Work, Assistive Technology, and Transition-Aged Youth

Funding for Work-Related Assistive Technology Through Special Education Programs, State Vocational Rehabilitation Agencies, Medicaid, Medicare and SSI’s Plan for Achieving Self Support

March 17, 2009

National Disability Rights Network2009 Annual Conference

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Presenters….

James R. Sheldon, Jr., Esq.National Assistive Technology Advocacy Project

Steven Elliot, Esq.Advocacy, Inc.Austin, Texas

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Purpose of Session

• Look at transition – From high school to college– From college to work

• Look at expected AT needs

• Look at several funding sources

• Age 17, cerebral palsy

• High school junior

• Regular classes – OT, PT, speech

• Resides with mother, stepfather, brother $420 Social Security Survivors benefits Not eligible for SSI or Medicaid

Wants to Attend Cornell

• Ithaca, NY – hilly community and campus

The Case of Sharon

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Power Wheelchair Needed

• Current lightweight chair

• Cannot self propel long distances

• Cannot self propel on hills

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AAC Device Needed

• Speech not easily understood

• Current device 7 years old

• Constantly in for repairs

• Hard to find parts

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Laptop Computer Needed

• Difficulty writing

• Special education funds note taker

• 6 year old home computer – adapted keyboard

• Recommended – voice input software -- dual-purpose laptop/AAC device

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Ceiling Track Lift Needed

• Has traditional hydraulic lift– Transfers from bed– Transfers in bathroom

• Mom struggles to operate

• Ceiling track is safer, more efficient

• Can leave home for college

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Access Ramp Needed

• Stairs an issue when leaving home

• Two long planks currently used

• Two persons needed to guide wheelchair

• Planks not realistic with power wheelchair

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Wheelchair Van Needed

• Evaluation – Sharon can drive

• Needs modified van– Hydraulic lift– Wheelchair lock down– Hand controls

• Transportation– To school– Later, to work

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Special Education – Eligibility for Services

• Disabled and requires special education services

• Must need special education to qualify for related services

• Services pursuant to IEP

• Services must ensure “educational benefit”

• Education in least restrictive environment

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Special Education – Eligibility for AT

• AT device, AT service defined in IDEA

• Key questions– Needed for educational progress– To remain in least restrictive setting– Prepare for adult life

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Special Education – Sharon’s Eligibility for AT

• AAC Device – can be funded– To communicate with teachers, peers– Software, training can be funded– Home use allowed to ensure benefit from AT

• Laptop computer – can be funded– Meet increased homework demand– Prepare for transition to college

Ownership an issue with both items

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Special Education – Sharon’sEligibility for AT

• Ceiling track lift, access ramp, modified van– Special education not responsible– No direct connection to education– Not needed to “prepare for” college

• Power wheelchair– Can pay for mobility equipment in some cases– Can meet needs in school with current wheelchair

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Vocational Rehabilitation Agency– Eligibility for Services

• Disability interferes with ability to work

• VR services needed to:– Prepare for,– Secure,– Retain, or regain employment

• All services must be connected to work goal

• Must help “maximize” employability

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VR Agency – Eligibility for AT

• AT must be necessary to achieve work goal or benefit from other VR service

• Broad range of AT devices available– Prosthetic devices– Specialized transportation– Vehicle modifications– Adapted computer equipment– Home modifications if necessary to benefit

from VR program

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Vocational Rehabilitation –Financial Need Criteria

• State option to have needs test• Most services subject to financial need• Exempt from financial need criteria:

– Diagnostic services– Counseling, job placement– Personal assistance, interpreter, reader

services

• SSDI, SSI recipient automatically meets financial need criteria

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VR Agency – Sharon’sEligibility for AT

• Financial Needs Test– Sharon eligible for SSDI and SSI at age 18– Will then be exempt from financial needs test

• Power wheelchair, AAC device– Technically, both can be funded– Both needed to succeed at work goal– Practical issue – Medicaid or Medicare should

fund

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VR Agency – Sharon’s Eligibility for AT

• Laptop with accessories, access ramp– Funded if necessary to success of VR plan

