About WVATSPathways To Funding For Adults & Seniors:
A Handbook for WV's Older Residents
Section 1. Major Assistive Technology Funding Sources
Major Assistive Technology Funding Sources
Family Support Program
The Family Support Program helps West Virginia families who have someone living in their home with a developmental disability. This program offers services to help you and/or your family meet your basic needs and maintain your quality of life.
The family support program offers respite care, special equipment, transportation, home modifications, service coordination, assistance in getting benefits and other supports that the family requests.
Services are not based on family income. For more information on the Family Support Program nearest you, please call 800-558-0627 or visit www.wvdhhr.org/bhhf/famsup1.asp.
Medicaid
West Virginia's Medical Assistance Program, Medicaid, pays most of the cost of medical care for people who otherwise could not afford it. Medicaid is a state and federal assistance program, which covers medical costs for eligible individuals of all ages. Medicaid is administered by the Bureau for Medical Services, West Virginia Department of Health and Human Resources (DHHR).
Eligibility for Medicaid is determined by each local DHHR office. There are over fifty different ways to become eligible for Medicaid. If you think you might be eligible for Medicaid, you may file an application at the DHHR office in the county where you live. Individuals receiving Supplemental Security Income are also eligible for the Medicaid Program and automatically receive a medical card from the Department of Health and Human Resources.
Medicaid covers assistive technology that qualifies as durable medical equipment, prosthetic/orthotics, and medical supplies.
Durable medical equipment is equipment that:
- is long lasting
- is used to serve a medical purpose
- is not useful to a person who does not have an illness or injury
- can be used in the home
Examples of durable medical equipment are:
- wheelchairs
- hospital beds
- walkers
- oxygen equipment
Examples of medical services and supplies are:
- home healthcare
- speech, physical and occupational therapies
- surgical dressings
- splints and casts
Medicaid covers augmentative communication devices. Coverage of these devices will be only for the purpose to assisting a person to communicate basic medical needs. Devices intended to meet social, educational and vocational needs are not covered.
For more information about Medicaid please call the Bureau for Medical Services at 304-558-6078.
The Title XIX Medicaid Waiver Program provides in-home health care for eligible clients.
The West Virginia Bureau of Senior Services operates the Title XIX Medicaid Waiver Program, generally called the Aged and Disabled Waiver (A/D Waiver). This is a Medicaid reimbursed Home and Community Based Waiver Program that functions as an alternative to institutionalized care. The A/D Waiver program covers those elderly, blind and/or disabled individuals who are eligible for Medicaid or would be eligible for Medicaid if institutionalized. To be eligible:
- applicants must be 18 or older and a resident of West Virginia
- approved by the WV Medical Institute, which assesses individuals to determine if they are medically eligible for nursing facility care
- require the level of care provided in a nursing facility as determined by comprehensive medical, nursing, and social services assessments
- meet the Medicaid financial eligibility criteria for the program
- require services which do not exceed the statewide average cost of nursing home care
For more information on the Aged and Disabled Waiver please call 800-499-4080.
Medicare
Medicare is a national health insurance program completely funded and run by the federal government. The Social Security Administration signs up people and gives them Medicare information.
Medicare helps pay health care costs for people sixty-five years of age or older, adults with permanent disabilities who receive Social Security Disability (SSDI), and people who have permanent kidney failure.
The Centers for Medicare & Medicaid Services, which run the Medicare program, will mail Medicare cards to people with disabilities 24 months after their SSDI payments begin. Any person who qualifies for Medicare Part A will also be signed up for Part B. Part B has a monthly charge, but you may stop Part B if you do not choose to pay the monthly charge. Both parts A and B have deductibles, co-payments and co-insurance payments. Programs are available to help you pay Medicare premiums if you cannot afford them.
Part A - Hospital Insurance
Medicare Part A covers part of your stays in the hospital or stays in a skilled nursing facility, some home health care services and limited stays in hospice care. If you are admitted to a Medicare participating hospital, you should be given a copy of "An Important Message From Medicare." It explains your rights as a hospital patient. If you are not given one, ask for it.
Part B - Medical Insurance
Medicare Part B covers some medical care and outpatient costs, such as durable medical equipment and other medical services/supplies not covered under Part A, if prescribed by your doctor.
Medicare Premium Assistance Programs
Qualified Medicare Beneficiary (QMB)
This Medicaid coverage pays Medicare Part A and Part B premiums and Medicare copays and deductibles, including those related to nursing facility services. There is no prescription drug coverage.
