Frequently Asked Questions: Funding

"Yes, but you do need to keep several key elements in mind when submitting for funding. Even though Convaid chairs fold like “strollers” and provide “dependent mobility”, they have been classified by the Federal Government as “wheelchairs”. In your request for funding and medical justification, it is very important to use the correct classification “wheelchair” and NOT the word “stroller”. It must be described as a medical device “wheelchair”, which provides seating and mobility function and access; not merely a device for the convenience of the caregiver.

All insurance payers, public or private, require justification for a wheelchair, whether the patient already has a wheelchair or not. When justifying a need for a mobility device, it is important NOT to use the terms “primary” and “secondary” because each device serves different, but important seating and mobility medical and safety needs.

Examples of justification for getting a second wheelchair might include:

• The patient’s wheelchair is a power chair and he needs a manual backup chair for when the power chair is inoperable or cannot be used in the environment.
• The patient cannot be safely transported in a motor vehicle while seated in his wheelchair, and he cannot safely transfer or sit in the vehicle seat for transportation to medical appointments, work, school, or other activities in the community.
• The patient’s wheelchair cannot fit in the trunk of the car and the family does not have an accessible vehicle. The additional wheelchair is the least costly alternative to an accessible van.
• The patient must use public transportation, such as a taxi or bus, and his wheelchair cannot be safely transported so he also needs a compact folding wheelchair.
• The patient lives in an upper level house or apartment and his wheelchair is too heavy or bulky to safely be carried up the stairs, so he also needs a lighter weight wheelchair to be able to carry it upstairs to access his home environment."

"In the U.S. there are various funding sources for purchasing your manual wheelchair.

• Medicaid, SCHIP, Medicare and other government insurance plans or programs
• MedWaiver
• Private Insurance (HMO, PPO, etc.)
• Early intervention programs
• Groups in your community such as Rotary clubs, Lions, etc.
• Disability groups such as MDA, MS Society, etc.

For additional funding options, please visit http://www.abledata.com/abledata.cfm?pageid=113573&top=16040&ksectionid=19326."

Medicaid is a health program for eligible low-income parents, children, seniors, and people with disabilities. It is jointly funded by the states and federal government, and is managed by the states, with each state having its own set of guidelines for eligibility. Medicaid programs vary from state to state, but all states are required to offer a comprehensive set of services to meet Federal requirements for coverage of children’s health care (from birth to age 21) under their program called Early Periodic Screening, Diagnosis and Treatment (EPSDT). Because of EPSDT, Medicaid can be a good source of funding support for children who use wheelchairs. Please refer to http://www.cms.hhs.gov/MedicaidGenInfo/ for more detailed information.

"Medicare is the federally funded medical plan for Americans age 65 and over that covers medical expenses such as doctor's visits, hospital stays, drugs and other treatment. It is also an important source for funding wheelchairs and other durable medical equipment.

Medicare Part B is the part of Medicare that pays for wheelchairs. When it comes to your wheelchair, consumers and rehabilitation technology suppliers must deal with the Durable Medical Equipment Regional Carrier that serves your state. "

The State Children's Health Insurance Program (SCHIP) is a program which provides health insurance to uninsured children in families that have an income to high to qualify for Medicaid. This program is funded by the federal government who provides matching funds to each state.

"A Medicaid Waiver Program covers services not usually covered by Medicaid, which may include medical equipment. These programs are available in many states and typically are targeted to specific disability or age populations.

States may offer a variety of services to consumers under an HCBS waiver program and the number of services that can be provided is not limited. These programs may provide a combination of both traditional medical services (i.e. dental services, skilled nursing services) as well as non-medical services (i.e. respite, case management, environmental modifications). 

States have the discretion to choose the number of consumers to serve in a HCBS waiver program.  Once approved by CMS, a state is held to the number of persons estimated in its application but has the flexibility to serve greater or fewer numbers of consumers by submitting an amendment to CMS for approval.

The Federal government cannot determine eligibility for Medicaid, including waiver and demonstration projects. Each state has its own process and criteria for participation. If you are looking for information about how to apply for Medicaid, including waiver and demonstration programs in your state, please contact your state Medicaid agency."

Early Intervention Programs are for children who are discovered to have or be at risk of developing a disability or other special need that may affect their development. This program is for children from birth to school age, and provides services to lessen the effects of the disability.

Many wheelchairs are reimbursed by private insurance, but all insurance policies are different. Check with your insurance carrier for information on what your policy covers, or contact your local DME (Durable Medical Equipment) provider and speak with their reimbursement specialist.

In the U.S., many wheelchairs are reimbursed by Medicare or Medicaid. Please ask your local DME provider for assistance and information on funding in your area.

Our wheelchairs are classified as Durable Medical Equipment and have been assigned HCPCS Codes. Please refer to our HCPCS Code List to view our suggested codes.

Healthcare Common Procedure Coding System numbers, are numbers assigned to every task, service and product a medical practitioner may provide to a patient. Products are classified based on similarities in function and if the products exhibit significant therapeutic differences from other products. Since everyone uses the same codes, it ensures uniformity throughout the medical community. For a detailed overview, please refer to http://www.cms.hhs.gov/MedHCPCSGenInfo/.

Click here to download the HCPCS chart.

A Letter of Medical Necessity or Justification Letter tells what type of medical equipment is needed due to a verifiable medical condition or impairment. This letter must be written by a physician or therapist and is submitted to your payer. This letter explains the clinical need for the recommended equipment to the payer. Sample Letter