{"edition":"usa","organization":"Help America Hear","organizationId":"org:help-america-hear","boundaryVersion":"USA-50-states-DC-v1","updated":"2026-09-14","model":{"version":"usa-alpha-help-america-hear-2026-09-13-judgment-20260914","costScope":"Ordinary unrestricted recipient support, with all recipient fundraising, operations and scholarships retained in the planning cost. G=$10,000 is normalization only. c=$3,000 is a conditional full-support cash-cost prior anchored to gross expenses less identifiable donated aids divided by a conservative120-patient denominator; this ratio is not a verified production function. Patient tests, travel and fitting costs and donated provider/device resource costs are separately disclosed, not claimed free to society.","geographicAttribution":"Official program and return describe nationwide domestic services and no foreign operations. Conditional g=.99 allows incidental nonresident benefit; range.98–1. USA includes residents of50states and DC. Headquarters location and citizenship are not allocation keys.","formula":"D=sum[t=1..T]((1−m)/1.03)^t. N=(G/c)×b. Q_all=N×(s×u×p×D−h). Q_USA=Q_all×g. Price per10=10G/Q_USA only if positive. b is financing/provider/manufacturer additionality; s is benefit not otherwise obtained; p is sustained effective use; u is utility gain while using devices. h is an adverse-burden allowance retained for all additional fittings even when s=0. Central inputs are explicit judgments, with wide sensitivity tests.","counterfactual":"The financial screen makes otherwise-unmet need plausible but does not prove no alternative care. s allows Medicare Advantage, Medicaid, veterans' programs, other charities, family purchase or suitable OTC options. b separately discounts existing sponsorship, fixed donated-device quotas, provider slots and reserves. c includes failed applications/administration through the whole-recipient historical anchor; p discounts post-fitting use, not completion twice.","attribution":"No extra hearing gain is credited to both scholarship and standard-program recipients. Scholarship cash and awareness receive no assumed health benefit but remain in cost; their separate benefits are unquantified. Each recipient is counted once, not once per device. Clinical priors transfer from external trials with better follow-up, not from device retail values. The main uncertainty is donation-sensitive completed care, so numerical cases are conditional and do not establish a favorable bound.","uncertainty":"We adopt $3,000 per supported fitting, rounded up from the historical non-in-kind diagnostic, and 60% financing/capacity additionality. Existing last-resort fitting capacity and modest reserves support a nonzero response, while the 40% discount allows sponsor and provider constraints. These are judgments, not measured marginal rates. Zero and adverse outcomes remain possible; the quantified pathway is not a complete portfolio valuation.","nativeOutcomes":"The FY2025 return repeats an over-120 people/services narrative also present in earlier returns; this is not a verified annual cohort. It separately lists 164 donated device items, a different unit. Gross expense $426,522 minus $123,000 noncash aids equals $303,522, or $2,529.35 using a hypothetical 120-recipient denominator: a rough cost diagnostic, not an observed annual cost per patient. Conditional c=$3,000 and b=0.6 imply two additional fitted patients per arithmetic unit; net clinical QALYs per such patient are approximately 0.0733 before geography.","inputs":[{"name":"G","value":10000,"unit":"USD normalization","basis":"judgment","rationale":"Arithmetic only; not a funding commitment.","sourceIds":[]},{"name":"FY2025 gross accounting expense","value":426522,"unit":"USD","basis":"observed","rationale":"278776 PartIX +147746 PartVIII direct event costs; no asset-sale basis treated as operating expense.","sourceIds":["hah-99025"]},{"name":"FY2025 donated aids","value":123000,"unit":"USD recorded fair value","basis":"observed","rationale":"ScheduleM164items; matching expense line. Book value is not benefit or replacement cost.","sourceIds":["hah-noncash","hah-99025"]},{"name":"Historical recipient count