Specified Low-Income Medicare Beneficiary (SLIMB)
Medicaid coverage is limited to payment of the Medicare Part B premium. The SLIMB applicant/recipient may be a recipient of other Medicaid coverage.
Qualified Individual (QI - 1)
Medicaid coverage is limited to payment of the Medicare Part B premium. The QI - 1 applicant/recipient cannot be a recipient of any other Medicaid coverage.
The key to assistive technology funding is found in Part B. Assistive Technology falls under the categories of durable medical equipment (DME) and/or prosthetics, such as augmentative communication devices, if you lose your speech through a stroke or other condition.
Any decision about Medicare services can be appealed. This is true whether an individual is in the Original Medicare Plan or a Medicare managed health plan. If Medicare does not pay for an item or service you have been given, or if you are not given an item or service you think you should get, you can appeal.
Call the Social Security Administration for more information at 800-MEDICARE (800-633-4227) or 877-486-2048 (TTY) or visit www.wmedicare.gov
Private Insurance
Private insurance is a contract between you and your insurance company. Your contract may or may not cover assistive technology. Look over your policy carefully. Even when your insurance does cover assistive technology, your policy may have a cap on how much is covered.
If you receive private insurance from your employer there is a federal law known as the Employee Retirement Income Security Act (ERISA) that controls employee benefits plans. This law gives employees the chance to find out what the policy covers. Coverage guidelines will be written into a contract that private insurance companies by law have to follow. Every insurance policy is different. Make sure you understand what your insurance policy covers.
You may not have health insurance through your employer but you can get insurance on your own. If you have questions about what your policy covers or would like to get insurance on your own, call the West Virginia Insurance Commission at 800-642-9004.
Rehabilitation Services, Division of
The West Virginia Division of Rehabilitation Services (DRS) is a program of state government that helps West Virginians who have disabilities achieve independence within the workplace, family, and local community. DRS is funded through the state and federal government. For more information on rehabilitation services or any of their programs (listed below) call 800-642-8207 or your local office.
Rehabilitation Technology Unit Services
The West Virginia Division of Rehabilitation Services Rehabilitation Technology Unit provides services statewide including assessment, drawing up plans, training, equipment setup and follow-up for persons with disabilities.
Centers for Independent Living
There are three Centers for Independent Living in West Virginia. West Virginia Centers for Independent Living (CILS) have grants from the United States Department of Education/Rehabilitation Services Administration to provide services at no cost to people of all ages who have physical, mental, or sensory disabilities. The goal of this program is to give support to people with disabilities to help them become independent in their homes and other non-work settings. The Northern Center for Independent Living (NWVCIL) administers Independent Living funds. See Appendix J for a complete listing of Centers.
The Ron Yost Personal Assistance Services Program
In 1999, the West Virginia Legislature passed the Ron Yost Personal Assistance Act, (RYPAS) which created a new program, controlled by consumers, to help individuals with severe disabilities live in their own homes and be active in their communities. The RYPAS program provides individuals with severe disabilities the needed resources to help them get a personal assistant and the necessary support to participate in daily living activities.
You can get these Ron Yost services if you have a severe disability that affects one or more daily activities and:
- your disability will last at least 12 months
- you or a designee can meet your responsibilities as an employer
- you or a designee can manage your own financial and legal affairs
- you need assistance with daily living activities
- you are not receiving assistance through any other program
- you meet income guidelines
For additional information on any of the above Rehabilitation Services, please call 800-642-8207.
Social Security Programs
The Social Security Administration (SSA) administers the Social Security Insurance (SSI) and Social Security Disability Insurance (SSDI) Programs that can provide benefits based on the disability or blindness of individuals. The SSA can determine if an individual is eligible for one or both programs. You can call the SSA in your local area or by calling the toll free number 800-772-1213 or 800-325-0778. You can also find more information on Social Security's website at www.ssa.gov
Supplemental Security Income (SSI)
- SSI is a needs-based program that provides payments to individuals who are aged, blind, and/or disabled and who have limited income and resources.
- The amount of an SSI check can vary monthly due to earnings from work; unearned income (such as SSDI benefits; living arrangements and support that the individual may receive; the state the individual lives in; and any work incentives that may be used while that individual is working.
- When you are approved for SSI you will begin receiving payments because there is no waiting period.
- Report to Social Security any changes in your financial status, living arrangements, or supports that you may be receiving. These factors could change the amount of SSI that you receive and/or your eligibility.
- When you are approved for SSI in West Virginia you also become eligible to receive a Medicaid card.
