Transitional Funding for the Growing Child

• By Scott South, Priya Das
• May 01, 2005

Several resources are available for obtaining assistive technology for the pediatric population with disabilities. The key to funding is to show that the assistive technology is medically necessary and is required in order for the student to "benefit from special education."

State Medicaid programs are the primary funding resource, and many states have an expanded Federally supported State Children's Health Insurance Program (SCHIP). Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is one of the mandatory Medicaid services. This service should ensure that disabilities are diagnosed and equipment needs are recognized from an early age or at the onset of the condition.

The Individuals with Disabilities Education Act (IDEA) requires a free and appropriate education (FAPE) for everyone with disabilities under the age of 22. Students must be provided access to an education in the "least restrictive environment" (LRE) which may require the use of assistive devices.

A 1990 U.S. Department of Education's Office of Special Education Program (OSEP) policy letter stated that school districts may not refuse to consider a child's need for any form of assistive technology, or to provide the assistive technology devices and services that are determined to be necessary. Proper seating and positioning is a requirement for a student to maintain attentiveness in the classroom. Often physical or occupational therapy services are part of the education of a person with disabilities. School districts are required to furnish assistive equipment and physical and occupational therapy when necessary. Under IDEA, physical and occupational services are classified as "related services" and therefore funded by Medicaid under IDEA. In order to insure that necessary equipment is provided, it should be stated in the student's IEP (Individualized Education Program) that these services and assistive technology are necessary in order to provide the student with FAPE.

Another important consideration for funding assistive technology for the adolescent group is "transition" into adult life. Transition services are also a requirement of IDEA. By the time a student reaches age 14, school districts must include a transition plan in their IEP. This Transition Plan must include the transition service needs related to the child's studies, including academic or vocational planning. Actual transition services are required to begin at age 16. Their purpose is to prepare the student to move from special education into postsecondary education, vocational training, employment (including sheltered workshops and supported employment), continuing and adult education, adult services, independent living, and community participation.

At the age of 22, Vocational Rehabilitation (VR), mandated and funded by the Social Security Administration, takes the responsibility for implementing the Transition Plan. VR law's intent is to ensure that "there is no gap in services between the education system and the vocational rehabilitation system. The VR will help gain access to equipment and services that are needed to implement this plan.

Q: What solutions are available for these young adults who typically lose their funding during this time because they pass the legal minor/juvenile age limit?

A: After age 21, a person with a disability is no longer under the IDEA umbrella. For those who need assistive technology beyond that provided by Medicaid and/or Medicare, following are some additional sources for funding, advocacy, and resource information:

State Vocational Rehabilitation programs and Independent Living Centers provide resources for accessing assistive technology. In addition to funding, they advocate for persons with disabilities.

National Assistive Technology Project, funded by the National Institute on Developmental Rehabilitation and Research (NIDRR), provides information as well as advocacy for adults with disabilities who are experiencing difficulties in accessing assistive technology.

Local charitable organization chapters, such as Rotary Club, Easter Seals, often assist with funding for assistive technology. Organizations for specific disabilities, such as United Cerebral Palsy, Multiple Sclerosis Association, National Spinal Cord Injury Association, can provide resources, advocacy, and information about obtaining equipment.

Some states have Assistive Technology Loan Guarantee programs that help by guaranteeing loans from private lending institutions to fund assistive technology. These programs are for persons ineligible for other assistance programs. Because the loans are guaranteed, interest rates are lower or the loan payback times are extended.

Q: What advice do you give to the 21 age group who might be denied coverage or only receive coverage for basic assistive devices?

A: The most important advice is that of self-advocacy. One should exhaust all of the resources mentioned above. It is also important to become active in the legislative process by writing letters and making calls to local representatives who may be willing to listen to and help with the concerns of their constituents.

Q: Have there been any new developments with funding issues for the adolescent?

A: There have been tremendous new developments with funding issues for all ages. As a result of the implementation of the Health Insurance Portability and Accountability Act (HIPAA), all payers in all states are required to use national Health Care Common Procedure Coding System (HCPCS) codes for reimbursement. State or "local" codes for durable medical equipment (DME) have been eliminated. Many new national codes have been established and others have been combined. As a result of this, fee schedules have inadequate maximum allowables for some equipment, making it inaccessible or difficult to obtain.

The Americans With Disabilities Act (ADA) prohibits job discrimination against workers with disabilities and has increased accessibility in the workplace. More recently, the New Freedom Initiative and Ticket to Work programs have increased accessibility to jobs and job training for persons with disabilities. These programs provide incentives to employers to hire persons with disabilities and offer support in the goal of furthering independence. These programs coordinate with the Vocational Rehab programs in increasing access to assistive technologies.

Q: Do you expect to see any changes down the road?

A: Because of tight budgets in every state, the changes that we expect to see are an increased focus on cost savings and increased scrutiny of recommendations for assistive devices. Documentation of medical necessity for equipment will be more crucial.

Spending of Medicare and Medicaid programs may be reduced in several ways:

1. Reduction of services: States may opt to reduce or eliminate the non-mandatory services included in their state Medicaid programs.

2. Reduction in coverage: Requirements for coverage may become more stringent. An example was the clarification of coverage for power wheelchairs thereby reducing coverage.

3. Changes in eligibility: Raising the income requirements for eligibility is another way to reduce costs.

Overall, the increase in mandates by programs enacted to increase access to jobs and the community are in conflict with the decreases in funding dollars. It remains to be seen how this gap is reconciled.

This article originally appeared in the May 2005 issue of HME Business.