wheelchairs and hearing aids to products that assist with cognition and “wander management” systems for people with dementia. A recent report identified several barriers to the use of such technologies in institutions, including a perceived lack of financial resources (Freedman et al., 2005a). It noted that Medicaid and Medicare do not specifically reimburse organizations for the devices that they supply to the residents of nursing homes, although the programs do pay for covered devices that individuals obtain directly from equipment vendors.
The committee found little specific information on private health plan coverage of different kinds of assistive technologies.12 In general, people covered by private health plans will often encounter problems with coverage restrictions and medical necessity determinations similar to those that that Medicare beneficiaries face (Iezzoni, 2003; Iezzoni and O’Day, 2006).
A few states have mandates that require private insurance plans to cover certain assistive technologies, primarily hearing aids and prostheses, subject to various restrictions. For example, seven states (Connecticut, Kentucky, Louisiana, Maryland, Minnesota, Missouri, and Oklahoma) require coverage of hearing aids for children and one (Rhode Island) requires coverage for children and adults (ASHA, 2007). The reach of these mandates is, however, limited by federal law that exempts self-insured employer health plans from such mandates and from many other state regulations (Mendelsohn, 2006).
In addition to outright exclusions, private health plans often place fairly low limits (e.g., $1,500) on the maximum amount that they will pay for assistive equipment during a year. They may also limit how often they will pay for an item (e.g., once every 5 years) (Iezzoni, 2003).
Even with advances in the value, availability, and use of assistive technologies that can reduce the need for some kinds of caregiving, human caregiving remains a crucial resource that allows many people, particularly those with serious disabilities, to live independently and to participate in
A survey by McManus (2001) of 98 private health plans (half health maintenance organizations and half preferred provider organizations) of coverage of hearing services for children found that only 11 percent explicitly covered hearing aids (and most had cost caps or other limits) and more than 80 percent specifically excluded them. Two plans covered assistive communication devices under a state-mandated benefit for early intervention services, but most other plans included no specific information about coverage.