How to Fund AAC
Some augmentative and alternative communication (AAC) systems are as low-tech as printed pictures in a binder, while higher-tech AAC can range from an app on an iPad to a dedicated speech-generating device that costs tens of thousands of dollars. Speech-language pathologist Ali Steers never recommends that families attempt to pay for a device out of pocket, so where can you find funding for your child’s communication needs?
There are several funding sources you may have access to: private insurance, public benefit programs, the IEP process, and grant programs. Here’s a brief rundown of each and the answers to some commonly asked questions.
Private insurance
Steers emphasizes that communication is a medical necessity. “Everyone needs to be able to communicate, to speak to their doctors and their health team,” she says. “We need to be able to build relationships with those in our environment. Communication is absolutely a medically necessary function, in the same way that a wheelchair is.”
How to document medical necessity for insurance
When seeking private insurance coverage for an AAC device for your child, you will need to provide a letter of medical necessity from your child’s doctor that explains why the specific device is appropriate for your child’s diagnosis as well as a signed prescription. You will also need to provide an evaluation report from your child’s SLP or speech therapist that highlights the reason this specific device is essential for your child’s health and safety.
Health plan advocate Leslie Lobel explains, “Your health plan will want a speech evaluation recommending the specific device as well as why it is needed so that the doctor can reference that, and so the durable medical equipment (DME) provider has that information as well.” The majority of insurance companies require that the prescription from your child’s doctor be dated no more than six months after the date of the most recent face-to-face office visit — this is particularly true of Medicaid plans.
AAC as DME
Speech-generating devices are considered durable medical equipment under most insurance policies and are typically covered. However, Steers warns that every policy is different, and some may have exclusion policies and will not cover specific devices, such as speech-generating devices. (Low-tech systems such as PECS are typically not covered.)
Lobel suggests requesting a list of in-network DME providers from your insurance company “to gain a sense of their plan’s coverage for an AAC device in terms of their deductible and what share of the cost they have after deductible. Sometimes plans have a separate deductible for DME from the medical deductible, and sometimes it is the same,” Lobel adds. “Sometimes plans have an annual maximum dollar amount that they will pay per year for DME.”
DME providers can walk parents through additional steps needed for authorization, including a demo of the device and additional assessments. Lobel explains, “The DME company will submit to the health plan for pre-approval of the device once all the documentation is in order. If the health plan denies the first authorization request, an appeal may be needed.”
For a step-by-step walkthrough when funding AAC with insurance, check out our guide on the Undivided platform:
Fund AAC with insurance
Frequently asked questions about funding AAC through insurance
If health insurance buys the AAC device, is it my child’s to keep?
Lobel says, “If insurance buys an AAC device, it belongs to the child and can be used in all settings without restrictions, unlike school-funded equipment that may have limitations attached to its usage.”
How long does it take to get AAC through insurance?
National Seating & Mobility, one of the major DME providers in the US, says, “Insurance approval takes 1-4 weeks, and once approved, AAC devices generally ship in 1-4 weeks.” The timeline will depend on your insurance and your DME provider.
Will insurance repair or replace the AAC device if it breaks?
Lobel says, “If an item needs repairs, the health plan can issue an approval for repair or replacement to the provider. If the child needs new or different equipment, new funding will be required.”
Public insurance
If your child has Medicaid coverage, such as Medi-Cal in California, you can see about using the DME benefit of their plan to pay for AAC. However, you will need to get prior authorization from your Medicaid plan before applying for the device, which means Medicaid has to agree to pay for the item before they will provide it.
How to use Medicaid to pay for AAC
As with private insurance, you will need to provide a letter of necessity from your child’s doctor or therapist (or both) that details when your child was seen, which device is recommended, and why the device is medically necessary. It’s also important to know that Medicaid will only pay for the lowest-cost device that will meet a child’s needs.
What about using Medicaid as secondary insurance to pay for AAC?
If your child uses multiple insurance plans, Medicaid will be the payor of last resort. Lobel suggests that families whose children have Medicaid coverage should talk to their DME provider about using secondary coverage after private insurance. You’ll need to contract with a DME provider that accepts both your plans, including the specific type of Medicaid your child has.
Undivided Public Benefits Specialist Lisa Concoff Kronbeck adds that while Medicaid may fund the portion of the cost that insurance doesn’t cover, they may ask parents for additional documentation before they agree to that funding (including documentation of what insurance paid). For example, they might ask for additional letters of medical necessity, documentation of what other devices have been tried and haven’t worked, and more.
