Access to Medicaid Hearing Health Services for Adults



Policies, Perceptions, and Proposed Recommendations for Improved Access to Care
Author: Stephanie Czuhajewski, MPH, CAE

The following are selected excerpts from a policy analysis, written for course credit at the University of New England.
Introduction
Access to audiologic treatment services for vulnerable adult populations across the United States is limited by Medicaid coverage policies. The Centers for Medicare and Medicaid Services (CMS) classifies “hearing disorder services” among optional benefits for adult Medicaid beneficiaries.1 As a result, Medicaid coverage of hearing evaluation and treatment services for adult Medicaid beneficiaries is unreliable and lacking. Currently, only 30 U.S. states provide audiology and hearing aid coverage for this population.2,3,4, Even in states that opt to provide adult Medicaid coverage for hearing disorders, patient access to hearing healthcare services is often erratic. Varying levels of Medicaid coverage and state regulatory policies routinely impede provider participation and restrict treatment.
Hearing Health Treatment Disparities
Despite the significant risks and costs associated with untreated hearing loss and the promising evidence of the benefits of treatment, only about 25% of those who would benefit from hearing aids are using them, and that rate of adoption has remained unchanged since 1980.5 High costs and poor access to hearing health care services have been identified as two key barriers to hearing care for adults.5,6,7 A 2018 study of 1,133 Medicare beneficiaries who self-identified as hearing aid users, identified income as a primary determinant of whether or not they received hearing treatment services.8 In all, less than 40% of these hearing aid wearers obtained hearing health services in the previous 12 months.8 Further, among low-income, Medicaid-eligible, Medicare participants (dually eligible), 27% of respondents reported “having a lot of trouble hearing with a hearing aid.”8

Medicare Part B covers medically necessary diagnostic audiology services. However, hearing aids and much-needed audiologic treatment services such as hearing aid candidacy determination, hearing aid fitting and programming, counseling, auditory rehabilitation services performed in conjunction with hearing aid services, and hearing health follow-up care are statutorily excluded from Medicare Part B coverage.9 More than 10 million Americans are eligible for both Medicare and Medicaid benefits, including 45% of non-elderly adults with disabilities and 60% of nursing home residents.10 These dually eligible beneficiaries often carry substantial disease burdens, and are the greatest cost burden beneficiary segment in both programs.10
Current Medicaid Landscape
CMS provides regulatory oversight and shared financial support for state Medicaid programs. States are required to cover categorically eligible populations including the elderly, disabled, pregnant women, and families with children. CMS also dictates a core set of services that must be covered and regulates certain enrollment and reporting processes. Beyond that, states have considerable latitude in structuring Medicaid benefit coverage and payment models, eligibility requirements, cost-sharing, and administrative oversight.10

The comprehensive review of state Medicaid hearing aid coverage policies affecting adults across the United States, conducted by Arnold et al. in 2016,2 found that coverage variances posed challenges for effective hearing health service delivery along the hearing health continuum.2 The authors used a systematic approach to rate each state Medicaid program, based on beneficiary eligibility criteria and coverage of the following: assessment and treatment of hearing loss, allowance for two hearing aids (when two are medically necessary), follow up care, supplies and repairs (including batteries), and the replacement of hearing devices at regular intervals.2

Study data show significant discrepancies among states providing Medicaid coverage for hearing aids and associated services, related to required hearing loss thresholds for coverage, coverage models, amounts, and methods of payment for devices and services.2 The study data also indicate a tendency by many state Medicaid programs, to prioritize coverage for hearing aid devices over therapeutic audiology services such as counseling, rehabilitation, and follow up treatments that are usually necessary for patient success with hearing aids. The authors noted that, in several states, service coverage policies were ambiguous, which could pose ethical dilemmas for providers and lead to inconsistent or deficient standards of care.2
A Deeper Analysis of Coverage for Four Selected States
Using data obtained from the Arnold et al. study, Medicaid Hearing Aid Coverage for Older Adult Beneficiaries: A State-By-State Comparison,4 four states were selected for further analysis: California, Indiana, Massachusetts, and Texas, as depicted in Table 1. Each selected state achieved a rating of either excellent or good by Arnold et al., for quality of adult Medicaid hearing health coverage. Selection criteria for states to examine as part of the policy analysis also included geographic diversity, state government political composition, and the percentage of the non-child Medicaid population in relation to the overall Medicaid population.11,12,13,14,15
Table 1: State Demographics for Selected States
State Total Non‐ Child Medicaid Population* (Millions) Total Medicaid Population (Millions) Population (Millions) Political Party Controlling State Government Percentage of Adults with Hearing Loss Medicaid Expenditures as Percent of Total State Expenditures Medicaid Expansion Under Affordable Care Act?
CA 10.02 14.66 39.54 Legislature (D)
Executive (D)
12.3% 33.7% Yes
IN .58 1.3 6.67 Legislature (R)
Executive (R)
18.3% 34.5% Yes
MA 1.44 1.95 6.86 Legislature (D)
Executive (R)
16.3% 28.8% Yes
TX 1.8 5.07 28.3 Legislature (R)
Executive (R)
16% 30.9% No

