Select State
line top nav icon pharmacy line top Nav icon provider Find a Provider line top nav icon Hospital Find a Hospital line top nav icon login Web Portal line top nav Home Home line top nav

Button About Molina
Button Members
Button Providers
  Molina Healthcare Home   Logo line    Logo Your Extended Familys
Font size 11 Font size 12 Font Size 13 Font Size 14
 
 
 
Button find march vision providers 
 
manual
forms
policies
HIPAA
EDI
drug list
health resources
communications
contact us

Hearing Aids

Medicaid provides for medically necessary hearing aid services for eligible recipients such as hearing aid dispensing, replacement, and repairs exceeding $100. Prior approval is required for hearing aids.

Request hearing aids on forms MAD 303 and ISD 394 (Hearing Aid Evaluation form). The MAD 303 must indicate which ear the hearing aid is being requested for, along with the specific hearing aid make and model information. A physician's signature must be present, indicating that the recipient is a suitable candidate. If the recipient is institutionalized, there must be a physician's statement to the effect that the recipient will derive some significant benefit in terms of quality of life; and, the provider will need to indicate whether the recipient will be responsible for caring for the hearing aid or if the facility will assist with the care of the hearing aid.

icon PDF Mad 303

icon PDF Mad 394

 

icon PDF Adobe Acrobat Reader is required to view the file(s) above. Download a free version.