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Non-Traditional Funding Sources and Funding Strategies for Assistive Technology. Creative Ways to Access Traditional AT Funding Sources, Some Little-Known AT Funding Sources and Funding Strategies. 2010 Annual Conference of AT Act Programs Presenter : Diana M. Straube, Esq.

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non traditional funding sources and funding strategies for assistive technology
Non-Traditional Funding Sources and Funding Strategies for Assistive Technology

Creative Ways to Access Traditional AT Funding

Sources, Some Little-Known AT Funding Sources

and Funding Strategies

2010 Annual Conference of AT Act Programs

Presenter : Diana M. Straube, Esq.

National Assistive Technology Advocacy Project

Neighborhood Legal Services, Inc., Buffalo, New York

dstraube@nls.org

1

background
Background

AT Advocacy has traditionally focused on 5

key funding sources:

  • Medicaid
  • Medicare
  • Special education programs
  • State vocational rehabilitation programs
  • Private insurance plans
slide3

A “Big Five” Funding Source May Not be Available Because:

  • Individual not eligible for program, or not eligible for special benefit within program
  • Eligible for program, but AT device is not covered.
  • Eligible for program, AT is covered by program … BUT
    • individual has not demonstrated “need” for the item under program criteria
    • i.e., not medically necessary, educationally necessary, vocationally necessary, etc.

3

resolving the big five funding dilemma
Resolving the Big Five Funding Dilemma
  • Identify way to make person eligible for program.
  • Identify another program to fund device.
  • Identify an available funding strategy to cover all or part of device:
    • Anti-discrimination laws, like Americans with Disabilities Act
    • Use of tax provisions, like Flexible Spending Account
medicaid several paths to potential eligibility
MedicaidSeveral Paths to Potential Eligibility
  • Receipt of SSI = automatic eligibility in 39 states
  • Medically needy or “spend down” category
  • Home and community based services “waiver”
  • Child Adopted -- federal Adoption Assistance Program
  • Medicaid Buy-In for working people, more than 40 states
ssi for child of working parent
SSI for Child of Working Parent

Darlene is a widow, with three children: Chris, age 11; Carey, age 13; Jason, age 16

    • Jason has cerebral palsy
    • Jason gets SSI of $373 and automatic Medicaid
  • Medicaid covers medications, speech therapy, $10,000 power wheelchair, $8,000 communication device
  • Keeping Medicaid is critical!
  • State SSI rate is $674, with automatic Medicaid
jason s ssi based on darlene s wages
Jason’s SSI Based on Darlene’s Wages

Darlene earns $33,000 gross, working 60 % time ($2,750 per month)

Employer wants Darlene to increase hours:

  • 80 percent time -- $44,000 per year/$3,667 per month
  • 90 percent time -- $49,500 per year/$4,125 per month
  • Full time -- $55,000 per year/$4,583 per month

Jason will lose SSI if Darlene makes $3,495 per month.

four strategies to keep ssi and medicaid
Four Strategies to Keep SSI and Medicaid
  • Play it safe – keep working 60 percent time
  • Accept 80 percent time job if:
    • Employer “pays” Darlene $350 less
    • Employer pays Darlene’s $350 share for health insurance
    • Darlene’s taxable wages reduced to $3,317
    • Jason eligible for SSI of $89 per month
four strategies to keep ssi and medicaid continued
Four Strategies to Keep SSI and Medicaid(Continued)
  • Accept 80 percent time job if:
    • Employer offers “Flexible Spending Account”
    • $350 deducted each month for health insurance payment
    • Jason eligible for SSI of $89 per month
  • Wait until Jason’s 18th birthday to increase pay.
medicare savings plans qmb slmb qi 1
Medicare Savings Plans: QMB, SLMB, QI-1

Qualified Medicare Beneficiaries program (QMB)

  • State must pay Medicare deductibles, coinsurance and premiums ($96.40), for nearly all disabled individuals ($110.50 for newly eligible)
  • Must have income at or below 100 percent of federal poverty level (FPL) ($903 in 2009)
medicare savings plans qmb slmb qi 112
Medicare Savings Plans: QMB, SLMB, QI-1

Specified Low-Income Medicare Beneficiaries program (SLMB)

  • State must pay Medicare Part B premiums only
  • Income between 100 and 120 percent of FPL (up to $1,083 in 2009)

Qualified Individual Program (QI-1)

  • State must pay for Part B premiums only
  • Income between 120 and 135 percent of FPL (up to $1,219 in 2009)
how qmb helps pay for at
How QMB Helps Pay for AT

If Medicare funds a power wheelchair at approved rate of $8,000:

  • Medicare pays 80 percent ($6,400)
  • Individual must pay balance ($1,600)
  • Medicaid would typically pay the $1,600

If person not eligible for Medicaid or chooses not to pay a spend down:

  • Medicare pays the $6,400
  • QMB pays the $1,600
state vocational rehabilitation vr agencies
State Vocational Rehabilitation (VR) Agencies

Financial Need Criteria – General Rule

  • VR agency may use financial need criteria for most of its services.
  • E.g., college tuition, vehicles modifications, computers, and AT.