*Non-child includes adult, elderly, and disabled.
Policy Documentation
Medicaid coverage for hearing aids, supplies, repairs, and associated audiology provider services for adults in each state was catalogued using Medicaid coverage manuals, provider handbooks, and provider fee schedules from each selected state.16,17,18,19,20 Provider reimbursement and authorization requirements were also documented.
Qualitative Interviews with Audiology Practice Representatives in Selected States
Study participants included a non-probability, purposeful sample of 14 audiology practice representatives, in California, Indiana, Massachusetts, and Texas. Recorded telephone interviews were conducted with each practice representative using a combination of scripted questions and open dialogue to capture audiologists’ perceptions about Medicaid coverage of hearing aids and associated healthcare services in their states. Interview recordings were transcribed using Sonix transcription software. Qualitative data was subsequently manually coded, sorted, compared, and grouped into common themes.
Research Findings: Review of Provider Manuals
The analysis of state Medicaid provider manuals, coverage policies, and audiologist fee schedules from California, Indiana, Massachusetts, and Texas revealed significant programmatic coverage diversity. Three out of four states’ Medicaid policies contained minimum requirements for treatment that appear inconsistent with published clinical standards and pose barriers to evidence-based hearing care.16,17,20 For example, two of the state hearing aid coverage benefit manuals (California and Indiana) contain outdated hearing aid specification requirements that default to analog devices and allow for coverage of programmable and/or digital hearing aids only if certain audiologic conditions are present, and/or if a second prior authorization is obtained.16,17

Digital hearing aids, introduced in 1996, and programmable hearing aids, introduced in 2000, are the accepted standard of care today.21 Mandating additional requirements for the most frequently used devices is potentially burdensome to patients and audiologists, and provides no additional value to the Medicaid system.

According to the Texas Medicaid Providers Manual Vision and Hearing Services Handbook, Texas Medicaid insurance will cover a maximum of one hearing aid for adults diagnosed with a 35 dB or greater loss in both ears.20 Adult Medicaid beneficiaries in Texas are not eligible for binaural amplification, even when it is deemed medically necessary, nor are they eligible for treatment with amplification for unilateral hearing loss under any circumstances.

Evidence-based guidelines require audiologists to assess more than just the measured degree of hearing loss when making treatment recommendations for patients.22 Texas’ restrictive eligibility and dispensing requirements do not consider the cause, type, and impact of the hearing loss or associated auditory processing functions unique to each patient, or the patient’s potential for success with amplification, based on his environment and communication needs.

Inconsistent coverage directives and requirements for hearing aids and accessories, as well as varied reimbursement schemes for diagnostic and treatment services were found across the state Medicaid programs studied, indicating a lack of consensus regarding the importance and value of audiologic and hearing aid services by state Medicaid policy officials. There were notable discrepancies among states with regard to reimbursement for comprehensive diagnostic testing, hearing aid selection, fitting, and verification services, as well as treatment services including follow-up consultations, auditory rehabilitation, and hearing aid repair services. Hearing aid coverage amounts also varied considerably state to state.

