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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

1

slide2
Presenters….

James R. Sheldon, Jr., Esq.

National Assistive Technology

Advocacy Project

Steven Elliot, Esq.

Advocacy, Inc.

Austin, Texas

2

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
slide4

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

3

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 www.nls.org/av/fall07.pdf
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 (jsheldon@nls.org).Thank you….
  • Check out National AT website (www.nls.org/natmain.htm)

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