Non-Traditional Funding Sources and Funding Strategies for Assistive Technology

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Non-Traditional Funding Sources and Funding
Strategies for Assistive Technology

• Creative Ways to Access Traditional AT Funding
• Sources, Some Little-Known AT Funding Sources
• and Funding Strategies

2010 Annual Conference of AT Act
Programs Presenter Diana M. Straube,
Esq. National Assistive Technology Advocacy
Project Neighborhood Legal Services, Inc.,
Buffalo, New York dstraube_at_nls.org
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Background

• AT Advocacy has traditionally focused on 5
• key funding sources
• Medicaid
• Medicare
• Special education programs
• State vocational rehabilitation programs
• Private insurance plans

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A Big Five Funding Source May Not be Available
Because

• Individual not eligible for program, or not
  eligible for special benefit within program
• Eligible for program, but AT device is not
  covered.
• Eligible for program, AT is covered by program
  BUT
• individual has not demonstrated need for the
  item under program criteria
• i.e., not medically necessary, educationally
  necessary, vocationally necessary, etc.

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Resolving the Big Five Funding Dilemma

• Identify way to make person eligible for program.
• Identify another program to fund device.
• Identify an available funding strategy to cover
  all or part of device
• Anti-discrimination laws, like Americans with
  Disabilities Act
• Use of tax provisions, like Flexible Spending
  Account

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Ensuring Eligibility for the Traditional,
Big-Five Funding Sources
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MedicaidSeveral Paths to Potential Eligibility

• Receipt of SSI automatic eligibility in 39
  states
• Medically needy or spend down category
• Home and community based services waiver
• Child Adopted -- federal Adoption Assistance
  Program
• Medicaid Buy-In for working people, more than 40
  states

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SSI for Child of Working Parent

• Darlene is a widow, with three children Chris,
  age 11 Carey, age 13 Jason, age 16
• Jason has cerebral palsy
• Jason gets SSI of 373 and automatic Medicaid
• Medicaid covers medications, speech therapy,
  10,000 power wheelchair, 8,000 communication
  device
• Keeping Medicaid is critical!
• State SSI rate is 674, with automatic Medicaid

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Jasons SSI Based on Darlenes Wages

• Darlene earns 33,000 gross, working 60 time
  (2,750 per month)
• Employer wants Darlene to increase hours
• 80 percent time -- 44,000 per year/3,667 per
  month
• 90 percent time -- 49,500 per year/4,125 per
  month
• Full time -- 55,000 per year/4,583 per month
• Jason will lose SSI if Darlene makes 3,495 per
  month.

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Four Strategies to Keep SSI and Medicaid

• Play it safe keep working 60 percent time
• Accept 80 percent time job if
• Employer pays Darlene 350 less
• Employer pays Darlenes 350 share for health
  insurance
• Darlenes taxable wages reduced to 3,317
• Jason eligible for SSI of 89 per month

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Four Strategies to Keep SSI and
Medicaid(Continued)

• Accept 80 percent time job if
• Employer offers Flexible Spending Account
• 350 deducted each month for health insurance
  payment
• Jason eligible for SSI of 89 per month
• Wait until Jasons 18th birthday to increase pay.

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Medicare Savings Plans QMB, SLMB, QI-1

• Qualified Medicare Beneficiaries program (QMB)
• State must pay Medicare deductibles, coinsurance
  and premiums (96.40), for nearly all disabled
  individuals (110.50 for newly eligible)
• Must have income at or below 100 percent of
  federal poverty level (FPL) (903 in 2009)

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Medicare Savings Plans QMB, SLMB, QI-1

• Specified Low-Income Medicare Beneficiaries
  program (SLMB)
• State must pay Medicare Part B premiums only
• Income between 100 and 120 percent of FPL (up to
  1,083 in 2009)
• Qualified Individual Program (QI-1)
• State must pay for Part B premiums only
• Income between 120 and 135 percent of FPL (up to
  1,219 in 2009)

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How QMB Helps Pay for AT

• If Medicare funds a power wheelchair at approved
  rate of 8,000
• Medicare pays 80 percent (6,400)
• Individual must pay balance (1,600)
• Medicaid would typically pay the 1,600
• If person not eligible for Medicaid or chooses
  not to pay a spend down
• Medicare pays the 6,400
• QMB pays the 1,600

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State Vocational Rehabilitation (VR) Agencies

• Financial Need Criteria General Rule
• VR agency may use financial need criteria for
  most of its services.
• E.g., college tuition, vehicles modifications,
  computers, and AT.
• Social Security, SSI Recipients Exempt from Needs
  Test
• With any amount of SSI or SSDI, eligible for VR
  services at no cost.
• Income/resources of parents, spouse do not count.

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VR Agencies and Financial Need Criteria The
Case of Ted

• Ted Receives 1,500 in Social Security Benefits
• This is too much to qualify for SSI.
• Also too much to qualify for states Medicaid
  spend down program
• Ted Automatically Meets the VR Agencys Financial
  Need Criteria
• The VR agency can pay for expensive AT, like van
  modifications, access ramps at home, or adapted
  computer equipment
• The agency cannot make Ted pay toward cost of
  items it provides.