The most consistent feature of policies across states, based on information contained in the policy manuals, is the requirement for redundant referral, medical clearance, and/or prior authorization requirements, which force patients to go back and forth between providers, wasting time and money.
Research Findings: Interview Results
Interviews with audiology practice representatives yielded important information and a deeper understanding of the perceptions of providers and administrators, regarding the influence and impact of Medicaid policies on care quality and access to hearing aids and treatment services for adult beneficiaries in their states. Characteristics of the practices and study participants included small practices (defined for this study as practices employing five audiologist providers or fewer), medium practices (defined for this study as practices employing six to 10 audiologist providers), and large practices (defined for this study as practices employing greater than 10 audiologist providers). Practices from rural, suburban, and urban locations were represented. A breakdown of practice characteristics by state can be found in Table 2.
Table 2: Audiology Practice Study Participant Demographics
State Number of Audiology Practice Representatives Interviewed Number of Audiology Practices Accepting Medicaid *Practice/Clinic Size Location
California 4 1 3 Small and 1 Large 2 Urban,
2 Suburban
Indiana 4 1 4 Small 2 Rural,
2 Suburban
Massachusetts 3 1 2 Small and 1 Large 2 Suburban,
1 Urban
Texas 3 1 2 Small and 1 Large 2 Suburban,
1 Urban

* Small practice is defined as five or fewer audiologist providers. Medium practice is defined as six through 10 audiologist providers. Large practice defined as greater than 10 audiologist providers.

In general, participating audiology practice representatives perceive that state Medicaid policies have a negative impact on access to evidence-based hearing health care for adults with hearing loss. Several themes emerged, from the qualitative interview data, many of which point to Medicaid policy deficiencies that could be administratively or legislatively mitigated.

THEME 1: More than 70% of audiology practice representatives interviewed for this study reported that the practice either does not accept Medicaid insurance for adult patients, or it significantly caps the number of Medicaid patients accepted.

Four of the 14 audiology practices interviewed accept Medi-caid insurance for adult patients. One of those four practices reported accepting Medicaid insurance for existing patients but accepting no new Medicaid patients. Two of the four practices that accept Medicaid insurance for adult patients, cap the number of new Medicaid patients scheduled each month. One practice out of 14, reported accepting adult Medicaid patients without any cap or restriction. Three of the four practices that accept Medicaid insurance are either large or multi-location clinics, situated in urban areas. One-quarter of the practices that reported not accepting Medicaid, do accept dually eligible (Medicare-Medicaid) patients for Medicare-covered hearing assessments, but refer those patients to other providers for downstream (Medicaid-covered) services. Three practices reported that they have not considered accepting Medicaid insurance because their providers’ schedules are already filled with private-pay and privately insured patients.

Practice participants from three states noted that, based on their own interactions with other practice representatives within their states, there is a shortage of audiology practices willing to accept Medicaid insurance. According to study participant accounts, the dearth of providers treating adult Medicaid beneficiaries, significantly delays and impedes their access to hearing health care resources. In two cases, participants were not aware of any provider currently accepting Medicaid and reported having no place to refer adult Medicaid patients. One practice representative commented that state records of Medicaid-accepting providers are inaccurate, which causes Medicaid patients to routinely waste time contacting practices only to be turned away.

"I don't know of any audiology practices in the Houston area taking Medicaid within a reasonable amount of time. I think Medicaid beneficiaries are either putting off hearing aids, or just accepting the fact that it will take a long time to get into a clinic. We don't even know where to refer them."
Audiology practice representative in Texas


THEME 2: Claims management and administrative burdens pose significant barriers to audiology practice participation in state Medicaid programs.

Six study participants reported that Medicaid paperwork requirements are time consuming for providers and front office staff. Among chief complaints, is the fact that patient eligibility must be repeatedly and frequently reconfirmed for continued reimbursement. The process to obtain prior authorization approval to order hearing aids is also inefficient. Two practices reported not accepting Medicaid because the paperwork to enroll as a provider was too cumbersome. Three practices reported difficulties in keeping up with changes in coverage from managed care programs sometimes affects hearing health benefits and reimbursement midway through a patient’s treatment. Two clinics reported that requiring a physician referral prior to the audiologic testing and then a second medical clearance exam prior to dispensing hearing aids is wasting time and creating an unnecessary duplication of services.

THEME 3: Medicaid reimbursement and coverage policies do not support the delivery of evidence-based care.

One participant reported that reimbursement for follow-up services, post- hearing aid fitting are not covered, so audiologists either end up performing the services for free, or the patient has to go without treatment. Three practices reported that, dictating specific thresholds for hearing loss as a requirement, diminishes the provider’s ability to treat patients effectively.

One practice representative commented that the lack of coverage for two hearing aids, even when two are medically necessary, puts audiologists in a bad position, because they want to deliver quality care. One clinic representative noted that hearing aid verification testing is not covered, even though it is recommended for best practices.

