Wheelchairs and Assistive Technology in a Nursing Home
Nursing homes are places people live when they need more care than they can get at home. But sometimes, people in nursing homes need more than someone looking after them. Sometimes, people in nursing homes need assistive technology.
What is assistive technology? Assistive technology is technology that helps people who have disabilities. Any device that takes the place of some body part that does not function properly can be assistive technology. A wheelchair is a good example. If you have problems with your legs, a wheelchair can help you get around by doing what your legs would normally do. Another example of assistive technology might be software that makes a computer "speak." Such software could be used by people with vision problems who have trouble reading a monitor.
What if you live in a nursing home and need assistive technology? If you can pay for it, that's great. If your insurance will pay for it, that's even better.
But what if your insurance is Medicaid?
Medicaid, also called "Title 19," is the largest public medical insurance program in Iowa. About 470,000 Iowans receive Medicaid. Medicaid is sort of a partnership between the federal government and the state government. If a state wants to offer Medicaid, the federal government pays most of the cost. But the state must follow the federal Medicaid rules.
The way Medicaid pays nursing home bills has rules. If you are on Medicaid, and you have to go to a nursing home, Medicaid pays the nursing home's bill. But the rules say the nursing home is supposed to provide everything you need for the Medicaid payment the nursing home receives. So let's say you are in a nursing home, and you need a wheelchair. Who has to pay for it? The rules say the nursing home has to pay for it. Remember, the nursing home gets one payment a month from Medicaid, and they have to provide whatever you need. If you need a wheelchair, Medicaid expects the nursing home to pay for it.
So if you are in a nursing home and need a wheelchair, you should start by asking the nursing home to provide it. Make your request in writing and ask the nursing home for an answer in writing. If they won't provide the wheelchair you need, you have a couple of choices.
You can appeal the nursing home's decision to the Iowa Department of Human Services (DHS), which runs the Medicaid program in Iowa. You can also file a complaint with the Iowa Department of Inspections and Appeals (DIA), which supervises nursing homes in our state. Either way, you can ask for a hearing in front of an administrative law judge (ALJ). An ALJ is just like a regular judge, except he or she works for DHS or DIA, and only hears cases involving government programs like Medicaid. If you are not satisfied with the ALJ's decision, you can ask for the case to be heard by a regular judge in district court. This is called "judicial review."
Some people are reluctant to do either of these things. That's understandable. After all, if you're in a nursing home, it's where you live. Some people prefer not to get into such a dispute with the management of the place where they live.
That's why another possibility is an Exception to Policy request. This is a request you make to DHS. Remember, normally DHS does not buy wheelchairs for people in nursing homes: DHS pays the nursing home and the nursing home is supposed to provide everything a patient needs. In an Exception to Policy request, you tell DHS why you think it should make an exception to this rule. If DHS approves the request, Medicaid will pay for the wheelchair (or whatever you need) separately, and not make the nursing home pay for it. Unfortunately, if DHS denies the request, there is no way to appeal it.
Whatever you do, good medical documentation is very important. "Medical documentation" means letters, reports, and other documents from your doctor (and other healthcare providers) describing why you need a wheelchair or other assistive technology device. You should ask your doctor to be as specific as possible. Your doctor should describe your medical condition, and how the wheelchair or other device would help you. You doctor should be mention any special features you need, like seat cushions that help you sit properly in a wheelchair, for example.
Iowa COMPASS is Iowa's information and referral program for people with disabilities. People with disabilities who have questions or problems about assistive technology or any other issue are encouraged to contact COMPASS at 800-779-2001 or via email at firstname.lastname@example.org.
Iowa Legal Aid works with COMPASS as part of the Assistive Technology Legal Project. If you are having legal problems related to assistive technology, contact COMPASS first. They can refer you to Iowa Legal Aid, or another source of legal help.