State of the States 2002 State budget shortfalls during the 2002 fiscal year have left little money for legislation to advance the delivery of speech, language, and hearing services. Rather, state advocates have had to fight to avoid cuts in education and Medicaid funding, typically the two largest items in state budgets. Despite the financial ... Features
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Features  |   July 01, 2002
State of the States 2002
Author Notes
  • Charlie Diggs, is ASHA’s director of state and consumer advocacy.
    Charlie Diggs, is ASHA’s director of state and consumer advocacy.×
Article Information
Hearing Aids, Cochlear Implants & Assistive Technology / Practice Management / Regulatory, Legislative & Advocacy / Features
Features   |   July 01, 2002
State of the States 2002
The ASHA Leader, July 2002, Vol. 7, No Pagination Specified. doi:10.1044/leader.FTR2.07132002.np
The ASHA Leader, July 2002, Vol. 7, No Pagination Specified. doi:10.1044/leader.FTR2.07132002.np
State budget shortfalls during the 2002 fiscal year have left little money for legislation to advance the delivery of speech, language, and hearing services. Rather, state advocates have had to fight to avoid cuts in education and Medicaid funding, typically the two largest items in state budgets.
Despite the financial woes, there were victories—not surprisingly in areas with minimal budget impact. Vermont and Washington enacted licensure laws. In the area of hearing health care, an early hearing detection and intervention law passed in Ohio, and Kentucky and Oklahoma enacted laws providing reimbursement for hearing aids for children.
Budget Crisis
The financial crisis in the states has arisen from a double whammy of:
  • Higher spending. In the prosperity of the late 1990s, many state legislatures cut taxes while spending more on schools and health benefits for the uninsured. States were caught short when costs for existing programs escalated. Medicaid costs alone, for example, increased 25% over the past two years.

  • Falling revenue, which occurred for different reasons in different states—declining tourism after Sept. 11 in Florida and Hawaii; the dot.com debacle in Washington and California, which drove unemployment costs up and corporate tax revenue down; and general erosion of state tax bases due to economic recession.

Some legislatures have held special sessions to try to balance the budget without substantially increasing taxes or cutting favorite voter programs in an election year. Other states have implemented hiring freezes or layoffs for state employees. Rainy day funds are being spent. Licensing fees and targeted taxes like cigarettes are being increased. As a last resort, Medicaid and education cuts are being considered.
Medicaid
Because Medicaid expenditures account for about $1 of every $6 of a state’s general fund, lawmakers are examining these costs as they try to balance budgets. They do so reluctantly, as cuts in state Medicaid funds bring cuts in matching federal funds. A state’s per capita personal income determines the size of the match; states with lower personal incomes fare worse with the loss of state Medicaid dollars. Legislators cannot eliminate required Medicaid services such as hearing aids and speech-language pathology for children, but they can reduce payments for these services.
Other services, including hearing aids for adults and speech-language pathology for adults after stroke, have been added in some states as optional Medicaid benefits. States can reduce or eliminate such benefits and still participate in the Medicaid program, and some states are proposing to do exactly that.
Education
The state budget crisis also has slowed the advocacy efforts of school-based audiologists and speech-language pathologists seeking a salary supplement based on ASHA’s Certificate of Clinical Competence. Bills introduced in Alabama, South Carolina, Rhode Island, and West Virginia stalled in committees and faced opposition from education factions who wanted any available funds directed to classroom teachers. The Oklahoma Senate passed a bill, which stalled in the House.
ASHA’s State Education Action Team supported salary supplement efforts in Oklahoma, Rhode Island, and West Virginia as part of ASHA’s 2001–2003 Schools Focused Initiative. The team also worked with Virginia to have a budget amendment introduced to reduce maximum caseload. State associations in these targeted states are looking ahead to the next legislative session, recognizing that progress is made step by step, year by year—especially in economically lean times.
Licensure Gains
Persistence does pay off! The Vermont Speech-Language-Hearing Association has won a 10-year battle to enact a licensure law for audiologists and SLPs. After passing both legislative chambers, a licensure bill was signed June 27 by Gov. Howard Dean. It wasn’t an easy process—the bill’s final language followed multiple committee amendments, revisions on the floor of both chambers, and still more changes as the House and Senate hammered out a final compromise.
State activists in Washington were expecting a similar struggle when they introduced their licensure bill this year. Since 1996, clinicians in the state could not refer to themselves as certified audiologists or SLPs without a state certificate. Now they wanted licensure.
What happened was surprising—and an example of how unpredictable the political process can be. In less than two months, both legislative bodies passed the bill, and Gov. Gary Locke signed it into law on April 2.
Hearing Health Victories
State legislatures also supported early hearing detection and intervention (EHDI) and reimbursement for hearing aids for children. In May, Ohio became the 37th state with EHDI legislation, in addition to five states that voluntarily screen at least 85% of newborns. Equally important to 100% screening is improvement in tracking systems so that newborns who fail screening receive necessary follow-up treatment. Data from the Centers for Disease Control and Prevention suggest that only 56% of referred newborns receive a follow-up evaluation, and even fewer receive early intervention services.
New hearing aid reimbursement legislation passed this year in Kentucky and Oklahoma should help infants and other children as well. Both laws cover audiologic evaluation and hearing aids for children under 18 when prescribed by an audiologist. These services are provided every 36 months in Kentucky and every 48 months in Oklahoma. Kentucky caps payment at $1,400 per hearing aid, with the insured being able to choose a costlier hearing aid and pay the difference in cost, while Oklahoma sets no reimbursement maximum. Oklahoma also requires audiologists to dispense hearing aids.
Showing their continued interest in reimbursement for hearing aids over the past three years, a dozen states introduced bills this year to require some form of health insurance payment for hearing aids. Those states are California, Colorado, Connecticut, Kentucky, Missouri, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Rhode Island, and Virginia.
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July 2002
Volume 7, Issue 13