• Ceiling track lift– She has argument if necessary to get her out of home

to attend school– Mechanical equivalent of personal assistance

services which are covered

• Vehicle purchase, modification– A few states authorize lease or purchase– Modifications clearly covered

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Medicaid – Eligibility for Program

• SSI recipient – Medicaid automatic in 39 states, District of Columbia

• Medicaid spend down – available in two thirds of states

• Medicaid buy-in – special program for workers with disabilities, 43 states

• Medicaid waivers – optional program, may ignore income/assets of spouses, parents

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Medicaid – Eligibility for AT

Must be Covered Service• Mandatory services

– Durable medical equipment

• Optional categories covering AT– PT, OT, speech– Prosthetic devices– Rehabilitation services

• EPSDT – for kids under 21– All optional services available

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Medicaid – Eligibility for AT

Must be Medically Necessary

• No federal definition

• Look for state’s definition/criteria

• Services available to help “attain or retain … capacity for independence or self-care.”

• EPSDT standard, for kids under 21, is to “correct or ameliorate”

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Medicaid – Sharon’sEligibility for AT

Medicaid eligibility

• At age 18, Sharon will be eligible for SSI

• In 39 states and D.C., Medicaid will be automatic

• Power wheelchair, AAC device– Should be covered in every state if medically

necessary

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Medicaid – Sharon’sEligibility for AT

• Ceiling track lift– Could be covered as DME– Less costly, equally effective alternative

available?

• Access ramp– Will be challenge to fund– Should meet DME criteria

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Medicaid – Sharon’sEligibility for AT

• Laptop computer– Hard to get funded– Useful in absence of illness or injury– “Dual purpose” AAC device/laptop may be

solution

• Van, van modifications– Challenge similar to laptop– Less expensive than van transport?

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Medicaid Waiver Can Fund AT

• All states will have HCBS waivers

• Waivers targeted to specific groups

• Limited enrollment

• Wide range of AT possible

• See www.nls.org/av/fall07.pdf

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Medicare – Eligibility for Program

• Persons age 65 or older

• Persons receiving Social Security Disability Insurance

• Persons receiving Railroad Retirement disability benefits

• Persons with end stage renal disease

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Medicare – Eligibility for AT

AT covered in Part B as DME

• Four-part criteria

• Must be needed “in the home”

• Some items excluded

• Part B premiums ($96.40 most cases)

• 20 percent co-payment

• QMB can cover premiums, co-payments

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Medicare – Sharon’s Eligibility for AT

• Power wheelchair– Covered, but “in the home” criteria– Sharon’s only need outside the home?

• AAC device– Covered as “speech generating device”

• Ceiling track lift– Covered under new Local Coverage

Determination

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Medicare – Sharon’sEligibility for AT

• Laptop– Not “primarily and customarily” used for

medical purpose– Dual purpose device?

• Van, van modifications– Not for use “in the home”

• Access ramp– Is it for use “in the home”?

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SSI’s Plan for Achieving Self Support - Eligibility

General criteria for PASS:

• Income or resources other than SSI

• Plan to spend on vocational goal

• Written PASS plan

• Approved by Social Security Administration

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AT Available with a PASS

• Modifications to home, office• Customized desk• Computer

– Special keyboard– Enhanced screen

• Software– Screen reader– Dictation software

• Vehicle modifications

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Sharon’s Use of PASS

PASS proposal:

• Goal to be attorney

• $400 of SSDI saved monthly for van

• If approved, VR agency will pay for modifications

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Sharon’s SSI Budget with PASS

Currently receives SSI of $274 ($674 – 400 SSDI counted).

New budget: $420 SSDI- 20 Disregard- 400 PASS exclusion$ 0 Counted

New SSI rate: $674

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Sharon’s Benefit from PASS

• Save $19,000 for van

• Leverage $15,000 or more from VR agency for modifications

• Keeps same income for living expenses

• Retains Medicaid (most states)

• Extra PASS money not counted– By subsidized housing– By food stamp program

Thank you….

Other materials available on each topic through National AT Advocacy Project. Contact Jim Sheldon (jsheldon@nls.org).

Check out National AT website (www.nls.org/natmain.htm)

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