Volume 12, No. 1, Winter 2004	Previous Issues Subscribe to AT Messenger Download PDF Viewer
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Home Modifications:
Essential but Difficult to Fund

Laura J. Waterland, Senior Staff Attorney Disabilities Law Program

It has been nearly four years since the Supreme Court affirmed in Olmstead that states have an obligation under the Americans with Disabilities Act to provide services for people with disabilities in the least restrictive environment. Many states have at least one of their feet on the community integration bandwagon, although many gaps in the service continuum remain.

States have conducted assessments of their service systems to identify barriers to community living for people with disabilities. One barrier that has been repeatedly identified, but that no one seems to want to "own," is the lack of accessible, affordable housing. Finding an apartment or house in which a person with disabilities can actually get in the door, much less function inside, remains a major hurdle to community integration. This lack of housing makes it difficult for people to move from institutions when they are ready, and makes it hard for people in the community to stay there when they find that they need accessible housing.

Yet, in many cases, relatively minor modifications can make an "inaccessible" house or apartment livable, if not "accessible." Home modifications are alterations that make a living space more livable. They may include minor items, such as shower grab bars, handrails, and lever handles; more expensive alterations may involve widening doorways, installing ramps, or removing high pile carpeting so that someone in a wheelchair can use the unit. Some individuals may need specially-designed appliances such as stoves and refrigerators, environmental control systems, or accessible shower units.

Many modifications are inexpensive. For example, lowering a peep hole on a door for a person using a wheelchair can cost around $50. Installing remote control devices on light switches costs as little as $100. Grab bars cost approximately $25; add the labor and the cost is still under $100. A portable ramp costs around $300.

With these modifications, a fundamental barrier to community living is removed. The problem, as always, is money. Who pays for these modifications? Private funds, of course, are always an option, but what if the person has limited resources?

Make the landlord modify the unit (or at least let you do it)

Unfortunately, in most rental situations, a landlord cannot be made to modify a unit (1). Generally, if a unit in a multi-family dwelling has been built or substantially renovated since 1991, and if it is a first floor unit or on an upper floor served by an elevator, the unit should contain features of accessible design mandated by the Fair Housing Amendments Act and Section 504 of the Rehabilitation Act. Local building codes now contain similar requirements. If you find yourself in such a unit and it has not been properly designed, you would be within your rights to ask the owner or landlord to make accessibility modifications. If the request is refused, your only real recourse would be to sue, and that can take time that you don't have.

State and federal fair housing laws do require landlords to allow you to make modifications to make a unit accessible at your expense. The landlord can, within reason, express an opinion on the type of modifications to be made, and can require you to return the unit to its original state at your expense at the end of the tenancy. Refusal by a landlord to allow a tenant to make modifications is actionable discriminatory conduct.

If you live in housing funded by the federal government (2) , in some circumstances you can ask the housing authority or project owner to pay for needed modifications as a reasonable accommodation under Section 504 of the Rehabilitation Act. The housing authority or project owner, as a "federally assisted housing provider," is required to bear costs which do not amount to an undue financial and administrative burden.

Ask Delaware Medicaid to pay for modifications

Traditional Medicaid, and many private insurers, won't pay for home modifications because they are perceived as being a "non-medical" service. Most states, including Delaware, have taken advantage of the Medicaid Home and Community Based Services Waiver (HCBW) Program authorized by Congress (3). Waiver programs allow states to offer traditionally non-medical services (i.e., home or environmental modifications, case management, homemaker services, transportation, habilitation, and respite care) to people in the community who would otherwise qualify for institutional care, in exchange for the federal government suspending some of its requirements for Medicaid programs, such as statewideness and comparability. Many individuals with disabilities who are transitioning out of nursing homes use the home and community based waivers to facilitate community placement. Without the waiver, living in the community would be impossible for many.

" Environmental accessibility adaptations" is actually a "tick off" item on the standard HCBW application form, and is clearly contemplated by Centers for Medicare and Medicaid (CMS) as an appropriate service in waiver programs. According to the "Overview of State Home and Community Based Services Waivers" on the CMS website (www.cms.gov/medicaid/1915c/agedphysdis.pdf), the vast majority of states that participate in the waiver provide this benefit. Delaware does not, and this is extremely unfortunate. Delaware is one of very few states in the country that have chosen not to include home modifications in their waiver programs (4).

Looking to neighboring states, New Jersey, Maryland, and Pennsylvania all provide a home modification benefit as part of their HCBW programs. For example, Maryland provides up to $5,500 per participant annually for environmental accessibility adaptations and assistive technology. Adaptations include lifts, ramps, visual alarms, widening of doors, grab bars, and many others. Pennsylvania, in several of its waivers, provides up to $10,000 per Medicaid recipient per site for home modifications.

