Funding
AAC Funding Help
AAC Funding Help is a website created by Lewis Golinker, Esquire that provides an overview and historical perspective on public funding sources most frequently used to provide speech generating devices. Although much of the content has not been updated, this valuable information is useful to anyone considering SGD (speech-generating device) funding for the first time.
Note many SGD providers now have their own funding guidance, templates and staff who can assist, such as:
Frequently Asked Funding Questions
- What is a speech-generating device (SGD)?
A speech generating device (also called augmentative and alternative communication device) is purpose-built equipment for communication. This is the term that was coined by the Medicare Durable Medical Equipment Regional Carrier (DMERC) medical directors in 2000.
- How do people fund speech-generating devices in the United States?
SGDs can be funded (or procured) by the following health and disability related benefits in the United States:
- Medicare
- Medicaid
- Insurance & Health Benefits Plans
- Federal Employee Health Benefits Plan
- Tricare
- Department of Veterans Affairs
- Special Education & Early Intervention
- Vocational Rehabilitation
- Telecommunications Equipment Distribution Program
- What medical need does a speech-language pathologist have to justify to insurance in the United States?
The "medical purpose" of SGDs and the "medical need" for SGDs, is to treat severe expressive communication impairment that precludes individuals from meeting all daily communication needs using natural communication methods.
All daily communication needs are considered equally in determining whether an SGD is required. There is no priority given to specific conversations. The medical need for an SGD is not determined by who the individual seeks to communicate with; what the individual seeks to say; or where the communication will occur.
SGDs serve as a functional by-pass of body parts that are not working due to illness, injury or disability. To generate speech, the brain must first formulate a message; then, code the message into language; code motor instructions for the message to be spoken; transmit the instructions to the diaphragm, lungs, larynx, vocal folds, tongue, teeth and lips (collectively the speech organs); and those instructions must be executed correctly. These five steps have been described as a "communication chain." If, due to disability, any link in that chain is broken (malfunctions or is non-functional), the person's speech will be impaired. In this circumstance, the brain can achieve the original intent to communicate by re-directing the instructions to the fingers, for example, which when aided by an SGD, can create or select the message, which the SGD will then speak. The original intent to communicate is thereby achieved, through a by-pass of the body parts that are not working and with the use of an SGD. This functional by-pass for speech is identical to the functional by-pass role served by wheelchairs for individuals with mobility impairments. The Food and Drug Administration as well as numerous funding program decisions recognize the functional equivalence of SGDs and wheelchairs.
SGD funding is not diagnosis dependent. No funding source – either public or private – limits SGD coverage to specific neurologic diagnoses by policy guidance or by practice. The list of common conditions (ALS, CP, etc) is illustrative, not exclusive.
