Helping the Mute to Speak: The Availability of Augmentative Communication Devices under Medicaid


One of the most severe disabilities is the inability to speak. Nearly one half million people in the United States with normal intelligence are unable to communicate either verbally or with standard hand signs. Perhaps 100,000 more have been diagnosed as retarded just because they do not have the physical ability to communicate. There are augmentative communication devices on the market today that would enable many people with severe speech impairments to communicate verbally. With the ability to communicate, many would be able to live independently and to be employed in positions commensurate with their abilities rather than their disabilities. Although our science and technology have created these devices, they are often unavailable to those who need them most. Because the majority of people with severe disabilities are unemployed and dependent on government benefits, access to this modem technology depends on government benefit programs.

This Article will focus on the availability of augmentative communication devices under Medicaid, which provides medical assistance to poor people, and will address the proper standard for providing augmentative speech devices through the Medicaid program. There are some devices which are not programmable and only provide very minimal speech, enabling the user to communicate only the most basic information. There are also other, more expensive devices that provide the user with access to unlimited vocabulary. The question then becomes whether a limitation of funding to a device that provides access to a limited number of words and phrases satisfies Medicaid’s provision requiring that it give funds for “medical necessities.” This Article concludes that federal and state laws and regulations provide that the appropriate test of medical necessity is whether the device corrects the speech impairment. Thus, a Medicaid recipient is entitled to a device which provides the user with unlimited speech.

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