Two clinics reported that prior authorization requests are not answered timely, delaying needed treatments for patients. One participant stated that claims must frequently be refiled because the Medicaid administrator loses them or arbitrarily denies them, delaying reimbursement (and sometimes patient treatment), for months, in some cases.

"Virtually nobody takes Medicaid in Indiana. It's not a mystery. They make you jump through a ridiculous amount of regulation just to file the claim. Then, sometimes it takes six months or more for them to process it. I mean the system's broken. It's completely and utterly broken."
Practice representative from a small practice in Indiana


"It (Medicaid) needs to allow reimbursement for the best practices that we (audiologists) can provide. If a patient needs two hearing aids, they should be able to get two hearing aids. You wouldn’t give someone a monocle and only let them see out of one eye, would you? Why would you think it is okay to only let someone hear out of one ear?"
Audiology practice representative from a Texas practice that accepts adult Medicaid patients


THEME 4: It is easier and more rewarding to go outside of the Medicaid program to help low-income adults with hearing loss.

Three practices, that do not accept Medicaid, have established non-profit organizations for the express purpose of being able to donate hearing aids and services to adult patients in need. Three additional practices reported donating hearing aids and/or offering a sliding scale for those in need, rather than accepting Medicaid insurance. These participants blamed stringent and sometimes archaic Medicaid requirements for patient eligibility and hearing aid specifications. One participant used the word “freedom” to describe being able to donate services and refurbished or donated hearing aids outside of Medicaid. Participants described accepting Medicaid insurance as a “hassle,” a “nightmare,” and “impossible.” None of the Massachusetts respondents indicated a need to create an alternative program or organization, in order to avoid challenges imposed by the Medicaid system.

"Everybody used to have straight Medi-Cal. Patients could go to any provider that accepted Medi-Cal. So, there were audiology practices that developed a niche, especially for providers who spoke a second language like Korean. Those practices became known in the community as those who care for poor people. Then, all of a sudden Medi-Cal switched over to this managed care, where you have to be a provider in an HMO group. And, it was impossible to get in there when the corporate-owned practices set up the contract. So, all of these patients were left without a provider who spoke their language."
Audiology practice representative from a California practice that would like to but can no longer accept Medi-Cal because of managed care restrictions

”I provide for lower income people, outside of the hassles with the Medicaid system. I just do it my own way in a way where they're getting really good technology and great service. There are a lot of people that fall through the Medicaid cracks. I want them to have good hearing, so I acquire gently used hearing aids, refurbish, and donate them and charge a small fee for services. It’s my service to the community."
Practice representative from an Indiana practice


THEME 5: State-specific Medicaid policies affected clinic participation and perceptions.

California: Every California-based clinic representative described California’s Medicaid coverage policies as confusing. The lack of clarity results in an increased administrative burden as providers and billing departments investigate questions and problems. Two of the four California-based practice representatives reported that Medicaid managed care organizations (MCO) operate county-by-county, which makes it difficult for patients and providers to participate, because MCOs restrict the provider network or have inconsistent policies from one county to the next.

Texas: All four Texas study participants reported that Texas Medicaid coverage of hearing aids for adults has dramatically decreased in recent years.

Massachusetts: Massachusetts audiology practices have a generally favorable view of the MassHealth Medicaid program. Practice representatives do not believe that MassHealth patients generally have trouble finding providers that will accept MassHealth hearing aid and service coverage. One MassHealth representative reported that about 20% of the patients seen in that clinic are adult Medicaid patients. Two Massachusetts audiology practice representatives reported that MassHealth managed care plans can sometimes pose barriers to patient access, because patients don’t realize that if the audiology practice is not contracted with the patient’s specific MassHealth managed care plan, the patient cannot use their insurance coverage there, and must go somewhere that accepts the plan that h/she has. Practice representatives reported that MassHealth patients tend to have a higher no-show rate than other patients and that contributed to the decision by one practice to stop accepting Medicaid patients, even though the hearing aid and audiology benefit is “generous.”

Indiana: Three of four Indiana practice representatives stated that the state Medicaid program hearing aid reimbursement does not cover the entire out-of-pocket cost of the hearing aid, if you factor in the shipping costs and the administrative costs to dispense and fit the hearing aid. The representative from the single Indiana audiology practice (in this study) that accepts Medicaid insurance for adult patients, reported that the practice only accepts up to three new adult Medicaid patients per month, because the practice cannot afford to take more.

