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.

Medicaid Fair Hearings

You have a right to a fair hearing whenever your request for Medicaid is denied or not acted upon promptly. You also have a right to a fair hearing anytime your Medicaid services are suspended, terminated, or reduced. In other words, you have the right to a hearing to appeal the following:

1. The decision that you are not eligible for Medicaid services.
2. The decision to deny, suspend, reduce or stop Medicaid coverage for a service.
3. Failure to act upon your request for Medicaid eligibility or for service coverage with reasonable promptness.
In these situations, you must be granted a hearing if you request it. (The exception to this rule is that a hearing is not mandatory if the only issue is a change in the law that requires an automatic change that adversely affects some or all Medicaid recipients.)

The National Registry for Rehabilitation Technology Suppliers (NRRTS) supports individual’s rights to enhance their mobility and well being through complex rehab technology. Please read and interesting article just published in the latest edition of Directions, which discusses "A Beneficiary's Guide to Medicaid Fair Hearings" read more:

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.

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