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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 Network

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work assistive technology and transition aged youth
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 Network

2009 Annual Conference



James R. Sheldon, Jr., Esq.

National Assistive Technology

Advocacy Project

Steven Elliot, Esq.

Advocacy, Inc.

Austin, Texas


purpose of session
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

The Case of Sharon

  • 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


power wheelchair needed
Power Wheelchair Needed
  • Current lightweight chair
  • Cannot self propel long distances
  • Cannot self propel on hills
aac device needed
AAC Device Needed
  • Speech not easily understood
  • Current device 7 years old
  • Constantly in for repairs
  • Hard to find parts
laptop computer needed
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

ceiling track lift needed
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
access ramp needed
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
wheelchair van needed
Wheelchair Van Needed
  • Evaluation – Sharon can drive
  • Needs modified van
    • Hydraulic lift
    • Wheelchair lock down
    • Hand controls
  • Transportation
    • To school
    • Later, to work
special education eligibility for services
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
special education eligibility for at
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
special education sharon s eligibility for at
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

special education sharon s eligibility for at1
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
vocational rehabilitation agency eligibility for services
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
vr agency eligibility for at
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
vocational rehabilitation financial need criteria
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
vr agency sharon s eligibility for at
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
vr agency sharon s eligibility for at1
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
medicaid eligibility for program
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
medicaid eligibility for at
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
medicaid eligibility for at1
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”
medicaid sharon s eligibility for at
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
medicaid sharon s eligibility for at1
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
medicaid sharon s eligibility for at2
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?
medicaid waiver can fund at
Medicaid Waiver Can Fund AT
  • All states will have HCBS waivers
  • Waivers targeted to specific groups
  • Limited enrollment
  • Wide range of AT possible
  • See
medicare eligibility for program
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
medicare eligibility for at
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
medicare sharon s eligibility for at
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
medicare sharon s eligibility for at1
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”?
ssi s plan for achieving self support eligibility
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
at available with a pass
AT Available with a PASS
  • Modifications to home, office
  • Customized desk
  • Computer
    • Special keyboard
    • Enhanced screen
  • Software
    • Screen reader
    • Dictation software
  • Vehicle modifications
sharon s use of pass
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
sharon s ssi budget with pass
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

sharon s benefit from pass
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 ( you….
  • Check out National AT website (