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Alternative and Little Known Programs for
Funding AT

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Alternative Financing Programs(AFPs) - A Source
of Loans for AT

• An AFP can make a loan available by
• A revolving loan fund
• A loan guarantee
• An interest buy down

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The Most Common Items Purchased with Loan Funds

• Vehicles modifications
• Computers, costs for computer access
• Mobility equipment, such as wheelchairs, scooters
• Equipment for daily living, like environmental
  control devices
• Hearing aids, vision aids
• Home modifications
• See www.resnaprojects.org/AFTAP for AFP
  information in 40 States.

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AFPs - Advocacy Tips

• The AFP loan An excellent way to cover
  out-of-pocket costs related to AT purchase
• Amounts that exceed the payment limitations of
  private insurance
• The 20 percent co-payment required under Medicare
  Part B
• Any share of cost requirement charged by a state
  VR agency
• Any AT-related costs that exceed the amount
  available for purchases under an SSI Plan for
  Achieving Self Support (PASS)
• Amounts not otherwise covered by charity payments
• Through an appeal process.

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The Federal Adoption Assistance Program

• Help for parents who adopt a Child with Special
  Needs
• Includes cash assistance and other special
  services
• Assistance with AT Funding through Automatic
  Medicaid
• If child with special needs criteria met and
  adoption assistance agreement in effect (i.e.,
  a federal adoption)
• At state option if child receives state or local
  adoption assistance program

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The Federal Adoption Assistance Program

• Additional Payments for AT, at State Option, with
  State/Local Funds
• Covered through Minnesotas adoption program
• Specialized communications equipment
• Ramps
• An accessible shower, elevated bathtubs and
  toilets
• Blinking lights and tactile alarms as alternate
  warning systems
• Lowered kitchen work surfaces
• Disability-related modifications to a vehicle

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Related Benefits

• Kinship guardianship assistance payments when
  relative foster parent has chosen not to pursue
  adoption
• Foster care maintenance payments payments for
  food, clothing, shelter, daily supervision,
  school supplies, a child's personal
  incidentals,etc

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In NY, Foster Care Agency Paid for

• Van lift including installation, accessories and
  equipment
• Bathroom renovations
• Rehab wet vest for swimming
• Special recreational items (swing, beneficial for
  respiration)

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• Funding Strategies
• That Do Not Involve a Program That Funds AT In a
  Conventional Sense

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The Flexible Spending Account (FSA)Under Federal
Tax Law

• Known as flex plans, cafeteria plans or 125
  plans
• Employee contribution deduction from pay, pre tax
• Reduces taxable wages
• Types of expense covered
• Uncovered medical insurance premiums,
  co-payments, uncovered services, AT devices
• Non-medical child care, adoption fees, parking
  fees, public transportation costs

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Using Flexible Spending Account for AT- Back to
Darlene Jason Green

• Darlene Pays 350 Share of Insurance Premium
• Taxable income reduced by 4,200. Taxes reduced.
• Reduced income for SSI eligibility. Jason keeps
  SSI.
• By Keeping SSI, Jason Also Keeps Medicaid
• Medicaid pays for new wheelchair
• Medicaid pays for new communication device

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Creative Structuring or Restructuring of a Child
Support to Obtain or Retain SSI and Medicaid

• Purpose of Strategy is Twofold
• Disability-related and other needs met through
  the child support without decreasing the SSI
  amount.
• By obtaining or retaining eligibility for SSI, we
  ensure eligibility for Medicaid (in most states).
• Both support dollars and Medicaid can fund AT.

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Creative Structuring of Child Support- Back to
Darlene Jason Green

• Works 80 Percent Time, Earns 3,667 Per Month
• Wages reduced by 350 through FSA contribution.
• Jason gets 89 SSI check plus Medicaid.
• Jasons Dad to Pay 450 in Monthly Child Support
• SSI program would count two thirds, 300.
• Extra income makes Jason ineligible for SSI.
• Jason will also lose Medicaid.

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Alternative Child Support Settlement for Jason

• Darlenes Dilemma No Adequate Transportation
• Cannot afford van for travel with wheelchair.
• Drives used car. Two adults must lift Jason in
  and out of car.
• Instead of Cash, Dad Pays Directly to Vendors
• 400 to bank for loan on accessible van
• 50 to car insurance company toward 150 monthly
  insurance

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How Creative Child SupportAgreement Helps Jason

• Jason Keeps Same Amount of SSI
• Money paid to vendors not available for food or
  shelter
• Not counted by SSI
• Jason Keeps Medicaid
• Getting 1 or more in SSI keeps Medicaid in 39
  states.
• Medicaid pays for power wheelchair, communication
  device.
• Darlene Get Van and Insurance
• Child support arrangement makes it possible for
  Darlene to get a van with insurance to transport
  Jason.

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Thank you.

• Other materials available on each topic through
  National AT Advocacy Project. Contact Diana
  Straube (dstraube_at_nls.org).
• Check out National AT website (www.nls.org/natmain
  .htm)
• Materials by James R. Sheldon, Supervising
  Attorney
• National Assistive Technology Advocacy
  Project
• Neighborhood Legal Services, Inc., Buffalo, New
  York