HB 109

HB 109

TCDD Bill of the Week: House Bill 109 Featured Graphic

For this weekly feature, the Texas Council for Developmental Disabilities (TCDD) profiles a noteworthy bill that is going through the legislative process. The bill may relate directly to TCDD’s Public Policy Priorities or another disability-related issue.

Bill: House Bill (HB) 109, relating to health benefit coverage for hearing aids for children and adults.

Bill Author: Rep. Julie Johnson, House District 115 (Dallas)


The 85th Texas Legislature required health benefit plans to provide coverage for the cost of a medically necessary hearing aid for certain patients. However, some plans do not allow a patient to receive a device that costs more than what is permitted under the plan, even if the patient can pay the difference in price.

What does the bill do?

HB 109 would prohibit a health benefit plan that provides coverage for hearing aids from denying an enrollee’s claim for a hearing aid solely based on the price of the hearing aid. The bill stipulates that a health benefit plan would not be required to pay an enrollee’s claim for a hearing aid that costs more than the benefit available under the health benefit plan. The enrollee, or some other entity, would need to make up the difference between allowable benefit and actual cost.

The bill lists the types of health benefit plans that would be covered under the new mandate, and specifically exempts the following:

  • plans that provide coverage for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury;
  • plans that provide coverage only for hospital expenses; and
  • the state Medicaid program, including the Medicaid managed care program.

If passed, HB 109 would take effect on Sept. 1, 2023. However, it would apply only to health benefit plans delivered, issued for delivery, or renewed on or after Jan. 1, 2024.

Statement from the bill author, Rep. Julie Johnson:
Rep. Julie Johnson

Statement from the bill author, Rep. Julie Johson

Rep. Julie Johnson
“Current Texas law requires that insurance companies cover hearing aids for children, yet many insurance companies prohibit patients from selecting improved devices, even if the patient is willing to pay the difference in cost. Patients deserve the chance to enjoy the benefits of an improved hearing aid device. HB 109 would provide patients the freedom to choose from a wider variety of hearing aid options, without an increased cost to the health insurance provider.”

Where is the bill in the process?

On Nov. 14, 2022, HB 109 was pre-filed for the 88th regular session. Since House committee assignments have yet to be named, the bill is waiting to be referred.

Who supports the bill and why?

The following comments were taken from a March 23, 2021, public hearing on a bill identical to HB 109:

  • Texas Academy of Audiology: Brad Shields, speaking on behalf of the Texas Academy of Audiology, testified in favor of the bill. He clarified the point that most insurance companies do allow patients to pay the difference for a more expensive hearing aid, but there are some that do not. This bill would ensure patients their preferred choice of a hearing aid device and restrict insurance companies from taking that choice away. Shields also emphasized that the bill is not asking insurance companies to be responsible for covering a larger portion of the price.
  • CTD: Dennis Borel, executive director of the Coalition of Texans with Disabilities (CTD), submitted written comments in support of the bill. He indicated that, “factors such as technology, quality, and personal choice will be reflected in the cost of a hearing aid,” and that a “preferred hearing aid can make the difference of full inclusion in society.”
  • DD Policy Fellow: Laura Marquez, a social service worker, also submitted written comments on the bill. She noted how early and effective intervention is essential in language development for infants and toddlers and should not be delayed due to confusion among insurance companies. She stated, “parents of children or adults who utilize hearing aids/devices should, under the guidance of their audiologist, have the ultimate decision on what device they choose — including deciding if they want to pay out of pocket to cover a cost difference in the device.”


The following groups also registered their support for the 2021 legislation but provided no testimony: Texas Society of Anesthesiologists, Texas Hearing Aid Association, Texas Medical Association, Texas Watch, and Texas Pediatric Society.

Who opposes the bill and why?

No opposition to the identical bill was registered at the 2021 hearing.

How much will the bill cost?

In 2021, the Legislative Budget Board found that a bill identical to HB 109 would not increase the state budget in a significant way.

Is there a Senate companion to the bill?

Senate Bill (SB) 51, authored by Sen. Judith Zaffirini, is identical to HB 109 and was also filed on Nov. 14, 2022. It awaits referral to a committee.

Share this bill:

TCDD has created a Bill of the Week one-pager for HB 109 (PDF). This is a simplified explanation of the bill that you can share with your representative and personal network.

Stay informed:

For the latest information about where HB 109 is in the process, follow the bill on the Texas Legislature Online. To receive future legislative updates from TCDD, subscribe to TCDD eNews or follow us on TwitterFacebookLinkedIn, or Instagram.

Bill of the (Next) Week:

Due to the TCDD quarterly meeting on Feb. 10, our next Bill of the Week feature will be published on Friday, Feb. 17.



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