Assistive Technology Public Funding

 

MEDICAL ASSISTANCE - "MA" or Medicaid


What agency runs the program?


The state Department of Human Services ("DHS") runs the Medical Assistance ("Medicaid") program in Rhode Island. To apply for Medicaid services, you should contact the DHS office nearest you. DHS has offices in most cities and towns in Rhode Island.

 

Who can get services from the program?


Medicaid pays for medical services for people who are too poor to be able to obtain health care any other way. You will get Medicaid services automatically, without applying, if you receive,

 

SSI (Supplemental Security Income), or AFDC (Aid to Families with Dependent Children).

If you are not eligible for SSI or AFDC because you have other income, you may still qualify for Medicaid. Your income and assets will need to fall within certain guidelines established by DHS. This kind of Medicaid eligibility is often called the "flex-test" or "spend down" eligibility. Depending upon the amount of your income, Medicaid may pay for all or only part of your health care costs. When you apply for Medicaid, the DHS staff will tell you how much (if anything) you will have to pay towards your health care services.

[Note: Low-income children have the right to receive a broad range of health care services until they are 21 years old, through the Early and Periodic, Screening, Diagnosis, and Treatment ("EPSDT") program of Medicaid. See the separate EPSDT fact sheet for more information.]

 

 

What kinds of AT help can the program provide?


Because Medicaid is a health insurance program, it will pay for those AT devices or services, which look "medical" in nature. This means that Medicaid can pay for a wide variety of AT services and devices, as long as you can show the services or devices are "medically necessary." It is usually easy to show that things like wheelchairs, walkers, artificial limbs, or hearing aids are "medically necessary." Medicaid routinely pays for these things, if a doctor states there is a medical need.

Things like computers with voice output, or environmental control units may be more difficult to obtain, because they do not look like traditional "medical" equipment. However, if you need these kinds of devices to help restore or improve your functioning, then there is a good argument that Medicaid should provide these devices.

Medicaid should also pay for services to help you benefit or use your device. For example, speech therapy services should be provided if you need to learn to use a new communication device.

[Note: Low-income children have the right to receive a broad range of health care services until they are 21 years old, through the Early and Periodic, Screening, Diagnosis, and Treatment ("EPSDT") program of Medicaid. See the separate EPSDT fact sheet for more information.]

 

 

What is the cost for AT services?

 

Medicaid will pay for the cost of AT services and devices. If you use Medicaid to purchase an AT device or service, you cannot be charged extra by the AT provider. If you have other insurance coverage in addition to Medicaid, then Medicaid will require that insurance to pay for the AT you need as well.

Medicaid sets specific rates for AT services and devices. Generally, AT providers in Rhode Island will accept the Medicaid rate for AT services and devices. Sometimes the rate that Medicaid will pay for a device is less than what any AT provider will accept. If you need a device that is very customized to fit your needs, you may not be able to find a provider who is willing to accept the Medicaid rate. You should get legal help, if this happens to you.

 

How can I make a request for AT?

You should make your request for AT on specific forms provided by DHS. Most AT providers will have these forms and can help you get them filled out. Your doctor, and sometimes other appropriate health professionals (e.g., speech therapist, occupational therapist), will need to fill out a "Certificate of Medical Necessity" form. For many "off-the- shelf" devices, this is the only form you will need to use. For some devices, particularly customized devices, a "Prior Authorization" form will have to be completed. You should ask your doctor or other health professionals to describe what you need as specifically as possible on these forms.

Once the forms are completed, the AT provider will either supply you with what you need (e.g., the "off-the-shelf" device), or will submit the forms to DHS and request prior authorization. If the provider has to request prior authorization, the provider may also ask you to obtain additional medical information. It is always best to obtain as much medical information as needed before making a prior authorization request to DHS.

After DHS receives your request, it may take some time before you find out whether your request is approved. If more than one month goes by after the AT provider has submitted your forms to DHS and you have not been told that your request was approved, you should get legal help.


How can I appeal a denial of AT?

 

DHS should send you a written notice if it denies your request for Medicaid payment of AT. You have 30 days from the date of the notice to request an "administrative hearing." The administrative hearing will be run by a Hearings Officer from DHS. You have the right to bring a representative or an attorney with you to this hearing. You also have a right to bring witnesses, and to ask questions of DHS staff at the hearing. After the hearing, the Hearings Officer will write a decision, which contains his opinion about whether the denial of Medicaid was legally correct.

If you are not satisfied with the Hearing Officer's decision, you may appeal this decision to state court. You have 30 days from the date when the hearing officer's decision was mailed to file in court.

Where can I get legal help?

 

RIPAS (the Rhode Island Protection and Advocacy System, Inc.) can provide free legal advice and/or representation if you have questions or need help getting Medicaid payment for AT.

 

More information about Medicaid coverage of AT can be found in a booklet published by the Rhode Island Disability Law Center, Inc., (formerly RIPAS) called: A Guide to Medicaid Payment for Assistive Technology.

For more information or help contact:

RI Disability Law Center
349 Eddy Street
Providence, Rhode Island 02903
Voice (401) 831-3150, (800) 733-5332
TDD (401) 831-5335
Website: http://www.ridlc.org/
E-mail: info@ridlc.org

 

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