It’s a question we hear often: Does my state cover assistive technology?
It’s not a surprising question: Working through pages and pages of waivers and other documents can make you feel like you are working in the dark.
As we work with providers, clients, families, and loved ones, most want to know if Medicaid funding can be used to implement assistive technology – and specifically, to use that technology to promote independence as a part of a life in the community.
The short answer to the question? Yes.
According to federal mandates about providing supports to people with disabilities, all states should be including community supported living (CSL)* as a residential option for people with disabilities.
As part of CSL, states and providers are beginning to see the value of integrating enabling technology into the natural support system. From simple plug-and-play devices like medication dispensers to sophisticated systems such as wireless smart home technology, individuals are benefiting from using assistive technology in their daily routines.
The long answer to the question? Maybe.
Due to the history** of these federal mandates regarding CSL, this is actually a rather complex question. Currently, Medicaid and its waivers are evolving very rapidly. The funding that is available for residential enabling technology varies from state to state.
Additionally, some waivers consider very specific devices (such as a PERS or a Dynavox) to be assistive technology, but have not been broadened to include assistive technology as defined in the Assistive Technology Acts of 1988, 1998, and 2004: “Any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.”
Although it can be confusing, there are several tools you can use to find out what’s happening with assistive technology in your state.
To find out if your state's waivers cover Assistive Technology:
2. Select your state and read the waiver descriptions. Here is one example from North Carolina.
3. As you read through the descriptions, look for:
- Assistive technology: What’s covered and how much funding is available
- Timeline: The time period that the waiver includes (usually 3-5 years)
- Population: The individuals that qualify to apply for the waiver.
- Services: Coverage of any additional fees such as monthly service fees associated with the technology.
To find out what technology is covered under the term “Assistive Technology” in your state’s waiver:
Ask questions of your local care coordinator and state CMS office:
- How has the term “assistive technology” been interpreted in the past?
- Does it include both stand-alone items (such as a medication dispenser) that support one task (such as taking medication safely) and systems that promote a more complete vision of independence for the individual?
- Does it include assistive technology that promotes residential independence, such as sensor-based systems that work as a natural support?
Applying for Funding:
- Contact your state’s CMS (Center for Medicaid Services) office to determine the process of applying for funds through the specific waiver that mentions assistive technology.
- Work with your local care coordinator (or the entity they work for) to collect the information you need to make an application.
What if my state isn’t quite there yet in terms of Medicaid waivers?
There are other sources of funding for assistive technology besides waivers:
1. Some states have their own Assistive Technology programs – and their websites may list “Sources for AT Funding.”
2. Many private foundations are eager to partner with programs that promote more independence, choice, and quality of life for people with disabilities.
3. Some disability-specific agencies, such as UCP, Autism Society, or the Down syndrome Association, may have opportunities for funding technology.
Some of the agencies we work with have initially funded their assistive technology programs through private grants, and then taken the results of those projects back to the state, convincing them that assistive technology truly does make a difference, both in people’s lives and in funding the kind of support they want and need.
What We Know for Sure: It’s Cost-Effective and It Works!
States have begun to apply community supported living (CSL) success stories to their considerations for Medicaid funding. How they define "assistive technology" and interpret "community supported living" is creating new opportunities and new legislation in several states. The infographic below highlights a few examples of how enabling technology is becoming a widely accepted natural support for those who want to live more independently.
*What is Community Supported Living?
In community supported living (CSL), the individual is integrated into the community; the individual gets to select the supports; the rights of privacy, dignity, and freedom from restraint are ensured; and the individual’s independence and self-determination are facilitated and optimized.
**Curious about the history of this legislation? Read on...
In the education-focused Assistive Technology Acts of 1988, 1998, and 2004, assistive technology was defined as “…any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.” These particular laws were written for the purpose of equipping schools and students with disabilities with the equipment they needed.
In 1999, however, the Olmstead decision by the U.S. Supreme Court ruled that the integration mandate of the American with Disabilities Act requires public agencies (not just schools, but now also residential services for people with disabilities) to provide services "in the most integrated setting appropriate to the needs of qualified individuals with disabilities."
This decision eventually led to the establishment of Home and Community-Based Services (HCBS), the requirements of which were spelled out in the Final Rule in 2014. Because of the Final Rule, providers must enable their clients who receive services to live in a context and manner of their own choosing, as the result of person-centered planning.
One way providers try to attain this outcome is to have staff onsite around the clock. This both limits the individual who is ready for more independence, and is incredibly expensive due to 24/7 staffing costs (not to mention challenging because of the shortage of DSP’s).
Some providers, however, have realized that using technology as a natural support for clients leads both to greater independence for the client and sustainable funding and staffing models. You can read some of these providers' stories here, here, and here.
Want to learn more? Get in touch.