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AAC Funding:

A User’s Prospective

By David Chapple

ugmentative and Alternative Communication (AAC) devices have helped numerous of people with significant speech disabilities in this country and throughout the world.  However, they are very expensive and manufactures need to get compensated to stay in business.  Therefore, unless you are financially well-to-do, you will need to find a funding source to purchase your AAC device.  Since I am a device user myself, I would like to discuss what a user needs to know regarding funding opinions and what to do if a request is denied. 

Surprisingly, it has only been about fifteen years since Medicaid began to fund communication devices. In the past, devices were not considered a medical necessity.  This was a big problem because most of us, especially as adults, rely on Medicaid for our medical needs.  On the other hand, if you are lucky enough to have private insurance, many companies have been funding communication devices for almost thirty years.  I was still on my parents’ insurance in 1985, and they paid for my first communication device, the Epson Speech Pac.  Another funding opinion is your state’s Office of Vocational Rehabilitation (OVR).  They are more concerned about how a communication device can help you vocationally than medically. 

No matter which funding source you utilize, you will need an AAC evaluation by a certified speech-language pathologist (SLP).  It might be a shock to you (Can you sense my sarcasm?) but some SLP’s do  not know a thing about AAC in general let alone how to write a proper evaluation.  An improper evaluation directly leads to funding for a device being denied.  I would to like to take a few moments to write about what you, as the consumer/user, need to know when being evaluated for an AAC device. 

First of all, you have the right to know what communication devices are on the market, and you have the right to choose which device meets your needs the best.  Many SLPs just know one or two devices, and unfortunately, they will only recommend that device.  The evaluation would be invalid. An user could be stuck with a device for five years that is useless.  Also, some private insurance companies will only pay for certain devices because they have a preferred provider agreement with that particular manufacturer.  Therefore, it is up to you, the user, to do research BEFORE the evaluation so you can tell the SLP you like this device because it has internet access, or you like that device because of access methods, or you need this device because of the size.  You can do your research by browsing a manufacture’s website or posting to an online community, such as ACOLUG or Facebook, to get input from actual users. 

The second thing you need to be aware of is that the funding source will want to know how the device you choose will impact your quality of life.  I have heard of some SLPs just writing something like this: “This individual cannot speak therefore he/she needs an AAC device”.  The SLP is then surprised as to why the funding was denied.  Funding sources want documented evidence showing why you need this $8,000 communication device, and the SLP writing you cannot speak is not enough.   

The greatest way to prove that the device of your choosing is the best for you is actually trying the device for a period of time and collecting evidence that supports your choice. Seeing documented evidence of how quickly and spontaneously you can communicate with a particular device will help tremendously with getting funding approval.  Currently data collection is very simple because many modern devices have a way to collect data built into the device called the Language Activity Monitor or LAM.  The data from the LAM can be analyzed into a detailed report outlining speed, language representation (Semantic Compaction, spelling, word prediction), and length of sentences.  I would like add that although physical data is important, having something written about how this device would positively impact your life also helps. 

People are denied device funding for a number of reasons, but unfortunately, the two most common reasons are ones I just mentioned: an improper AAC evaluation due to the lack of evidence and preferred provider agreements.  However, you do have the right to appeal Medicaid’s or your private insurance company’s decision.  Unfortunately, the appeal process can be long and very frustrating, but it is well worth it if the decision is ultimately overturned.  The appeal process is your time to collect the evidence that was missing in your initial evaluation.  If the denial is a case of preferred provider, you have to give evidence why the device you chose will work better for you than the one your funding source wants to purchase. 

You need to remember you are the person who knows your needs best, not the funding source, in some cases, not even the SLP who did the initial evaluation.  This gets me to the second reason you could get a funding denial: you could have a SLP who is clueless.  Again, the SLP needs to provide more evidence than just you are unable to speak.  I mean, come on, why would you be requesting an AAC device if you could speak?  If you think the SLP did a poor job with your evaluation, you have the right to go to another SLP to help with your appeal.  However, (I know I am repeating myself but this is worth repeating because it is very important) you have to do research yourself because you know your needs and abilities the best. 

If you want more specific information about funding, you can contact Dr. Katya Hill at khill@aacinstitute.org or Rachel Harkawik at rharkawik@aacinstitute.org.   Dr. Hill and Ms. Harkawik are Speech Language Pathologists at our new ICAN™ Talk Clinics of the AAC Institute and they have helped numerous individuals through the appeal process by providing useful advice, additional information and/or supporting documentation to their refunding requests.   

Finally, next year’s AAC Symposium on Thursday 4 August 2011 is dedicated to funding issues.  This will be an important event to attend whether you are a user, a parent, or a professional.  The symposium will be held at the Sheraton at Station Square in Pittsburgh, Pennsylvania the day before the Pittsburgh Employment Conference for Augmented Communicators (PEC) on 5-7 August 2011. Start planning and saving now and I hope to see everybody there! 

SAVE THE DATES: AUGUST 4-7, 2011

Your feedback is always valued. AACConsumerNet@aacinstitute.org.

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