Tip for State-specific

Children are entitled to hearing aids under Medicaid's EPSDT benefit

Tip for State-specific

Adult hearing aid coverage varies dramatically by state — some states do not cover hearing aids for adults

Tip for State-specific

Many states limit hearing aid replacement to once every 3-5 years

Dental, Vision & HearingmoderateDoctor signature required

Medicaid Hearing Aid Authorization

State-specific · State Medicaid agencies

Authorization for Medicaid-covered hearing aids and audiology services. Not all states cover hearing aids for adults.

Form Details

Total fields: 30
Auto-fillable: 20 (67%)
Time without BeneFill: 20 minutes
Time with BeneFill: 6 minutes
Time saved: 14 minutes
Filled by: doctor
Frequency: as needed
State-specific: Yes — form may vary by state

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Where to Submit This Form

🌐

Submit through the state Medicaid provider portal or hearing benefits administrator

The audiologist or hearing instrument specialist typically submits this on behalf of the patient.

📠

Fax to the Medicaid hearing benefits administrator

Fax number varies by state and managed care plan.

🌐

Call the state Medicaid hearing benefits line

Contact the provider services line for prior authorization.

Filing Deadline

Must be approved before hearing aids are dispensed. Submit at least 10-15 business days before the planned fitting.

Required Attachments

📎 Prior authorization request form
📎 Complete audiological evaluation with audiogram
📎 Medical clearance from a physician or otolaryngologist
📎 Hearing aid recommendation with specific make, model, and cost
📎 Documentation of medical necessity and functional impact

Processing Time

10-15 business days for standard requests. Expedited requests may be available for urgent medical need.

What Happens Next

If approved, the audiologist can order and fit the hearing aids. The authorization will specify the approved devices, accessories, and time period for fitting.

Tips for This Form

✓ Children are entitled to hearing aids under Medicaid's EPSDT benefit
✓ Adult hearing aid coverage varies dramatically by state — some states do not cover hearing aids for adults
✓ Many states limit hearing aid replacement to once every 3-5 years
✓ If denied, appeal with additional documentation — peer-to-peer reviews can be effective

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Standard dental claim form used for billing all dental insurance plans. Includes pre-treatment estimates and procedure codes.

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Authorization for Medicaid-covered vision services. Coverage varies widely by state, with some limiting to one exam every two years or glasses only after cataract surgery.

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Application for vouchers for prescription glasses for individuals with low income. Must be submitted by a social worker or case manager on behalf of the client.

Lions Club Hearing Aid Program Application

Local club application · Local Lions Clubs

Local program distributing refurbished or low-cost hearing aids to those in need.

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Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the State Medicaid agencies or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.