Work, Assistive Technology, and Transition-Aged Youth

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. 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. 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 3

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

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

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

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. 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. 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. 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

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. 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. 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. 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

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. 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. 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. 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. 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

24. 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

25. 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?

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. 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. 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. 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. 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”?

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

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. 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

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