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

August 7, 2009
Midnight Sun Assistive
Technology Conference
Anchorage, Alaska

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Presenter….

James R. Sheldon, Jr., Esq.

National Assistive Technology
Advocacy Project
Neighborhood Legal Services, Inc.
Buffalo, New York
jsheldon@nls.org

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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

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 The Case of Sharon
• 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

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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’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

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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’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
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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’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
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 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

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 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?

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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’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”?

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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
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Thank you….

 Other materials available on each topic through National AT

Advocacy Project. Contact Jim Sheldon (jsheldon@nls.org).

 Check out National AT website

(www.nls.org/natmain.htm)

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