- The SSA has developed Work Incentives that are available to individual with disabilities who receive SSI and are thinking of going to work. It is important for disability beneficiaries to understand that they can still receive benefits while they test their ability to work. To learn more about the work incentives that are available, you can contact the Social Security Administration or the Work Incentive Planning and Assistance (WIPA) Program at 304-293-4692.
Social Security Disability Insurance (SSDI)
- SSDI provides benefits to disabled or blind individuals who are insured by worker's contributions to the Social Security trust fund.
- To qualify you must be the worker, or the worker's widow(er), or the worker's disabled adult child. You must also meet Social Security's definition of "disability". Unlike the SSI Program, this is not a needs-based program.
- The amount of an SSDI check is based on the worker's lifetime average earnings covered by Social Security.
- Usually there is a 5-month wait to receive SSDI cash payments, but in some situations it may be sooner.
- With SSDI a person will receive Medicare.
- Work Incentives are available to individuals with disabilities who receive SSDI and are thinking of going to work. The incentives provide the person with the opportunity to maintain benefits while testing their ability to work and gradually becoming self-supporting and independent. To learn more about the SSDI Work Incentives that are available you can contact the SSA or the Work Incentive Planning and Assistance (WIPA) Program at 304-293-4692.
U.S. Railroad Retirement Board (RRB)
The RRB provides benefits for railroad employees who are retired and have disabilities .
The RRB has special considerations for individuals who have a medical recovery, permanent medical condition, are permanently disabled, or who have work expenses related to their disability.
The RRB Help-Line is an automated telephone service. You will not be able to speak to an RRB representative by calling the RRB Help-Line. Call the RRB field office if you want to speak to one of ther representatives.
Call the RRB Help-Line at 800-808-0772. Call the WV field office at 304-529-5561. For more information visit the RRB website at www.rrb.gov
Veteran's Affairs, Division of
Veteran's Affairs (VA) provides health care for veterans and family members of veterans with disabilities.
Tricare
Tricare, formerly CHAMPUS, the health benefits program for dependents of active duty military service members and military retirees, will provide alternative/augmentative communication (AAC) devices to all program enrollees who require them. An augmentative communication device may be provided as a voice prosthesis under subsection 1077(a)(15).
For more information call the local Veteran Affairs office in your area (see Appendix D) or the regional office at 800-827-1000.
Veterans Specially Adapted Housing Program
Adapted Housing is part of the Department of Veterans Affairs (VA) program for the Paralyzed Veterans Administration. It provides qualified veterans financial help toward accessible housing. Veterans and family members of veterans who meet disability guidelines can get services. This program builds new homes, adapts existing homes and accommodates disability-related needs.
The special housing adaptation grant for veterans who are blind or who have lost or no longer have the use of both hands is $10,000. Veterans may also use the grant to assist in acquiring a residence already adapted with special accessibility features. The one-time adapted grant for disabled veterans with loss of one or both lower extremities is $50,000.
If you have any questions regarding your eligibility for any of the above housing grant programs or need assistance with applying for them, call the VARO in Huntington at 800-399-9251 or call the local Veterans Affairs office in your area (see Appendix D) or the regional office at 800-827-1000.
Veterans Hearing-Aid Program
The Veterans Administration National Hearing Aid Program (VANHAP) evaluates hearing-aid technology with the National Institute of Standards and Technology and establishes national contracts for products of high technical quality. These hearing-aid devices are then available free to veterans in VA audiology clinics, which must meet criteria as hearing-aid dispensing programs.
Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)
"CHAMPVA for Life" is designed for spouses or dependents who are 65 or older. They must be family members of veterans who have permanent and total service-connected disabilities, who died of a service-connection or who were totally disabled from a service-connected condition at the time of death. They also must have Medicare coverage.
For more information on the above programs call your local Veterans Affairs office (see Appendix D) or the regional office at 800-827-1000.
Visually Impaired Seniors In-Home Outreach and Networking Services (VISIONS)
VISIONS is a statewide program funded by the federal government to provide in-home services to West Virginians 55 and older with visual impairments. The goal of VISIONS is to help these individuals achieve their desired level of personal independence.
VISIONS offers:
- In-home independent living assessments
- Development of independent living plans
- Low vision aide including: magnifiers, large print items like check registers, diabetic registers, address books and large button phones, adaptive equipment for the kitchen and other low vision aids
- Skills training
VISIONS conducts activities to improve public understanding of the concerns and problems faced by older adults with visual impairments by providing:
- Outreach to community groups through presentations at workshops and meetings
- Exhibits and demonstrations of low vision assistive technology at conferences and other events
Call 800-642-3021 for more information.
