Hearing Care for Medicaid Patients: Why You Should Get Involved

When I opened my practice, I did so with bright eyes and optimism. I was a blank slate, having never worked or trained as a student in a private practice. However, along the way, I serendipitously picked up a lot of relevant knowledge. Driven by idealism and the motivation to improve our profession for all, my goal was to create the kind of practice where all patients wanted to go, all audiologists wanted to work, and all students wanted to learn. Therefore, on August 1, 2018, after over four years of education, eight years of practice, and zero years in a private practice, I officially became my own boss.www.shutterstock.com. Medicaid, business management, access, affordability.Sounds of Life Hearing Center, which is approaching its fifth anniversary, has experienced growth. We’ve expanded our staff from just me to three full-time members, soon to be four, along with externs. Our financial growth has been continuous, with a 28% increase in gross revenue from FY 2021 to 2022, and we anticipate a further 25%-30% growth this year. Since 2019, I have managed to maintain some level of profitability. Despite serving a significant number of Medicaid patients and engaging in charitable services in our community, we have achieved our growth. We firmly believe that income and financial status should not determine one’s right to better communication and improved quality of life through better hearing. To further support our charitable initiatives, we established a 501(c)(3) nonprofit project called Hearing the Call – Northeast Ohio in 2021. Running a practice has not been easy. It involves crunching numbers, working late nights, and battling with Medicaid for payment. Nevertheless, someone needs to do this work, and here are some reasons why. INCOME, AFFORDABILITY, AND ACCESS In the United States, 1.6 million people live in extreme poverty, with less than $2 per person per day. 1 Even those above the Federal Poverty Level struggle to afford anything beyond necessary expenses. Just because someone makes above “minimum” wage does not mean it’s a livable wage. There are many who may not qualify for Medicaid and have commercial health insurance, but by no means can afford anything beyond their necessary expenses. Often, for this population caught in the financial middle, access to diagnosis and treatment of hearing loss is even more difficult. Lower income is associated with reduced life expectancy and increased prevalence of health conditions. 2 Low-income individuals face numerous challenges in receiving adequate hearing care due to lack of insurance coverage and limited financial resources. Geographic limitations and a shortage of providers in rural areas contribute to delays in accessing care, affecting job performance and educational opportunities. Data shows that individuals who do not fit the non-Hispanic white, high-income, older, educated man living in an urban or suburban location profile are less likely to access audiological care. 3 HEARING LOSS AND EMPLOYMENT DISPARITIES Untreated or undertreated hearing loss negatively impacts employment opportunities and earnings, leading to financial struggles and limited access to hearing healthcare. Difficulties in communication, social interactions, and productivity result in diminished career advancement and earning potential. 4 Compared with individuals with normal hearing, those with a hearing disability have lower median income, higher incidence of unemployment 5, and higher levels of job dissatisfaction, stress, burnout, and mental and physical health problems. 6,7 Further, individuals with hearing loss are more likely to work in loud, manual labor jobs 8, which make it harder to hear instructions and increase the risk of further hearing loss. These jobs may also involve exposure to toxins that synergize with noise, exacerbating hearing loss. SOCIOECONOMIC IMPACTS Poor access to care extends beyond income to include race, ethnicity, and place of residence. Those living in rural areas face longer wait times for diagnosis and treatment of hearing loss due to a scarcity of audiologists. 9 Older individuals, especially those aged 65 and older, are more likely to live in rural areas and may face transportation difficulties for their appointments. African American and Hispanic communities experience reduced access to care. 10 These disparities extend to children. Babies with hearing loss living in rural areas are often fit about 5 months later (6 vs. 11 months) 11 than those closer to urban centers and are implanted 2 years later (2 vs. 4 years). 12 Controlling for other factors, African American babies and toddlers are 1.56 times less likely to be implanted prior to the age of two than Caucasian babies. Loss to follow-up rates are higher for non-White babies, and babies born to rural families experience much higher rates. PROVIDING EFFECTIVE AND RESPECTFUL CARE It is crucial to provide compassionate audiological care to all patients, considering their unique circumstances. Here are some considerations: Adopt your patient’s perspective when planning their treatment. Recognize that what may be easy for you can be difficult or impossible for them. Recommending treatment options that are inaccessible to patients sets them up for failure. Believe patients when they say they can’t afford hearing aids. Understand that financial limitations often force them to prioritize their basic needs over hearing aids. Appreciate that patients may lack stable transportation, communication, or a safe living environment. Avoid judgment and seek to understand their challenges. Work with patients to find flexible appointment scheduling and assist in coordinating transportation. Support children and families for success. Minimize disruptions to kids’ education by scheduling appointments outside of class time and meal time (as some children get their only meals at school) and avoiding naptime for toddlers. Accommodate shared custody situations by providing extra chargers or care kits. Help in any way possible. Consider adding Medicaid or pro bono patients to your caseload, even if only in a very limited capacity. If you don’t have the resources in your own practice, be aware of community organizations that do this good work and support them through donations of time, talents, and resources. In conclusion, audiologists have the power and responsibility to ensure inclusive and accessible care for all, regardless of socioeconomic factors. By recognizing the unique challenges faced by individuals with economic hardships, implementing patient-centered approaches, and collaborating with community organizations, we can make a positive impact on their lives. Together, we can strive for a society where everyone has equal access to hearing health care and the opportunity to thrive. Thoughts on something you read here? Write to us at [email protected].