Medi-Cal Funding • Eligibility: • A state and federally funded program for individuals with limited income and resources. Medi-Cal pays for medically necessary treatment services, medicines, durable medical equipment, and medical supplies. It covers people with disabilities who meet its income and resource rules.
Medi-Cal Funding • Coverage: • Medically necessary is defined as those services, medicines, supplies and devices necessary to protect life, to prevent a significant illness or disability, or to alleviate severe pain.
Medi-Cal Funding Also provides: The Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) federal program that provides additional benefits to children and youth under age 21 using a commonsense medical necessity definition rather than the adult definition.
Medi-Cal Funding • Note: • Puts assistive technology in a number of categories. For example it may be called medical supplies, durable medical equipment, or a prosthetic device. • Medi-Cal recipients can now get augmentative and alternative communication (AAC) devices and services. • Will only pay for the least expensive item that meets your medical needs.
Medicare Funding • Eligibility: • Medicare is a federal health insurance program for people who are elderly or who have disabilities and also receive Social Security benefits.
Medicare Funding • Coverage: • When Medicare covers assistive technology devices and services, it will generally be under Part B (outpatient services). Part B services include: • Comprehensive outpatient rehabilitation facility services; • Physical and occupational therapy; • Speech pathology services; • Prosthetic devices; and • Durable medical equipment (DME).
Medicare Funding • Coverage: • Medicare will only pay for services and equipment that it finds to be reasonable and necessary. • If the carrier finds a less expensive appropriate alternative device, it will limit payment to the reasonable charge for that device. • Medicare generally requires that you purchase equipment first and then seek reimbursement.
Medicare Funding • Durable Medical Equipment: • Medicare says that DME is equipment which: • Can withstand repeated use; • Is primarily and customarily used to serve a medical purpose; • Generally is not useful to you in the absence of an illness or injury; • Is appropriate for use in the home; and • Is necessary and reasonable to treat an illness or injury, or to improve functioning. • All of these elements must be satisfied before Medicare will cover an item of DME.
CCS Funding • Eligibility: • California Children’s Services (CCS) is a statewide health program for children under the age of 21 who have severe medically disabling conditions, and whose families have adjusted gross income of less than $40,000. • To receive CCS services, a child should be a California resident. The immigration status of the child and the parents is not considered. • Anyone, including the child’s physician, can make a referral to CCS for services.
CCS Funding • Coverage: • CCS provides medically necessary services, equipment, tests and drugs related to a child's CCS-eligible condition. • Equipment includes durable medical equipment such as wheelchairs and crutches, medical supplies, medical appliances, electronic communication devices and medications. • CCS only provides equipment and services that are not the responsibility of a private health plan or Medi-Cal.
Early Intervention • Eligibility: • Infants and toddlers under age three are eligible for early intervention services if they: • Have a developmental delay; • Have established conditions that have a high probability of leading to developmental delay; and • Are at a high risk of having substantial developmental disability • Children aged three to five years are eligible under the same criteria as school-age children.
Special Education • Eligibility: • Children who have a qualifying disability are eligible for special education if they are at least three years old, but have not yet turned 19 and have not graduated form high school; • Students between 19 and 21 are eligible for special education if they: • Are enrolled in (or are eligible for) special education programs before their 19th birthday; and • Have not completed their prescribed course of study.
Special Education • Coverage: • Children who have disabilities and need special education services to benefit from education have the right to special education and related services. Related services include assistive technology. • Schools get specific funding for students with low-incidence disabilities (visual, hearing, or solely orthopedic impairments).
Special Education • Individualized Educational Plan (IEP): • The IEP is a legal document. The IEP sets out a student’s present levels of educational performance, goals and objectives, special education and related services, placement for each school year, and any assistive technology that your child needs as part of her educational program. • An IEP team develops the IEP. The IEP team must include the parent and student (if appropriate). • The school district may consider cost in deciding whether to provide a device but only if a less expensive device is also appropriate.
General Education • Eligibility: • Students who are not eligible for Special Education under the IDEA may still qualify for assistive technology to allow them equal access and opportunity to participate with non-disabled peers. • Assistive technology may be provided as a reasonable modification or auxiliary aid or service under the Americans with Disabilities Act (ADA) and Section 504 of the Rehabilitation Act of 1973.
Higher Education • Eligibility: • Students must, with or without reasonable modifications or the use of auxiliary aids, meet the academic and other standards required for admission or participation, and have: • A physical or mental disability that substantially limits one or more of major life activities; or • A record of such a disability; or • Be regarded as having such a disability.