Vol. 1, No. 1 July/August 1993	Previous Issues Subscribe to AT Messenger Download PDF Viewer
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Assistive Technology Funding for Children with Disabilities

Ron Sibert, DATI Funding Specialist

These are exciting times for children with disabilities. Assistive technology (AT) can enable many to learn and participate more fully in activities with their nondisabled peers. While not all AT is expensive, paying for devices and services is still a common concern. Resources are out there. Getting to them is just a matter of understanding and working within the appropriate system. Described here are two major AT funding streams for children and adolescents with disabilities: Medicaid and the School System.

Medicaid/ EPSDT

The Medicaid program was created under Title XIX of the Social Security Act “to provide assistance to states to furnish medical assistance on behalf of families with dependent children and of aged, blind or disabled individuals whose income and resources are insufficient to meet the cost of necessary medical services”. People who know that Medicaid exists also know that it is a “means [or income] tested” program; that is, eligibility depends on one’s limited income and inability to pay for medical care.

Many families with disabled children will actually forego the program’s medical benefits because they don’t want to be regarded as poor. The fact is that some families whose incomes may qualify them for Medical Assistance do not apply for it because it seems like “welfare”. Also, families whose incomes fall above the poverty level believe that their children with disabilities do not qualify for Medicaid benefits. Many children with disabilities can qualify for Medicaid regardless of the family’s income level. Once it has been established that a child is disabled, the child may qualify for Medicaid either because of that disability or due to lack of personal income. In such instances the child’s income, which is usually modest or nonexistent, is considered independent of the family’s income. This, is called the MEDICAID OPTION FOR DISABLED CHILDREN. Use this term when inquiring about eligibility.

Every state that participates in the Medicaid program receives matching funds from the federal government. In Delaware, the match is 50 cents on the dollar. That is, the Federal Government reimburses the State for 50% of the funds spent on providing Medicaid services. Each state must file a state plan detailing the services covered under its Medical Assistance (Medicaid) program. Some of these services are mandatory and others are optional. That is, participating states are required to provide some Medicaid services, and can choose whether or not to provide others. The durable medical equipment (DME) funding component of the program (the part that would pay for assistive technology devices) is an optional service. However, that distinction need not be a concern for younger age groups because Medicaid eligible children with disabilities are not bound by state plan service restrictions under the Medicaid’s Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program. EPSDT is a mandatory service for Medicaid eligible children from birth through age 21. Because of its comprehensiveness, it has been referred to by some as the “gold card” of medical service coverage for children with disabilities. Under the “treatment” part of EPSDT, Medicaid will pay for medically necessary equipment (DME) and services that are covered under Title XIX, even if the equipment and services are not specifically listed in the state plan.

The only catch is, like with most other insurances, equipment purchased by Medicaid must be “medically necessary” and prescribed by a physician. Now exactly what does medical necessity mean?

Let’s say a child who is both deaf and blind needs an Arkenstone reader - a device that can scan written materials and translate those materials into braille. The child needs this device in order to read and communicate. Are reading and communicating medically necessary? Think about it. If you were unable to communicate would you be able to make your doctor understand your illness well enough to obtain adequate medical care? Not likely. Does an augmentative communication device replace a function which is absent due to a disability? Of course it does. That communication device is just as medically necessary as a wheelchair is for a person who is paralyzed from the waist down. Both types of devices replace a function that is diminished due to a diagnosed disability.

Of utmost importance is the language that is used to document medical necessity. The prescribing physician should explain how the patient’s impairment/illness affects the ability to function, and how the prescribed device would improve the situation. Delaware Medicaid requires a complete description of the prescribed device (i.e., price, brand, and model number) and the specific features that make that particular item the most appropriate to meet the individual’s needs. Comparing it to similar, less expensive products is also advisable. It will speed up the processing of the claim. If there is other insurance coverage, all claims should be submitted at the same time to avoid delays. Medicaid is the “payor of last resort” and will therefore require written denials from other insurers before purchasing any equipment or services.

Schools

Besides Medicaid, schools are another major funding source for assistive technology for children and adolescents with disabilities. According to Public Law 101-476, the Individuals with Disabilities Education Act (IDEA), every child with a disability is entitled to a Free Appropriate Public Education (FAPE) in the Least Restrictive Environment (LRE). FAPE includes Special Education Services for children with disabilities. Because AT can accommodate functional needs that impact learning and education of children with disabilities, it must be considered a component of Least Restrictive Environment and Free Appropriate Public Education.

In order for a school district to pay for equipment, it must be deemed a part of Special Education, Related Services, or Supplementary Aids and Services. Above all, the equipment must be EDUCATIONALLY NECESSARY. Here again, note the importance of wording in the equipment justification. It should always be tailored to the funding source. So how are assistive technology needs documented in Special Education? According to IDEA, every child who receives special education or early intervention services must also have its amount, duration and scope documented in an Individualized Education Program (IEP) for Special Education or an Individualized Family Services Plan (IFSP) for Early Intervention. If a child needs assistive technology devices or services to compensate for an educational deficit, and that need is documented on the IEP, the school district must provide that device or service. The law requires it.

Parents have the right to participate in the IEP’s development at a meeting convened for that purpose. Children with disabilities have the right to assessments in which AT is considered. At the IEP meeting the parent and child also have the right to be represented or accompanied by any advocate, clinician, or technology expert they choose. Parents may also appeal any decision made at the IEP meeting through due process; but schools and parents need not be adversaries. A great deal can be accomplished with cooperation.

The incorporation of technology into educational programs is a challenge that must be shared by consumers, schools, and service providers. For example, assistive technology device recommendations should always be based on thorough professional evaluations and assessments of individual needs. No device should be selected solely because of its price, attractiveness or prevalence in the marketplace. The usefulness of a device is not a function of cost or popularity; it is a question of the individual’s unique needs.

Finally, school districts in Delaware are approved Medicaid/EPSDT providers. Recall that assistive technology devices, as well as necessary assessments and evaluations, may be charged to the State’s medical assistance program - if they are shown to be medically necessary. This would significantly offset the cost of equipment and related services incurred by the schools. While school districts cannot require parents to apply for or divulge existing Medicaid coverage, it may be in the child’s best interest for them to do so. Why? Because if the school district pays for the equipment, it is the school district’s property; but if it is purchased by Medicaid, the device belongs to the child.

New legislation and increased awareness is challenging parents, schools, state agencies and service providers to work together to meet the technology needs of children with disabilities. There is every indication that it can and will be done...with persistence, a little resourcefulness, and a lot of cooperation.