floor","value":120,"unit":"people","basis":"observed","rationale":"Narrative says over120;120 used only as conservative denominator, not exact matched fitting count.","sourceIds":["hah-99025"]},{"name":"c","value":3000,"unit":"USD/marginal completed fitting","basis":"judgment","rationale":"We adopt $3,000 per supported fitting, rounded up from the historical non-in-kind diagnostic, and 60% financing/capacity additionality. Existing last-resort fitting capacity and modest reserves support a nonzero response, while the 40% discount allows sponsor and provider constraints. These are judgments, not measured marginal rates.","sourceIds":["hah-99025","hah-noncash","hah-program"]},{"name":"b","value":0.6,"unit":"financing and capacity additionality","basis":"judgment","rationale":"We adopt $3,000 per supported fitting, rounded up from the historical non-in-kind diagnostic, and 60% financing/capacity additionality. Existing last-resort fitting capacity and modest reserves support a nonzero response, while the 40% discount allows sponsor and provider constraints. These are judgments, not measured marginal rates.","sourceIds":["hah-99025","hah-program"]},{"name":"s","value":0.7,"unit":"fraction of benefit not otherwise available","basis":"judgment","rationale":"Last-resort screening supports targeting; allow30% alternative access/benefit. Range0–.9. OTC alternatives do not cover all ages/severities.","sourceIds":["hah-program","hearing-medicare","hearing-otc"]},{"name":"u","value":0.04,"unit":"QALY/year while effectively aided","basis":"judgment","rationale":"One-third of Singapore.12 short-term HUI difference, discounted for modified scoring and generic-US composite nulls. Stress0–.10; not an HHIE-to-QALY mapping.","sourceIds":["hearing-utility","hearing-generic","hearing-communication"]},{"name":"p","value":0.75,"unit":"effective sustained-use fraction","basis":"judgment","rationale":"Allows nonuse, partial use, poor fit, maintenance and limited follow-up. Range.5–.9. Not a measured recipient adherence rate.","sourceIds":["hah-faq","hearing-utility"]},{"name":"T","value":4,"unit":"years","basis":"judgment","rationale":"Conditional four-year benefit; evidence supports three-year communication effect and program allows application everyfiveyears, but that is not proof of durability. Range1–5.","sourceIds":["hearing-communication","hah-program"]},{"name":"m","value":0.02,"unit":"annual competing mortality probability","basis":"judgment","rationale":"Broad mixed-age allowance; actual age mix absent. Range.01–.04; no mortality benefit credited.","sourceIds":[]},{"name":"h","value":0.001,"unit":"QALY/additional fitting","basis":"judgment","rationale":"Small acclimation/discomfort/adverse burden allowance, not an observed serious-harm rate; test0–.002. Retained when alternative benefit offsets hearing gains.","sourceIds":["hearing-cognition","hah-program"]},{"name":"g","value":0.99,"unit":"USA resident health share","basis":"judgment","rationale":"Domestic mission and operations; outcome-weighted residence unknown. Range.98–1.","sourceIds":["hah-program","hah-99025"]}],"scenarios":[{"id":"central","label":"Best estimate — explicit judgment","costUSD":10000,"allPopulationQalys":0.14657758694931936,"editionQalys":0.14511181107982615,"assumptions":"c=3000; b=0.6; s=0.7; u=0.04; p=0.75; T=4; m=0.02; D=3.5375615940314136; h=0.001; g=0.99. Hearing/function only; no mortality or dementia prevention credited. We adopt $3,000 per supported fitting, rounded up from the historical non-in-kind diagnostic, and 60% financing/capacity additionality. Existing last-resort fitting capacity and modest reserves support a nonzero response, while the 40% discount allows sponsor and provider constraints. These are judgments, not measured marginal rates."},{"id":"conditional","label":"Cautious fitted-device hearing/function model","costUSD":10000,"allPopulationQalys":0.14657758694931936,"editionQalys":0.14511181107982615,"assumptions":"c=3000; b=0.6; s=0.7; u=0.04; p=0.75; T=4; m=0.02; D=3.5375615940314136; h=0.001; g=0.99. Hearing/function only; no mortality or dementia prevention credited."