Social Security, SSI Recipients Exempt from Needs Test

  • With any amount of SSI or SSDI, eligible for VR services at no cost.
  • Income/resources of parents, spouse do not count.
vr agencies and financial need criteria the case of ted
VR Agencies and Financial Need Criteria – The Case of Ted

Ted Receives $1,500 in Social Security Benefits

  • This is too much to qualify for SSI.
  • Also too much to qualify for state’s Medicaid spend down program

Ted Automatically Meets the VR Agency’s Financial Need Criteria

  • The VR agency can pay for expensive AT, like van modifications, access ramps at home, or adapted computer equipment
  • The agency cannot make Ted pay toward cost of items it provides.
alternative financing programs afps a source of loans for at
Alternative Financing Programs(AFPs) - A Source of Loans for AT

An AFP can make a loan available by:

  • A revolving loan fund
  • A loan guarantee
  • An interest buy down
the most common items purchased with loan funds
The Most Common Items Purchased with Loan Funds
  • Vehicles modifications
  • Computers, costs for computer access
  • Mobility equipment, such as wheelchairs, scooters
  • Equipment for daily living, like environmental control devices
  • Hearing aids, vision aids
  • Home modifications

See www.resnaprojects.org/AFTAP for AFP information in 40 States.

afps advocacy tips
AFPs - Advocacy Tips

The AFP loan: An excellent way to cover out-of-pocket costs related to AT purchase:

  • Amounts that exceed the payment limitations of private insurance
  • The 20 percent co-payment required under Medicare Part B
  • Any share of cost requirement charged by a state VR agency
  • Any AT-related costs that exceed the amount available for purchases under an SSI Plan for Achieving Self Support (PASS)
  • Amounts not otherwise covered by charity payments
  • Through an appeal process.
the federal adoption assistance program
The Federal Adoption Assistance Program

Help for parents who adopt a “Child with Special Needs”

  • Includes cash assistance and other special services

Assistance with AT Funding through Automatic Medicaid:

  • If “child with special needs” criteria met and “adoption assistance agreement” in effect (i.e., a federal adoption)
  • At state option if child receives state or local adoption assistance program
the federal adoption assistance program21
The Federal Adoption Assistance Program

Additional Payments for AT, at State Option, with State/Local Funds:

  • Covered through Minnesota’s adoption program:
    • Specialized communications equipment
    • Ramps
    • An accessible shower, elevated bathtubs and toilets
    • Blinking lights and tactile alarms as alternate warning systems
    • Lowered kitchen work surfaces
    • Disability-related modifications to a vehicle
related benefits
Related Benefits
  • Kinship guardianship assistance payments when relative foster parent has chosen not to pursue adoption
  • Foster care maintenance payments = payments for food, clothing, shelter, daily supervision, school supplies, a child's personal incidentals,etc
in ny foster care agency paid for
In NY, Foster Care Agency Paid for:
  • Van lift including installation, accessories and equipment
  • Bathroom renovations
  • Rehab wet vest for swimming
  • Special recreational items (swing, beneficial for respiration)
slide24
Funding Strategies

That Do Not Involve a Program That Funds AT In a Conventional Sense

the flexible spending account fsa under federal tax law
The Flexible Spending Account (FSA)Under Federal Tax Law

Known as “flex plans,” “cafeteria plans” or “125 plans”

  • Employee contribution deduction from pay, pre tax
  • Reduces taxable wages

Types of expense covered

  • Uncovered medical: insurance premiums, co-payments, uncovered services, AT devices
  • Non-medical: child care, adoption fees, parking fees, public transportation costs
using flexible spending account for at back to darlene jason green
Using Flexible Spending Account for AT- Back to Darlene & Jason Green

Darlene Pays $350 Share of Insurance Premium

  • Taxable income reduced by $4,200. Taxes reduced.
  • Reduced income for SSI eligibility. Jason keeps SSI.

By Keeping SSI, Jason Also Keeps Medicaid

  • Medicaid pays for new wheelchair
  • Medicaid pays for new communication device
creative structuring or restructuring of a child support to obtain or retain ssi and medicaid
Creative Structuring or Restructuring of a Child Support to Obtain or Retain SSI and Medicaid

Purpose of Strategy is Twofold:

  • Disability-related and other needs met through the child support without decreasing the SSI amount.
  • By obtaining or retaining eligibility for SSI, we ensure eligibility for Medicaid (in most states).
  • Both support dollars and Medicaid can fund AT.
creative structuring of child support back to darlene jason green
Creative Structuring of Child Support- Back to Darlene & Jason Green

Works 80 Percent Time, Earns $3,667 Per Month

  • Wages reduced by $350 through FSA contribution.
  • Jason gets $89 SSI check plus Medicaid.

Jason’s Dad to Pay $450 in Monthly Child Support

  • SSI program would count two thirds, $300.
  • Extra income makes Jason ineligible for SSI.
  • Jason will also lose Medicaid.
alternative child support settlement for jason
Alternative Child Support Settlement for Jason

Darlene’s Dilemma: No Adequate Transportation

  • Cannot afford van for travel with wheelchair.
  • Drives used car. Two adults must lift Jason in and out of car.

Instead of Cash, Dad Pays Directly to Vendors:

  • $400 to bank for loan on accessible van
  • $50 to car insurance company toward $150 monthly insurance
how creative child support agreement helps jason
How Creative Child SupportAgreement Helps Jason

Jason Keeps Same Amount of SSI

  • Money paid to vendors not available for food or shelter
  • Not counted by SSI

Jason Keeps Medicaid

  • Getting $1 or more in SSI keeps Medicaid in 39 states.
  • Medicaid pays for power wheelchair, communication device.

Darlene Get Van and Insurance

  • Child support arrangement makes it possible for Darlene to get a van with insurance to transport Jason.
thank you
Thank you….
  • Other materials available on each topic through National AT Advocacy Project. Contact Diana Straube (dstraube@nls.org).
  • Check out National AT website (www.nls.org/natmain.htm)
  • Materials by James R. Sheldon, Supervising Attorney

National Assistive Technology Advocacy Project

Neighborhood Legal Services, Inc., Buffalo, New York