Lobel says, “Some funding sources will not allow for or provide any preauthorization, and the family will have to order without knowing in advance that coverage will be forthcoming. In this case, they will be asked to sign a letter of financial responsibility.”
Your child’s school
AAC devices and programs can be funded through the IEP process if they are deemed necessary for a child to access a free, appropriate public education (FAPE). Here is a sample letter you can write to your school's special education specialist to request an evaluation for AAC.
If the school evaluation shows that your child needs AAC, then the school must pay for it. Non-attorney education advocate Lisa Carey says, “Schools must fund what the IEP decides is needed for a student to access their education.”
If the device needs accessories, such as a protective case or carrying strap, then the school should fund these items also as long as they are written into the IEP. The school might also decide to pay for a device insurance plan that covers repairs or replacement if it gets damaged.
Check out our step-by-step guide to requesting AAC in the IEP:
Request assistive technology or AAC in the IEP
Once the school-provided AAC is approved, be sure to request training in the IEP for your child, yourself, and anyone at the school who works with your child. Carey says, “Learning to use an AAC device is like learning a new language. You cannot learn it in a vacuum, so it is very important for parents and caregivers to know how to use it.” This includes helping your child set it up and use it, such as adding new vocabulary when needed.
We recommend reading our article AAC in the IEP to learn more about integrating AAC in your child’s IEP, with example IEP goals and tips from experts.
What if the school tells me to get an AAC device through insurance instead?
Carey says that as long as the IEP team agrees your child needs AAC, “The school must provide it. Some families prefer to get it through insurance, but the school cannot force the family to use their insurance.” She notes that a family could choose either option, but some school districts will not add vocabulary or update a device not owned by the district. The school will not cover repairs or replacement for a device purchased through insurance.
What if the school doesn’t want my child using their insurance-provided device?
Cary says, “Schools can sometimes resist using devices they haven't provided. A child has a right to access their preferred communication. In some cases, it can work out as long as the school uses the same program and layout as the home device. However, in some cases that is not possible, and I would insist the child be allowed to continue using their system.”
Can my child take their school-provided device home?
Whether your child can take their AAC device home depends on your state. For example, California's Education Code now includes Section 56040.3, so schools and local educational agencies are now required to provide eligible students with continuous access to their AAC devices at school, in their homes, and in the community, which means that students can bring those devices home with them after school hours and during all school holidays, including summer break.
On a nationwide basis, IDEA only says that students can take devices to settings outside school “on a case-by-case basis if the child’s IEP team determines that the child needs access to those devices in order to receive FAPE.” You can talk to your IEP team about ensuring that your child has continued access. You may need to sign an agreement in case you damage it because the device belongs to the school.
What if the school’s AAC device gets lost or damaged?
The school should repair or replace the device if it gets damaged at school. This can be written into the IEP or signed as a separate agreement.
Carey recommends making a plan with your IEP team about regularly backing up the device settings. “When a child uses AAC, it becomes their customized voice, meaning they will have vocabulary and a layout specific to them. If something happens to the device, you will need to restore the current layout from the backup. Parents should ask the school how often the system is backed up, where that backup is stored, how backups will occur during breaks and summer, and whether parents can connect it to their home Wi-Fi for automatic backups.”
What happens to the device when my child leaves school?
Whether your child is moving to a new school or exiting special education as an adult, the device must typically be returned to the school. Carey recommends backing up the device settings so that you can transfer it to another device for your child.
Other public benefits programs
Depending on your state, other programs that serve individuals with disabilities may be available to fund AAC devices. For example, in California, Orange County’s Assistive Technology Exchange Center (ATEC) can provide devices and training, and the DOR’s Voice Options Program funds devices as well. Lobel notes that California Regional Centers can help fund AAC if insurance and Medi-Cal don’t cover it.
Check out this list of organizations by state to see if there are additional AAC funding programs in your state.
Grants for AAC
Organizations that can help fund AAC via grants or scholarships include:
Self-funding AAC
If you are purchasing a device yourself, either as your child’s primary device or as a backup, be sure to take advantage of AAC software discounts that are typically available in April for Autism Awareness Month and October for AAC Awareness Month. Check out our article here for a roundup of companies that usually offer discounts.
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