state Medicaid agencies implement this legislation.

Methods: Information published online by Medicaid agencies was reviewed for the following 15 states: Alabama (AL), Alaska (AK), Arizona (AZ), Arkansas (AR), California (CA), Colorado (CO), Connecticut (CT), Delaware (DE), Florida (FL), Georgia (GA), Massachusetts (MA), Michigan (MI), New York (NY), Pennsylvania (PA), and Virginia (VA). We gathered data on the maximum age at which hearing aids are covered, how hearing loss is determined, frequency of hearing aid replacement, and earmold coverage.

Results: Of the 15 states, 11 cover hearing aids until a patient’s 21st birthday. AL, CA and PA mention age 21 as the maximum age of coverage but do not specify if coverage includes the duration of the 21st year. Coverage in MA ends at the beneficiary’s 22nd birthday. PA uses a 25 decibel (dB) cutoff when determining hearing loss. MI uses 26 dB and New York uses 30 dB. Florida covers hearing aids for children with moderate hearing loss or greater. The other states do not provide specific information about how hearing loss is determined. Of the 15, 8 states cover new hearing aids every 3 years. CO covers a new hearing aid within a 3 to 5 year period. MI and VA require a 5 year period. CA requires a Treatment Authorization Request through which medical necessity needs to be determined. Just 3 states do not have specific information regarding frequency of replacement. Of the total, 12 states cover earmolds. AR and NY require a prior authorization. AL does not specify coverage for earmolds.

Conclusions: EPSDT coverage of pediatric hearing aids varies across states. All states provide some coverage until a beneficiary’s 21st birthday, but hearing criteria for aids, earmold coverage, and frequency of replacement differs. This reveals an opportunity for Medicaid agencies to standardize the quality of care.