HOUSE OF REPRESENTATIVES STAFF ANALYSIS
BILL #: CS/HB 79 Insurance Coverage for Hearing Aids for Children
SPONSOR(S): Health & Human Services Committee, Brannan, Zika and others
TIED BILLS: IDEN./SIM. BILLS: CS/SB 498
REFERENCE ACTION ANALYST STAFF DIRECTOR or
BUDGET/POLICY CHIEF
1) Finance & Facilities Subcommittee 18 Y, 0 N Poche Lloyd
2) Appropriations Committee 26 Y, 0 N Lee Pridgeon
3) Health & Human Services Committee 17 Y, 0 N, As CS Poche Calamas
SUMMARY ANALYSIS
Approximately 30 million people in the U.S. aged 12 years and older have hearing loss in both ears, based on
standard hearing examination. Hearing loss is also one of the most common birth defects in the U.S. – two or
three out of every 1,000 children are born with a detectable level of hearing loss in one or both ears.
Many people who are deaf or hard-of-hearing have some hearing. In some instances, a hearing aid may help a
child with hearing loss maximize their residual hearing. Hearing aids make sounds louder and can be worn by
people of any age, including infants. Babies with hearing loss may understand sounds better using hearing
aids. There are many styles of hearing aids that can help many types of hearing loss. A young child is usually
fitted with behind-the-ear style hearing aids because they are better suited to growing ears. Florida law does
not require private health insurance policies or health maintenance organization (HMO) contracts to provide
coverage for hearing aids.
CS/HB 79 requires individual health insurers and HMOs to cover hearing aids for a covered child 18 years of
age and younger who is diagnosed with hearing loss by a licensed physician or licensed audiologist and for
whom the hearing aid is medically necessary. The term “hearing aid” includes ear molds, but does not include
cochlear implants. The bill requires a minimum coverage limit of $3,500 per ear within a 24-month period, and
requires coverage of 6 ear molds within a 24-month period. The insured or subscriber is responsible for the
cost of hearing aids and related services that exceed the coverage limit in the policy or contract.
If, however, a child experiences a significant and unexpected change in his or her hearing or experiences a
medical condition requiring an unexpected change in the hearing aid before the existing 24-month period
expires, and if alterations to the existing hearing aid do not or cannot meet the child’s needs, the bill requires a
new 24-month period to begin, including full benefits and coverage. The bill applies to private individual policies
or contracts issued or renewed on or after January 1, 2023.
The bill may have a significant, indeterminate negative fiscal impact on state government and the private
sector. The bill does not apply to the State Group Insurance Program. However, for health plans obtained
through federal marketplace exchanges, the state may be required to reimburse the cost of any new coverage
mandate that raises the cost of those plans. See Fiscal Analysis & Economic Impact Statement.
The bill provides an effective date of January 1, 2023.
This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives .
STORAGE NAME: h0079e.HHS
DATE: 2/28/2022
FULL ANALYSIS
I. SUBSTANTIVE ANALYSIS
A. EFFECT OF PROPOSED CHANGES:
Background
Approximately 30 million people in the U.S. aged 12 years and older have hearing loss in both ears,
based on standard hearing examination.1 Hearing loss is also one of the most common birth defects 2 in
the U.S. – two or three out of every 1,000 children are born with a detectable level of hearing loss in
one or both ears.3
Many people who are deaf or hard-of-hearing have some hearing. In some instances, a hearing aid
may help a child with hearing loss maximize their residual hearing.4 Hearing aids make sounds louder
and can be worn by people of any age, including infants. Babies with hearing loss may understand
sounds better using hearing aids. There are many styles of hearing aids that can help many types of
hearing loss. A young child is usually fitted with behind-the-ear style hearing aids because they are
better suited to growing ears.5
Hearing loss may be in one ear (unilateral loss) or in both ears (bilateral loss). The degree of hearing
loss can range from mild to profound:6
Mild Hearing Loss (26-40 decibels): may hear some speech sounds, but soft sounds are hard
to hear.
Moderate Hearing Loss (41-70 decibels): may hear almost no speech when another person is
talking at a normal level.
Severe Hearing Loss (71-90 decibels): will hear no speech when a person is talking at a
normal level and only hear some loud sounds.
Profound Hearing Loss (91 decibels or more): will not hear any speech and will hear only very
loud sounds.7
Hearing loss can affect a child’s ability to develop communication, language, and social skills. Recent
research shows that early detection of hearing loss can help infants and children with learning and
reaching developmental milestones. In the U.S., researchers report children have more favorable
language outcomes, such as greater vocabulary and reading abilities, when hearing loss is identified
sooner and the child receives hearing aids and interventions at an earlier age. 8 A second study similarly
found children who received hearing aids and cochlear implants earlier had better language outcomes,
comparing language skills with a hearing aid at three months compared to 24 months:9
1 National Institutes for Health, National Institute on Deafness and Other Communication Disorders, Quick Statistics Ab out Hearing,
available at https://www.nidcd.nih.gov/health/statistics/quick-statistics-hearing.