Smaller states, perhaps more comparable in size to Delaware, also provide funding for modifications through their waivers. For example, Rhode Island pays for "minor home modifications," which include environmental controls, lifts, ramps, and grab bars. Idaho (similar population to Delaware) covers ramps, lifts, modifications of bathrooms and kitchens, and widening of doors. Idaho will pay for permanent modifications for owned residences, and temporary modifications to rental units.

Obtain a grant from another state agency or non-profit agency

The Division of Services for Aging and Physical Disabilities (DSAAPD) has very limited state funding for modifications to permanent residences, and will not pay for modifications to rental properties. There is a $10,000 lifetime cap for modifications. Although DSAAPD maintains a waiting list, funds are sometimes expended within the first few months of the fiscal year. Contact DSAAPD at (800) 223-9074.

The Delaware Division of Vocational Rehabilitation's Independent Living Program (DVR) has funds to pay for home modifications. As is the case with DSAAPD's program, DVR maintains a waiting list and demand far exceeds the funds available. DVR will pay for modifications to rental properties under some circumstances. Individuals must meet the eligibility criteria for the program. Contact DVR at (302) 378-5779.

Delaware-Maryland Paralyzed Veterans (PVA) runs a home modification program. The PVA has an application process and frequently runs out of funds. PVA strongly prefers homeowners for its program and prioritizes modifications for children with disabilities. Contact PVA at (800) 786-2039.

Christmas in April's Rebuilding Together Program operates a volunteer home rehabilitation program, which includes home modifications for low-income homeowners, including those with disabilities. Contact Christmas in April at (302) 655-5488.

Borrow the money

Several government agencies and local governments operate low interest loan programs that make funds available for renovations and home modifications. Federally, these include the Veterans Administration's Specially Adapted Housing Program (www.homeloans.va.gov/sah.htm) and the Home Repair and Loan Program of USDA Rural Development (http://www.rurdev.usda.gov/de/housing.htm). Contact the USDA Rural Development at (302) 697-4353.

The Delaware State Housing Authority administers federal Community Development Block Grants under its Housing Rehabilitation Loan Program. They provide low interest (3 percent) loans to low income Delawareans who own their homes, or landlords who rent to low income tenants. The loans must be used to rehabilitate homes or make them accessible. This program is not available to tenants. Visit www2.state.de.us/dsha/hrlp.htm or call (302) 577-5001 for more information.

The City of Wilmington administers the Community Development Neighborhood Rehabilitation Program, which provides home improvement loans for low to moderate income homeowners with disabilities to rehabilitate their properties (www.ci.wilmington.de.us/departments/housing.htm). Contact them at (302) 576-3000. Likewise, New Castle County Department of Community Affairs administers a Housing Rehabilitation Program that includes grants for emergency repairs and a low interest loan program for homeowners to make major renovations. For more information call (302) 395-5614. As always seems to be the case, money runs out quickly and the County maintains waiting lists. Dover's program is through the Department of Community Development at (302) 736-7175.

This patchwork of limited resources for home modifications is both inefficient and insufficient. Providing an opportunity for livable, affordable shelter for people with disabilities is a fundamental element of successful Olmstead compliance and the development of viable community living options. Delaware would be wise to rethink its reliance on this hodgepodge approach to providing resources for home modifications and begin by adding a home modification benefit within its home and community-based waiver programs.

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(1) If you own your home, you may still need to get approval from a homeowners' association and permits from local authorities, depending on the work being done. State and federal fair housing laws require homeowners and condominium associations to reasonably accommodate owners with disabilities, and to waive unreasonable restrictions that prevent an owner from making necessary changes to their properties.

(2) This would include public housing, federal low income tax credit housing, and project-based assistance, but not landlords participating in the Section 8 Voucher Program.

(3) One advantage of using Medicaid to fund home modifications is that Medicaid is a partially federally-funded program, with the state only paying 50 percent of the cost.

(4) Delaware's Division of Developmental Disability Services actually removed home modifications from its waiver program. Delaware's Division of Services for Aging and Physical Disabilities (DSAAPD) initially chose to include home modifications in its Acquired Brain Injury Waiver but then changed its mind. If a small, one time expenditure on a home modification can accelerate the transfer of a person from an institution, where the state is paying for all of the person's expenses, to the community and where housing and other costs will be paid for by someone else, how can it be cost-effective or good policy to refuse to pay for these services?