},{"id":"favorable","label":"Efficient coordination with durable otherwise-unavailable hearing benefit","costUSD":10000,"allPopulationQalys":4.624568735488061,"editionQalys":4.624568735488061,"assumptions":"c=700; b=0.9; s=0.9; u=0.1; p=0.9; T=5; m=0.01; D=4.446773820084557; h=0.0005; g=1. Hearing/function only; no mortality or dementia prevention credited."},{"id":"pessimistic","label":"Short use, alternatives and adverse burden","costUSD":10000,"allPopulationQalys":-0.0003009708737864078,"editionQalys":-0.0002949514563106797,"assumptions":"c=4000; b=0.2; s=0.3; u=0.01; p=0.5; T=1; m=0.04; D=0.9320388349514562; h=0.002; g=0.98. Hearing/function only; no mortality or dementia prevention credited."},{"id":"zero-funding","label":"Manufacturer or provider capacity fixed","costUSD":10000,"allPopulationQalys":0,"editionQalys":0,"assumptions":"c=3000; b=0; s=0.7; u=0.04; p=0.75; T=4; m=0.02; D=3.5375615940314136; h=0.001; g=0.99. Hearing/function only; no mortality or dementia prevention credited."},{"id":"no-alternative-benefit","label":"Equivalent hearing achieved elsewhere","costUSD":10000,"allPopulationQalys":-0.002,"editionQalys":-0.00198,"assumptions":"c=3000; b=0.6; s=0; u=0.04; p=0.75; T=4; m=0.02; D=3.5375615940314136; h=0.001; g=0.99. Hearing/function only; no mortality or dementia prevention credited."},{"id":"generic-utility-null","label":"No QALY gain under generic quality-of-life measure","costUSD":10000,"allPopulationQalys":0,"editionQalys":0,"assumptions":"c=3000; b=0.6; s=0.7; u=0; p=0.75; T=4; m=0.02; D=3.5375615940314136; h=0; g=0.99. Hearing/function only; no mortality or dementia prevention credited."}],"sensitivity":["At conditional clinical inputs and c=$3000, achieving$1million per10 requires b≥.4135; achieving$100000 requires b≥4.135, impossible. Lower costs or larger sustained clinical benefit are required for the tighter threshold.","At b=.6 and other conditional inputs, c must be≤$4353 for$1million per10 or≤$435 for$100000 per10. A free manufacturer device alone does not establish either full-support cost.","At c3000 and b.6, annual effective-use utility u must be≥.02773 for$1million per10 or≥.27248 for$100000. Generic quality-of-life nulls make the former uncertain; the latter exceeds the adopted hearing-utility evidence.","The best estimate uses judgmental funding-sensitive fittings; current observed marginal capacity would improve it. Zero manufacturer/provider capacity expansion means b=0.","Adding$1325 percase as an illustrative resource allowance for donated devices and external fitting/testing support increases the conditional social-cost price by44%, to about$993000 per10. This is not a procurement quote; actual donated opportunity cost and patient expenses are missing.","Reducing benefit to one year, or substantial failure to obtain replacement/repairs after the included service year, erodes most of the four-year gain.","No dementia, survival, earnings or scholarship-value addition is made. Communication points and device market values cannot be added to QALYs.","Current webpage deposit terms and FAQ fee/income language conflict. If up-front costs exclude the poorest or reduce completed care, historical referral counts overstate reachable benefit.","Case-mix and current donation allocation could differ from historical120-person volume. The whole-recipient model intentionally retains event and scholarship costs instead of pricing only the best donated-device episode."],"missingInputs":["Current marginal budget linking unrestricted donations to otherwise-unfunded completed fittings, with confirmed manufacturer quantities and professional appointments.","Reconciled person/device/cohort counts, scholarship overlap, inventory movement and cost of failed applications or missing follow-up.","Current application fee/deposit and income-tier terms; patient testing, travel, batteries, repair and fitting costs.","Recipient hearing severity, age and previous/alternative aid access; repeated measured hearing-function, utility and device-use data.","Long-term follow-up and repair/replacement capacity after the included service period.","Original-registry verification of a CauseIQ CA registration flag ('Dissolution Pending', as ofJune3,2026). This is unverified, may concern CA registration only, and is not evidence of national closure; current official program remains live.","Outcome-weighted50states/DC residence and manufacturer/provider opportunity cost."]