Audiology practice perceptions, regarding Medicaid coverage for hearing aids and audiology services, shed light on overarching issues that impact Medicaid programs, providers, and patients around the country, and offered specific insight into the most pressing challenges and opportunities to improve access to hearing healthcare for adult Medicaid beneficiaries.

Several of the findings are consistent with other studies that have examined provider participation in state Medicaid programs. Sommers and Kronick23 reported that state Medicaid physician participation (for all covered services) varies from 40 – 99%.23 Providers consider reimbursement rates, length of time to payment, and the amount of bureaucratic and “paperwork” requirements when determining whether to accept Medicaid patients.23,24
Limitations
Study limitations included sparse existing data on the impact of state Medicaid policies on the practical access to care for adult Medicaid beneficiaries with hearing loss. Medicaid policy manuals for traditional Medicaid programs in California, Indiana, Massachusetts, and Texas were examined. State Medicaid managed care plan manuals were not examined in the scope of this study, and may provide information about additional benefits, requirements, and reimbursement policies that could not be documented.

The audiologist practice sample size was low. No medium-sized practices were interviewed for the study. A purposeful sample of practice representatives was used, which may have reduced the variance of practice type. The self-reported perceptions of the practice representatives were subjective and may have been affected by recall bias. Additional research should be conducted to determine the impact of state Medicaid policies on the practical access to hearing aids and associated hearing health care services for adult Medicaid beneficiaries.

"We are contracted with some types of MassHealth managed care options and we're not contracted with others, so there's certainly sometimes a conversation, and it can be difficult because we might be contracted for diagnostic services, but we're not contracted for rehabilitation services or hearing aids and things like that. So, it is really confusing for the patient when they have MassHealth and we still can’t help them.
Practice representative in Massachusetts
Addressing the Problem of Access to Medicaid Hearing Health Services for Adults
Ten thousand Americans will turn 65 years of age every day between now and 2030.25 Falls are the leading cause of injury and injury death for older adults.26 A beneficiary with dementia will cost Medicaid roughly 19 times more than a beneficiary who is dementia-free.27 Untreated hearing loss is associated both conditions. Thus, policies promoting early intervention may reduce downstream costs and improve outcomes and quality of life. The prevalence of presbycusis among the older adult population and the emerging evidence about the risks and consequences of untreated hearing loss are beginning to increase awareness among health professionals, public health officials, advocacy groups, and policy makers about the importance of early intervention and treatment for persons with hearing disorders. Feedback from the media, the National Academies of Science, consumer and aging advocacy groups, and providers has already begun to stir interest from bureaucrats and policy makers, regarding the need to improve government-funded hearing health care for adults.5

Medicaid costs comprise more than one-quarter of state budgets on average and bipartisan solutions are being sought to reduce cost, without sacrificing quality or access. As more states have adopted Medicaid expansion programs, they are becoming more heavily invested in their success. “1115” Medicaid waivers are being used to test policy maneuvers that will streamline services across the board. Two states (Maryland and Washington) have enacted policy changes to add Medicaid coverage for hearing aids and hearing health services for adults in the past 12 months.3,4

Federal legislative initiatives to improve access to hearing health care may affect state Medicaid policies and vice-versa. In 2017, landmark legislation, the Over-the-Counter Hearing Aid Act, put forward by Senator Elizabeth Warren (D-MA) and Senator Chuck Grassley (R-IA) was signed into law, directing the FDA to design a regulatory framework that will negate state laws and allow hearing aids to be purchased over the counter across the United States.28 Legislation has already been introduced in the U.S. House of Representatives in the 116th Congress, which, if enacted will direct CMS to cover hearing aids for Medicare Part B beneficiaries.29 There is a tremendous potential for Medicaid implementation policies to bleed through into Medicare policy, making now the right time to advocate for improvements to both programs.
Policy Alternatives
A careful analysis of Medicaid policies related to hearing aid coverage and audiology services for adult Medicaid beneficiaries in four states, and subsequent interviews with audiology practice representatives, isolated specific policy deficiencies, that if remedied, may improve the delivery of hearing health care services and patient access.