2
Florida Newborn Screening, Early Hearing and Intervention Program , available at
https://floridanewbornscreening.com/hearing/early-hearing-and-intervention-programs/.
3 Id.
4 Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disorders (June 8, 2020), available
at https://www.cdc.gov/ncbddd/hearingloss/treatment.html. The amount of hearing a deaf or hard-of-hearing person has is referred to
as “residual hearing.”
5 Id. A plastic ear mold is connected to a behind-the-ear hearing aid and is fitted for the child’s ear, directing sound into the ear canal.
Each individual’s ear is shaped differently, and a child’s ear will change as he or she grows. An audiologist uses a soft material to make
a copy of the child’s outer ear canal, and the ear mold is made from it. As the child grows, new ear molds can be made and attached to
the same hearing aid.
6 Florida Department of Health, Children’s Medical Services, A Florida Parent’s Guide to Hearing (Apr. 2020 Edition), available at
http://floridanewbornscreening.com/wp-content/uploads/Hearing-Guide-English-FINAL-1.pdf.
7 Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disorders (June 8, 2020), available
at https://www.cdc.gov/ncbddd/hearingloss/types.html.
8 Christine Yoshinaga-Itano, Ph.D., et al, Early Hearing Detection and Vocab ulary of Children with Hearing Loss, Pediatrics (Aug. 2017,
Vol. 140, No. 2), available at https://pediatrics.aappublications.org/content/140/2/e20162964 .
9 Teresa Y.C. Ching, Ph.D., Age at Intervention for Permanent Hearing Loss and 5-Year Language Outcomes, Pediatrics (Sept. 2017,
Vol. 140, Issue 3), available at https://pediatrics.aappublications.org/content/140/3/e20164274 .
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The younger the child received intervention, the better the language
outcome. In addition, more substantial benefits of earlier access to
useful HAs (hearing aids) and CI (cochlear implants) were obtained
by those with worse hearing. Earlier intervening, rather than access
to UNHS (universal newborn hearing screening), improved
outcomes.10
Florida Newborn Hearing Screening Program
Florida has a universal newborn hearing-screening program 11 requiring all licensed facilities providing
maternity and newborn care to screen, or refer for screening, all newborns prior to discharge for
hearing loss, unless a parent objects to the screening. 12 All test results, including recommendations for
any referrals or follow-up evaluations by a licensed audiologist, a physician licensed under chapters
458 or 459, F.S., or other newborn hearing screening providers in the hospital facility, must be placed
in the newborn’s medical records within 24 hours after completing the screening.13
For babies born in a facility other than a hospital, the parents must be instructed on the importance of
having a screening conducted, information must be provided, and assistance must be given to make an
appointment within three months.14 The initial newborn screening and any necessary follow-up and
evaluation are covered benefits reimbursable by Medicaid, health insurers, and health maintenance
organizations, with some limited exceptions.15 For those newborns and children found to have
permanent hearing loss, the law also provides for referral to the state’s Part C program of the federal
Individuals with Disabilities Education Act16 and Children’s Medical Services’ Early Intervention
Program, Early Steps.17
Hearing Aid Coverage in Public Insurance Programs
Medicaid
Florida Medicaid provides hearing services for eligible recipients under the age of 21, if such services
are medically necessary to correct or ameliorate a defect, a condition, or a physical or mental illness. 18
Coverage includes diagnostic services, treatment, equipment, supplies, and other measures described
in 42 U.S.C. 1396d(a).19 Medicaid recipients under the age of 21 have coverage for the following
hearing-related services:
Recipients who have documented, profound, severe hearing loss in one or both ears have
coverage for:
o An implanted device for recipients age five years and older; or
o A non-implanted (softband) device for recipients under age five.
Cochlear implants for recipients age 12 months and older who have documented, profound to
severe, bilateral sensorineural hearing loss.
For recipients who have moderate hearing loss or greater, the coverage is:
o One new, complete (not refurbished) hearing aid device per ear, every three years, per
recipient;
o Up to three pairs of ear molds per year, per recipient; and
o One fitting and dispensing service per ear, every three years, per recipient.
10 Id.
11
Florida’s Early Hearing Detection and Intervention Program (EHDI) is Florida’s newborn hearing -screening program, available at
https://floridanewbornscreening.com/hearing/early-hearing-and-intervention-programs/.
12 S. 383.145, F.S.
13 S. 383.145(3)(e), F.S.
14 S. 383.145(3)(i), F.S.
15 S. 383.145(3)(j), F.S.
16 Pub. L. No. 108-446. The Part C program provides benefits and services for infants and toddlers from birth to 36 months. Children’s
Medical Services within the Department of Health administers the Part C program, known as Early Steps.
