1. 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 2009 Annual Conference 1

2. Presenters…. James R. Sheldon, Jr., Esq. National Assistive Technology Advocacy Project Steven Elliot, Esq. Advocacy, Inc. Austin, Texas 2

3. 3 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

4. 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 3

5. 5 Power Wheelchair Needed Current lightweight chair Cannot self propel long distances Cannot self propel on hills

6. 6 AAC Device Needed Speech not easily understood Current device 7 years old Constantly in for repairs Hard to find parts

7. 7 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

8. 8 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

9. 9 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

10. 10 Wheelchair Van Needed Evaluation – Sharon can drive Needs modified van –Hydraulic lift –Wheelchair lock down –Hand controls Transportation –To school –Later, to work

11. 11 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

12. 12 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

13. 13 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

14. 14 Special Education – Sharon’s Eligibility 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

15. 15 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

16. 16 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

17. 17 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

18. 18 VR Agency – Sharon’s Eligibility 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

19. 19 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

20. 20 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

21. 21 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

22. 22 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”

23. 23 Medicaid – Sharon’s Eligibility 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

24. 24 Medicaid – Sharon’s Eligibility 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

25. 25 Medicaid – Sharon’s Eligibility 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?

26. 26 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

27. 27 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

28. 28 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

29. 29 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

30. 30 Medicare – Sharon’s Eligibility 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”?

31. 31 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

32. 32 AT Available with a PASS Modifications to home, office Customized desk Computer –Special keyboard –Enhanced screen Software –Screen reader –Dictation software Vehicle modifications

33. 33 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

34. 34 Sharon’s SSI Budget with PASS Currently receives SSI of $274 ($674 – 400 SSDI counted). New budget:$420SSDI - 20Disregard - 400PASS exclusion $ 0Counted New SSI rate:$674

35. 35 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

36. Thank you….  Other materials available on each topic through National AT Advocacy Project. Contact Jim Sheldon (jsheldon@nls.org).jsheldon@nls.org  Check out National AT website (www.nls.org/natmain.htm) 39