The following policy alternatives take into account the improvements to Medicaid coverage policies for hearing health services and hearing aids for adult beneficiaries, suggested by audiology practices, while respecting the budgetary boundaries, incrementalism, and practical limitations that exist in today’s political environment.
  • Policy Alternative 1: Streamline the patient referral, eligibility, and prior authorization processes to speed time to diagnosis and treatment. Eliminate duplicative visits and allow patients to seek treatment directly from an audiology practice (as they do with dentistry and optometry). Digitize eligibility and prior authorization requests for hearing aids and establish maximum wait times for approval.
  • Policy Alternative 2: Eliminate archaic hearing aid specification requirements and allow audiologists to choose the hearing aid that is best suited to the needs of the patient, within the defined benefit cost range. Include digital and programmable hearing aids, which are now considered standard technology, as well as over-the-counter hearing aids, if appropriate.
  • Policy Alternative 3: Remove policy barriers that prevent the treating audiologist or physician from rendering care that is consistent with evidence-based practices, supported by medical necessity. Structure reimbursement models to reward the delivery of evidence-based protocols and successful outcomes.
  • Policy Alternative 4: Allow Medicaid beneficiaries to establish Health Savings Accounts to supplement their Medicaid insurance. Use a capped match payment to help beneficiaries cover much needed but non-covered services such as hearing aid repairs, batteries, and follow up services.
  • Policy Alternative 5: Remove regulations and barriers to innovation in service delivery. Allow participating audiology providers to adopt creative service delivery models and technologies, including remote hearing aid programming and telehealth services to reduce patient no-shows and increase the number of patients who can be helped.
  • Policy Alternative 6: Establish incentives and penalties for patients to encourage their attendance at appointments, compliance with treatment recommendations, and responsible stewardship of their Medicaid-funded hearing aids.
  • Policy Alternative 7: Eliminate regulatory barriers at state borders. Encourage and allow licensure reciprocity for audiologists in adjoining states who may be able to provide in-person and telehealth services for patients, particularly those near state borders to alleviate provider shortages.
  • Policy Alternative 8: Negotiate pricing for hearing aids directly with hearing aid manufacturers and publish the price list of different models from which providers can choose. Use the cost savings to increase provider reimbursement for diagnostic and treatment services, including investments in follow up care and counseling.
  • Policy Alternative 9: Establish reliable electronic claims billing processes for participating providers. Implement claims requirements and reimbursement timelines that are commensurate with the private insurance market. MassHealth provides an excellent model from which other states could draw.
  • Policy Alternative 10: Seek funding, coordination, and support from CMS for a longitudinal research study/demonstration grant to follow patients who obtain Medicaid-covered hearing care, to determine the return on investment in terms of a downstream reduction in Medicaid costs, increased employment, and/or improved quality of life.
Recommendations
Each of the policy alternatives presented poses limited financial risk and a tremendous opportunity for Medicaid hearing healthcare service delivery performance improvement and improved access to hearing aids and audiology services for adult Medicaid beneficiaries.30,27,31,32 Based on feedback from audiology practices, Policy Alternatives 1, 2, and 3 have the most potential for immediately improving access for adult Medicaid beneficiaries to evidence-based hearing healthcare services. Remaining policy alternatives can be floated alongside specific state regulatory and legislative initiatives as opportunities arise to marry high-impact solutions with those that are the most politically feasible. For example, licensure reciprocity and telehealth are becoming normalized and widely supported in some states.
Conclusion
Over the past decade, the body of evidence linking untreated hearing loss with increased falls risk and cognitive disorders has increased. Untreated hearing loss contributes to feelings of depression and social isolation. Further, older adults with hearing loss, who do not access hearing health treatment services are more likely to carry and contribute to higher overall healthcare cost burdens than those who access hearing health services.

Cost and convenience have been shown to be key barriers to audiologic treatment and hearing aid use. State Medicaid policies restrict access for adult beneficiaries to hearing aids and associated audiology services, despite the fact that the prevalence of hearing loss increases with age. In short, Medicaid coverage does not assure practical access to hearing aids or audiology services. Many audiology practices are not able to adequately serve low-income adults because of Medicaid policy restrictions that hinder audiologist participation in the program.

CMS may look to Medicaid for policy ideas as it considers proposals to provide Medicare coverage of hearing aids and associated services. It is, therefore, essential for the success of patients and the audiologists who serve them, to advocate for improvements to both programs simultaneously. Advocates may be able to better position Medicaid hearing health policies as a problem worth solving—and readily solvable, using a variety of low-risk, high-impact policy solutions.    
Stephanie Czuhajewski, MPH, CAE, serves as the executive director of the Academy of Doctors of Audiology. She holds an undergraduate degree in marketing from Sullivan University and recently acquired a Master of Public Health degree from the University of New England.
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