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Work, Assistive Technology, and Transition-Aged Youth. Funding for Work-Related Assistive Technology Through Special Education Programs, State Vocational Rehabilitation Agencies, Medicaid, Medicare and SSI’s Plan for Achieving Self Support March 17, 2009. National Disability Rights Network - PowerPoint PPT Presentation
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Work, Assistive Technology, and Transition-Aged Youth
Funding for Work-Related Assistive Technology Through Special Education Programs, State Vocational Rehabilitation Agencies, Medicaid, Medicare and SSI’s Plan for Achieving Self Support
March 17, 2009
National Disability Rights Network2009 Annual Conference
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Presenters….
James R. Sheldon, Jr., Esq.National Assistive Technology Advocacy Project
Steven Elliot, Esq.Advocacy, Inc.Austin, Texas
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Purpose of Session
• Look at transition – From high school to college– From college to work
• Look at expected AT needs
• Look at several funding sources
• Age 17, cerebral palsy
• High school junior
• Regular classes – OT, PT, speech
• Resides with mother, stepfather, brother $420 Social Security Survivors benefits Not eligible for SSI or Medicaid
Wants to Attend Cornell
• Ithaca, NY – hilly community and campus
The Case of Sharon
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Power Wheelchair Needed
• Current lightweight chair
• Cannot self propel long distances
• Cannot self propel on hills
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AAC Device Needed
• Speech not easily understood
• Current device 7 years old
• Constantly in for repairs
• Hard to find parts
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Laptop Computer Needed
• Difficulty writing
• Special education funds note taker
• 6 year old home computer – adapted keyboard
• Recommended – voice input software -- dual-purpose laptop/AAC device
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Ceiling Track Lift Needed
• Has traditional hydraulic lift– Transfers from bed– Transfers in bathroom
• Mom struggles to operate
• Ceiling track is safer, more efficient
• Can leave home for college
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Access Ramp Needed
• Stairs an issue when leaving home
• Two long planks currently used
• Two persons needed to guide wheelchair
• Planks not realistic with power wheelchair
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Wheelchair Van Needed
• Evaluation – Sharon can drive
• Needs modified van– Hydraulic lift– Wheelchair lock down– Hand controls
• Transportation– To school– Later, to work
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Special Education – Eligibility for Services
• Disabled and requires special education services
• Must need special education to qualify for related services
• Services pursuant to IEP
• Services must ensure “educational benefit”
• Education in least restrictive environment
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Special Education – Eligibility for AT
• AT device, AT service defined in IDEA
• Key questions– Needed for educational progress– To remain in least restrictive setting– Prepare for adult life
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Special Education – Sharon’s Eligibility for AT
• AAC Device – can be funded– To communicate with teachers, peers– Software, training can be funded– Home use allowed to ensure benefit from AT
• Laptop computer – can be funded– Meet increased homework demand– Prepare for transition to college
Ownership an issue with both items
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Special Education – Sharon’sEligibility for AT
• Ceiling track lift, access ramp, modified van– Special education not responsible– No direct connection to education– Not needed to “prepare for” college
• Power wheelchair– Can pay for mobility equipment in some cases– Can meet needs in school with current wheelchair
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Vocational Rehabilitation Agency– Eligibility for Services
• Disability interferes with ability to work
• VR services needed to:– Prepare for,– Secure,– Retain, or regain employment
• All services must be connected to work goal
• Must help “maximize” employability
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VR Agency – Eligibility for AT
• AT must be necessary to achieve work goal or benefit from other VR service
• Broad range of AT devices available– Prosthetic devices– Specialized transportation– Vehicle modifications– Adapted computer equipment– Home modifications if necessary to benefit
from VR program
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Vocational Rehabilitation –Financial Need Criteria
• State option to have needs test• Most services subject to financial need• Exempt from financial need criteria:
– Diagnostic services– Counseling, job placement– Personal assistance, interpreter, reader
services
• SSDI, SSI recipient automatically meets financial need criteria
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VR Agency – Sharon’sEligibility for AT
• Financial Needs Test– Sharon eligible for SSDI and SSI at age 18– Will then be exempt from financial needs test
• Power wheelchair, AAC device– Technically, both can be funded– Both needed to succeed at work goal– Practical issue – Medicaid or Medicare should
fund
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VR Agency – Sharon’s Eligibility for AT
• Laptop with accessories, access ramp– Funded if necessary to success of VR plan
• Ceiling track lift– She has argument if necessary to get her out of home
to attend school– Mechanical equivalent of personal assistance
services which are covered
• Vehicle purchase, modification– A few states authorize lease or purchase– Modifications clearly covered
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Medicaid – Eligibility for Program
• SSI recipient – Medicaid automatic in 39 states, District of Columbia
• Medicaid spend down – available in two thirds of states
• Medicaid buy-in – special program for workers with disabilities, 43 states
• Medicaid waivers – optional program, may ignore income/assets of spouses, parents
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Medicaid – Eligibility for AT
Must be Covered Service• Mandatory services
– Durable medical equipment
• Optional categories covering AT– PT, OT, speech– Prosthetic devices– Rehabilitation services
• EPSDT – for kids under 21– All optional services available
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Medicaid – Eligibility for AT
Must be Medically Necessary
• No federal definition
• Look for state’s definition/criteria
• Services available to help “attain or retain … capacity for independence or self-care.”
