Delaware Assistive Technology Initiative

	Vol. 9, No. 3 Summer 2001	Previous Issues Subscribe to AT Messenger Download PDF Viewer
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Frequently Asked Questions:
Policy and Funding Issues

by Beth Mineo, DATI Director

DATI staff members receive many calls related to funding for AT devices and services. People want to know whether AT is covered under their insurance plans, school or employment programs, or other benefits programs. They also want to know the steps they need to follow to take advantage of potential funding options.

We thought it would be helpful to share some of the most frequently-asked questions with our readers because—chances are—you are likely to have wondered about the same things.

QUESTION: Medicaid purchased my child’s augmentative communication device, which is now broken. Who is responsible for paying the cost of the repair?

ANSWER: If your child is still a Medicaid beneficiary, Medicaid will cover the cost of the repair. Depending on the cost, you may need to secure prior approval first. If the device is also written into your child’s IEP because the device is an important part of his education, the school also has an obligation to ensure that your child has access to a working device.

QUESTION: My insurance company refuses to pay for my child’s hearing aid, claiming that the policy doesn’t cover hearing aids. Do I have any recourse?

ANSWER: Your first course of action is to make sure that you have two documents from the insurance company: a written Denial of Benefits containing the specific reason for the denial, and a copy of your policy coverage manual. The Denial of Benefits statement must tell you why your request was refused, and that will dictate your response. It may be something as simple as the omission of a physician’s signature on the Letter of Medical Necessity, which can easily be remedied. If the insurance company indicates that your claim has been denied because a particular device or service is not a covered benefit, read your coverage manual carefully. You may find that the item in question is indeed covered, and you will need to bring this to the insurance company’s attention. All insurance companies have appeals processes in which beneficiaries may request reconsideration of a denial based on additional information or on clarification of the request or the policy. Follow your insurance company’s procedures for appeals precisely, and make sure that all communication between you and the insurance company is documented in writing. If they inform you of a denial over the phone, ask for it to be sent to you in writing, with the reason for the denial clearly stated.

QUESTION: I’ve heard that Medicaid will cover the cost of many AT devices, but that it is near impossible to get the cost of an AT evaluation or follow-up training paid by Medicaid. Is this true?

ANSWER: It depends on your circumstances—your age, your disability, and what type of services you need. For example, augmentative and alternative communication (AAC) training is typically provided by a speech/language pathologist. If you are eligible for speech therapy services under Medicaid, this affords you access to AAC services as well. Individuals under the age of 21 have access to a very broad array of services; the menu of services look somewhat different for an adult, or someone covered under one of the many Medicaid waiver programs. Contact Delaware Medicaid or DATI to discuss how this impacts your own situation.

QUESTION: We have used our savings to purchase a laptop computer for our child who has severe fine motor disabilities and is unable to write. He needs to use the computer at home to do his homework. The school principal refuses to allow him to bring it to school because she claims that the school cannot be responsible if it is damaged. Is there anything I can do?

ANSWER: If your child needs an AT device to benefit from his educational program, it should be written into the IEP. The Office of Special Education Programs in the U.S. Department of Education has issued a policy letter on the subject of school liability for family-owned devices. The letter states: “If a child needs assistive devices to benefit from his education program, the school is liable for a family-owned device used at school.” Conversely, federal special education regulations also indicate that the school may be responsible for providing AT in the home, or other settings, if the IEP team determines, on a case-by-case basis, that the student will need AT in that setting to receive a Free Appropriate Public Education (FAPE). 34 C.F.R. Sec. 300.308.

QUESTION: I am aware of my rights to access AT, but I can’t get the funding agency to comply with its own guidelines. What recourse do I have?

ANSWER: Although this is an incredibly frustrating situation to be in, you may have several options for help. DATI staff are familiar with most funding streams and can help you devise and implement a strategy for breaking through the barriers you’ve encountered. Another option is to pursue a legal remedy. Delaware’s Protection and Advocacy (P&A) agency, Community Legal Aid Society, Inc., gets funds allowing them to handle assistive technology cases. Be sure to ask for the AT attorney when you call the P&A office. The number in New Castle is 575-0660, in Dover 674-8500, and in Georgetown 856-0038.