by Tamiko Teshima, M.A., CCC-SLP
Practice Owner & Speech-Language Pathologist
Duncan Lake Speech Therapy, LLC
When we talk about speech therapy, we often talk about progress, milestones, and outcomes. What we don’t talk about enough is access. For many families in West Michigan, the hardest part isn’t doing the therapy. The hardest part is getting in the door in the first place! A study published by the American Journal of Speech-Language Pathology in 2022 reported that only 75% of children who needed speech services received it. However, this number varied significantly by “race/ethnicity, health insurance type, co-occurring diagnoses, and disorder duration.” All of this to say? 75% was the high end of the access spectrum.
And you know here at DLST, we are all about access. So let’s spend some time during National Speech-Language Hearing Month talking about why access to speech services is a problem even here in West Michigan.
Distance matters
If you live in or near a city like Grand Rapids, your speech therapy options are broader. Once you move even 20 to 30 minutes outside of those areas, the number of available speech-language pathologists drops quickly.
Two years ago, I participated in a pitch competition in which I sought to gets some funds to open a second location in an area where there were no SLPs. As it turns out, in Barry, Allegan, and Ionia counties combined, there were two private speech therapy clinics…between three counties.
Because of situations like this, families are often left with a choice – drive long distances multiple times per week, or go without services. For children, that can mean missing critical windows for early intervention. For adults, it can mean delayed recovery, reduced independence, and increased frustration.
Access shouldn’t depend on your zip code, but right now, it often does.
Insurance is the worst
Insurance is not only the biggest thorn in our Emily’s side, but it’s also one of the biggest barriers to speech services. Let’s just run down the list of reasons.
Many private practices in our area do not accept Medicaid. That’s not because providers don’t want to serve those families, it’s because reimbursement rates often don’t cover the actual cost of providing care. When reimbursement doesn’t keep up with inflation, clinics are forced into difficult decisions about what they can sustainably offer. The result is fewer providers accepting certain insurance plans, and fewer options for families who need them most.
In addition to that, many insurances don’t cover what is referred to as “habilitative” services. This means that unless a speech-language disorder arises from an injury (like a stroke, etc.), the disorder is considered “developmental.” In other words, unless you have an injury, a speech-language disorder is considered normal and apparently the person will “grow out of it.” This makes it so folks who need services can’t access the insurance that they have and they have to pay out of pocket.
Some policies have insanely high deductibles as well. This means that clients have to pay out of pocket until they hit that number. And folks, we’re talking like $7000, $10,000, or even $12,000 of deductibles. For most people, paying out of pocket for services isn’t doable.
Lastly, and probably Emily’s favorite barrier, is that insurance limits how many speech (and OT and PT) visits a person can have in a year. Some policies have unlimited visits. The vast majority, though? 20-36. That’s less than a 1 session per week. So, even if the person does have insurance
The revolving door of providers
Even when families do find a private SLP, consistency isn’t guaranteed around here. Unfortunately, the reimbursement rate of insurance is nowhere near close to keeping up with the rate of inflation. In fact, it wasn’t until this year that Priority Health raised their rate for the first time in over a decade.
If speech clinic takes insurance and the insurance reimbursement isn’t keeping up with the cost of living, it’s hard to pay people what they need in order to do their job, let alone what they’re worth. Furthermore, with the rising cost of everything, benefits, etc. are difficult to provide for many small practices. Ipso-facto, SLPs have to move on to try to find better pay.
Clients are often deterred by the lack of consistency and disengage from services altogether.
Waitlists for months (years?)
Many larger systems hold onto long waitlists rather than referring out. On paper, it may look like access exists. In reality, families can sit on waitlists for months, sometimes over a year, without receiving services. Putting profit before the people is unethical, yet clients often don’t even know their options, especially if their health insurance is tied to the system where they receive their healthcare.
So, what do we do?
Unfortunately, there isn’t a single solution to this. Improving access to speech services will take changes at multiple levels, insurance reimbursement, workforce support, and a shift in how systems collaborate instead of compete.
But in the meantime, there are a few things that can make a real difference:
- Families asking about referrals outside of large systems
- Providers building relationships across practices and disciplines
- Clinics exploring creative service models that bring care closer to underserved areas
- And perhaps most importantly, continuing to talk about it.
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