The routes below cover the US and England. Rules change and vary by state, plan and region, so check the details with your speech-language pathologist, insurer or school. We make an AAC app, which is sold through the App Store and not billed to insurers.
Medicare (US, mostly adults)
Medicare treats speech-generating devices as durable medical equipment. That includes devices, and software that lets a computer or other electronic device produce speech, for someone with a severe speech impairment whose needs can't be met by natural speech.1
- An SLP evaluation comes first. A speech-language pathologist assesses the person and documents why a device is needed, before anything is delivered.2
- It goes through a supplier that bills Medicare for the device.
- Tablets are generally excluded, because Medicare considers computers and tablets useful to anyone, not only someone with an illness or injury.1
If you have ALS, ask your clinic about the device application process before you need the equipment. Charities such as Team Gleason also help with equipment and voice banking for some people.3
Medicaid (US, children and some adults)
For children and young people under 21, Medicaid's EPSDT benefit requires states to cover services that are medically necessary to correct or improve a condition.4 Speech-generating devices can fall under this. How each state applies it varies a lot:
- Many states fund dedicated devices, which are locked to AAC use, but not general-purpose tablets.
- Some make exceptions. Massachusetts, for example, set up a process to cover iPads for some members under 21 with autism and severe expressive communication needs, with prior authorization.5
- Managed care plans add their own paperwork. Ask the plan for its speech-generating device policy in writing.
Ask your child's speech-language pathologist about your state's rules and the evaluation you'll need.
School (US): AAC in the IEP
Under the Individuals with Disabilities Education Act, the IEP team must consider whether a child needs assistive technology, and must consider the child's communication needs.6 AAC is assistive technology. If the team decides a child needs a device, the school provides it, and if the child needs it at home to benefit from their education, the school must allow that too.7 Our guide to AAC at school covers how to ask.
England: NHS AAC services
NHS England funds specialised AAC services, regional hubs for people with severe or complex communication difficulties, who often need high-tech equipment or specialist access. People with less complex needs are supported by local services.8 Referrals are made by professionals, usually through your local speech and language therapy team; ask them about a referral. Scotland, Wales and Northern Ireland organise this differently; ask your local SLT service.
Other routes worth asking about
- Private health insurance may cover speech-generating devices as equipment; ask for the policy wording and what evaluation they need.
- Veterans in the US can ask about AAC through VA speech pathology services.
- State assistive technology programs in the US often lend devices to try before you buy.
- Charities for specific conditions, such as ALS and MND associations, sometimes fund equipment or voice banking.
Where apps fit
Some people use an app while waiting for a funded device. Others use an app as their main system, or alongside a dedicated device, for example a funded device for school or specialist access and an app on a phone when they're out.
About Dawn and funding
Dawn is a subscription bought through the App Store, so it isn't billed to insurers.