Medicaid / Medicare / Insurance / CCS

Medicaid

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, Medicare can be a good source of funding support for children who use wheelchairs. Please refer to http://www.cms.hhs.gov/home/medicaid.asp for more detailed information.

Medicare

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 (DMERC) that serves your state. Visit www.dmerc.com to obtain the toll free number for the DMERC in your state.

Insurance

Health insurance is another option available to pay for your folding portable wheelchair. Insurance may be provided through government-sponsored programs or through private insurance companies. All insurance policies state if they will or will not cover wheelchairs. Since insurance can be confusing, check to see if your DME provider has an insurance specialist on staff to assist you with your purchase. Insurance specialists are highly trained, and know which type of questions to ask and type of information to submit.

California Children's Services (CCS)

California Children's Services (CCS) is a program funded by the state for children with certain diseases or health problems. This program is for children up to 21 years old, and allows the individual to get the health care and services they need. CCS will put you in contact with trained health care professionals who will be able to care for your child.

Letter of Medical Necessity or Justification

A letter of Medical Necessity or Justification tells what type of medical equipment is needed due to a verifiable medical condition or impairment. This letter is usually written by a physician, therapist, or an experienced rehabilitation technology supplier and is addressed to your third-party payer. Click here for an example of a letter that explains to the third-party payer why the recommended medical equipment is important.

Other helpful websites:

• Medicaid
• Senior Law
• CMS-Centers for Medicare and Medicaid Services (Formerly HCFA))
• Neighborhood Legal Services
• CCS