Funding Sources

The following are brief descriptions of funding options. Refer to the specific funding source for details. Some of these options can be combined.

Private Insurance

Some private insurance companies will fund SGD equipment. Prior authorization is usually required and coverage depends on the policy. The insurance company may need an explanation of what the SGD does. The insurance company may also need to be convinced of the medical necessity of the device. A consultation with an experienced Speech-Language Pathologist is highly recommended.

Schools

Legally, schools are required to provide appropriate assistive technology services for students. The Individuals with Disabilities Education Act (IDEA, P.L. 101-476) and the 1997 amendment specifically address the inclusion of assistive technology in the Individualized Education Plan (IEP).
Services must be provided at no cost to the parents if the IEP team determines that a student requires this type of assistive technology in order to receive a free and appropriate public education and designates the assistive technology as either part of special education or a related service.

Medicaid

The purchase of SGD equipment is typically covered for individuals up to age 21 in most states. Many states cover the purchase of equipment for individuals of all ages. However, each state varies as to their submission and coverage guidelines. Equipment manufacturers should be familiar with specific state funding practices and can assist in determining the documentation necessary for funding.

Division of Vocational Rehabilitation

The Individualized Plan for Employment (IPE) or comparable plan of action outlines the services provided through VR for the purpose of seeking employment. If a SGD is required to meet established goals, funding may be available.

Medicare

SGDs are funded by Medicare for Medicare Part B enrollees who live in their own home or in an assisted living facility. Medicare requires that a Speech-Language Pathologist perform an evaluation that meets the guidelines according to the Regional Medical Review Policies.

TRICARE

Formerly known as CHAMPUS, TRICARE is a health benefits program for dependents of active duty military service members and military retirees, but now covers SGDs for all program enrollees who require them. Congress explicitly directed the expansion of TRICARE, SGD coverage in the FY 2002 military reauthorization bill, signed by the President on December 28, 2001.

Telecommunication Equipment Distribution Programs (TEDP)

Many states have a TEDP that offers SGDs to individuals to enable access to home telephone equipment. These programs typically have eligibility requirements and specific equipment lists. States are not required to have a TEDP, not every program covers SGDs, and each state structures their TEDP differently.