17 The Early Steps program services children with disabilities, developmental delays, or children with a physical or mental cond ition
known to create a risk of a developmental delay, http://www.cmskids.com/families/early_steps/early_steps.html.
18 S. 1905(a)(4)(B) of the Social Security Act.
19 R. 54G-4.110, F.A.C. (2021). The hearing services coverage policy from the Agency for Health Care Administration is available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-06744.
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A recipient under the age of 12 months may receive up to two newborn screenings. A second
screening may be conducted only if the recipient did not pass the test in one or both ears. An eligible
recipient may receive one hearing assessment every three years to determine hearing aid candidacy
and, if necessary, the most appropriate hearing aid.20 Medicaid also covers repairs and replacement of
both Medicaid and non-Medicaid provided hearing aids, up to two hearing aid repairs every 366 days,
after the one-year warranty period has expired.21
State Children’s Health Insurance Program 22
The Children’s Health Insurance Program (CHIP) was enacted as part of the Balanced Budget Act of
1997, and created Title XXI of the federal Social Security Act as a joint state-federal funding
partnership to provide health insurance to children in low to moderate income households. 23 The
Florida Healthy Kids Corporation24 is one component of the Title XXI program, known as Florida
KidCare, and is the only program component using a non-Medicaid benefit package.25 The other
program components – Medicaid for children, Medikids, and Children’s Medical Services Network –
follow the Medicaid benefit package.26
For health benefits coverage to qualify for premium assistance payments, KidCare enrollees must
receive hearing screenings as a covered, preventative health service. 27 Additionally, s. 409.815(2)(h),
F.S., provides the benefits for durable medical equipment include within covered services equipment
and devices that are medically indicated to assist in the treatment of a medical condition and
specifically prescribed as medically necessary. Hearing aids are covered only when medically indicated
to assist in the treatment of a medical condition. There are no out-of-pocket costs for the well-child
hearing screening for subsidized Title XXI eligible children. 28
Hearing Aid Coverage in the Private Health Insurance Market
The Office of Insurance Regulation (OIR) is responsible for the regulation of all activities of insurers and
other risk-bearing entities that do business in Florida.29 Florida law does not require health insurance
policies or health maintenance organizations contracts to provide coverage for hearing aids. According
to the OIR, some of the plans offered by UnitedHealthcare cover hearing aids if recommended by a
physician, and bone anchored hearing aids are covered with some restrictions. Molina and Health First
cover implant type hearing aids, if medically necessary. 30
Currently, 24 states appear to mandate health benefit plans to provide coverage for hearing aids for
children.31 Coverage requirements range from authorizing a hearing aid every 24 months to every five
years. Many states include caps on the amount the insurer must pay, ranging from $1,000 to $4,000.32
State Mandated Health Insurance Coverage
Prior to 2012, OIR identified 18 state-mandated benefits.33 Subsequently, Florida has not enacted any
mandated benefits. Examples of benefits mandated under Florida law include:
20 Agency for Health Care Administration, Hearing Services Coverage Policy (June 2016), available at
http://ahca.myflorida.com/medicaid/review/specific_policy.shtml.
21 Id.
22
42 U.S.C. s. 1397aa-1397mm.
23 Pub. L. No. 105-33, 111 Stat. 251, H.R. 2015, 105th Cong. (Aug. 5, 1997).
24 Ss. 624.91-624.915, F.S.
25 Ss. 409.810-409.821, F.S.
26 S. 409.815(2)(a), F.S., and s. 391.0315, F.S.
27 S. 409.815(2)(a), F.S.
28 Florida Healthy Kids Corporation, Medical Benefits, available at https://www.healthykids.org/benefits/medical/.
29 OIR is under the Financial Services Commission, composed of the Governor, the Attorney General, the Chief Financial Officer, and
the Commissioner of Agriculture, who serves as the head of the commission. S. 20.121(3), F.S.
30 OIR correspondence (Dec. 8, 2020).
31 Information from the American Speech-Language-Hearing Association, available at
https://www.asha.org/advocacy/state/issues/ha_reimbursement/.
32 Id.
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Treatment for temporomandibular joint disorders;
Coverage for bone marrow transplants;
Coverage for certain cancer drugs;
Diabetes treatment services;
Osteoporosis;
Certain coverage for newborn children;
Child health supervision services; and
Treatment of cleft lip and cleft palate in children.34
Section 624.215, F.S., requires every person or organization seeking consideration of a legislative
proposal, which would mandate a health coverage or the offering of a health coverage by an insurer, to
submit to the Agency for Health Care Administration and the legislative committees having jurisdiction,
a report that assesses the social and financial impacts of the proposed coverage. Proponents
submitted a report to Senate Banking and Insurance Committee staff in 2021 indicating there are less
than 7,200 children under the age of 18 in Florida who are deaf.35 Hearing aids and the services