• EPSDT standard, for kids under 21, is to “correct or ameliorate”
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Medicaid – Sharon’sEligibility for AT
Medicaid eligibility
• At age 18, Sharon will be eligible for SSI
• In 39 states and D.C., Medicaid will be automatic
• Power wheelchair, AAC device– Should be covered in every state if medically
necessary
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Medicaid – Sharon’sEligibility for AT
• Ceiling track lift– Could be covered as DME– Less costly, equally effective alternative
available?
• Access ramp– Will be challenge to fund– Should meet DME criteria
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Medicaid – Sharon’sEligibility for AT
• Laptop computer– Hard to get funded– Useful in absence of illness or injury– “Dual purpose” AAC device/laptop may be
solution
• Van, van modifications– Challenge similar to laptop– Less expensive than van transport?
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Medicaid Waiver Can Fund AT
• All states will have HCBS waivers
• Waivers targeted to specific groups
• Limited enrollment
• Wide range of AT possible
• See www.nls.org/av/fall07.pdf
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Medicare – Eligibility for Program
• Persons age 65 or older
• Persons receiving Social Security Disability Insurance
• Persons receiving Railroad Retirement disability benefits
• Persons with end stage renal disease
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Medicare – Eligibility for AT
AT covered in Part B as DME
• Four-part criteria
• Must be needed “in the home”
• Some items excluded
• Part B premiums ($96.40 most cases)
• 20 percent co-payment
• QMB can cover premiums, co-payments
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Medicare – Sharon’s Eligibility for AT
• Power wheelchair– Covered, but “in the home” criteria– Sharon’s only need outside the home?
• AAC device– Covered as “speech generating device”
• Ceiling track lift– Covered under new Local Coverage
Determination
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Medicare – Sharon’sEligibility for AT
• Laptop– Not “primarily and customarily” used for
medical purpose– Dual purpose device?
• Van, van modifications– Not for use “in the home”
• Access ramp– Is it for use “in the home”?
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SSI’s Plan for Achieving Self Support - Eligibility
General criteria for PASS:
• Income or resources other than SSI
• Plan to spend on vocational goal
• Written PASS plan
• Approved by Social Security Administration
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AT Available with a PASS
• Modifications to home, office• Customized desk• Computer
– Special keyboard– Enhanced screen
• Software– Screen reader– Dictation software
• Vehicle modifications
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Sharon’s Use of PASS
PASS proposal:
• Goal to be attorney
• $400 of SSDI saved monthly for van
• If approved, VR agency will pay for modifications
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Sharon’s SSI Budget with PASS
Currently receives SSI of $274 ($674 – 400 SSDI counted).
New budget: $420 SSDI- 20 Disregard- 400 PASS exclusion$ 0 Counted
New SSI rate: $674
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Sharon’s Benefit from PASS
• Save $19,000 for van
• Leverage $15,000 or more from VR agency for modifications
• Keeps same income for living expenses
• Retains Medicaid (most states)
• Extra PASS money not counted– By subsidized housing– By food stamp program
Thank you….
Other materials available on each topic through National AT Advocacy Project. Contact Jim Sheldon ([email protected]).
Check out National AT website (www.nls.org/natmain.htm)
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