},"sources":[{"id":"hah-99025","title":"Original return for fiscal year ended February28,2025","publisher":"Help America Hear / IRS via ProPublica","url":"https://projects.propublica.org/nonprofits/full_text/202620159349301802/IRS990","published":null,"retrieved":"2026-09-13","dateNote":"Original document date supplied by researcher: 2026-01-13; web publication date not independently established."},{"id":"hah-99024","title":"Original return for fiscal year ended February29,2024","publisher":"Help America Hear / IRS via ProPublica","url":"https://projects.propublica.org/nonprofits/full_text/202422629349300912/IRS990","published":null,"retrieved":"2026-09-13","dateNote":"Original document date supplied by researcher: 2024-08-27; web publication date not independently established."},{"id":"hah-99023","title":"Original return for fiscal year ended February28,2023","publisher":"Help America Hear / IRS via ProPublica","url":"https://projects.propublica.org/nonprofits/full_text/202312839349301416/IRS990","published":null,"retrieved":"2026-09-13","dateNote":"Original document date supplied by researcher: 2023-10-02; web publication date not independently established."},{"id":"hah-noncash","title":"FY2025 Schedule M: donated hearing aids","publisher":"Help America Hear / IRS via ProPublica","url":"https://projects.propublica.org/nonprofits/full_text/202620159349301802/IRS990ScheduleM","published":"2026-01-13","retrieved":"2026-09-13"},{"id":"hah-program","title":"Current prescription hearing-aid eligibility, deposit and exclusions","publisher":"Help America Hear","url":"https://helpamericahear.org/help-america-hear-program","published":null,"retrieved":"2026-09-13"},{"id":"hah-faq","title":"FAQ and follow-up service terms","publisher":"Help America Hear","url":"https://helpamericahear.org/faq","published":null,"retrieved":"2026-09-13"},{"id":"hah-home","title":"Current national programs, scholarship and events","publisher":"Help America Hear","url":"https://helpamericahear.org/","published":null,"retrieved":"2026-09-13"},{"id":"hearing-utility","title":"Cost-utility analysis of hearing aids: randomized delayed-start study","publisher":"Kaur et al., BMC Health Services Research","url":"https://pmc.ncbi.nlm.nih.gov/articles/PMC7709244/","published":"2020-12-01","retrieved":"2026-09-13"},{"id":"hearing-communication","title":"ACHIEVE randomized trial: communicative function","publisher":"Sanchez et al., Journal of the American Geriatrics Society","url":"https://pubmed.ncbi.nlm.nih.gov/39266468/","published":null,"retrieved":"2026-09-13"},{"id":"hearing-generic","title":"ACHIEVE randomized trial: generic health-related quality of life","publisher":"Huang et al., JAMA Network Open","url":"https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2826555","published":"2024-11-21","retrieved":"2026-09-13"},{"id":"hearing-cognition","title":"ACHIEVE randomized trial: primary cognition outcome","publisher":"Lin et al., Lancet","url":"https://pubmed.ncbi.nlm.nih.gov/37478886/","published":"2023-07-18","retrieved":"2026-09-13"},{"id":"hearing-placebo","title":"Hearing-aid service delivery placebo-controlled trial","publisher":"Humes et al., American Journal of Audiology","url":"https://pubmed.ncbi.nlm.nih.gov/28252160/","published":"2017-03-01","retrieved":"2026-09-13"},{"id":"hearing-medicare","title":"Hearing aid coverage","publisher":"Centers for Medicare & Medicaid Services","url":"https://www.medicare.gov/coverage/hearing-aids","published":null,"retrieved":"2026-09-13"},{"id":"hearing-otc","title":"OTC hearing aids: intended population and limitations","publisher":"US Food and Drug Administration","url":"https://www.fda.gov/medical-devices/hearing-aids/otc-hearing-aids-what-you-should-know","published":null,"retrieved":"2026-09-13"},{"id":"hah-registry-flag","title":"Third-party California registration field requiring original-registry verification","publisher":"Cause IQ","url":"https://www.causeiq.com/organizations/foundation-for-sight-and-sound,200878279/","published":null,"retrieved":"2026-09-13"}]}