For those that qualify for assistance, Accessible Home Consultants will investigate funding resources available. If you have the equity, and interest rates remain low, utilizing a home equity line of credit or reverse mortgage might help provide necessary funds to remodel. For some this is an ideal time to remodel.
1. What resources are available for home modifications?
Contact Accessible Home Consultants to discuss your home modification needs with our team. We will advise you if your current situation qualifies you for modification under Medicare or Medicaid eligibility requirements or investigate other funding resources available.
2. What is covered by Medicare
- Manual Wheelchairs (capped rental)
- Power Wheelchairs
- Some Positioning Devices
- Walkers and Rollators (four-wheel walkers)
- Seat-Lift Mechanisms for Lift-chairs
- Mattress Over-lays (capped rental)
- Hospital Beds - Semi-Electric Type Only (capped rental)
- Patient Lifts (capped rental)
- Oxygen Equipment (capped rental)
- Artificial Limbs
- Orthotics, Splints
If you want Medicare coverage on one of the product types listed above visit a local dealer that sells/rents equipment and bills Medicare. Many people are surprised that manual wheelchairs and hospital beds fall under "capped rental" items. For these "capped rental" items, the dealer (provider) is required to maintain the equipment over the lease period (13 months). You must visit a local dealer for these products
Durable medical equipment, such as wheelchairs, are covered only when prescribed by a doctor and the coverage criteria is meet. You can find out what equipment is covered, and whether a supplier is approved, by calling Medicare's durable medical equipment regional carrier (DMERC) for your area call 1-800-MEDICARE.
3. What is NOT covered by Medicare?
Equipment not covered by Medicare includes; adaptive daily living aids such as: ramps, automobile lifts, reachers, sock-aids, utensils, transfer benches, shower chairs, raised toilet seats, adjustable based beds , pulse oximeter and grab bars. Basically, Medicare stops at the bathroom door. For more detailed information regarding coverage, call 1-800-MEDICARE.
4. Does Medicare insurance cover stair lifts, etc?
A common question comes to mind when a son or daughter wants to purchase a stair lift for thier aged parent who is having a hard time climbing up the stairs: “Will the insurance company pay for the cost of my mother or father's stair lift?” Unfortunately, Medicare, a form of insurance provided by the federal government, does not cover stair lifts. A stair lift is not considered by Medicare to be “durable medical equipment” but rather is termed a “home modification.” Although this may not seem fair or consistent with Medicare’s policy to cover other mobility assistive devices, such as scooters, power wheelchairs, etc., it is nonetheless their current position with stair lifts.
Yet, there are actually private medical insurance companies that are capable of paying at least some, if not the entire cost of your stair lift. There are hundreds of insurance companies in the United States, and it is better to clarify one point with your insurance provider. Is the cost of your stair lift partially or totally covered. So, to start things off, it would be a good idea to check with them to determine their policy. If they have covered the cost of your power wheelchair, then certainly it is reasonable to presume that they would be sympathetic with your stair lift. But it is not a given, so be sure to check.
A good place to start is the Western Reserve Area Agency on Aging (WRAAA). The Area Agency is responsible for planning, coordinating and administering state and federal funded programs and services for older adults. It is one of twelve regional area agencies on aging designated by the Ohio Department of Aging as authorized by the federal Older Americans Act.
They sometimes are able to use funds from the Older Americans Act to modify homes with such things as walk-in bathtubs and stair lifts. If they are not able to help you with your needs, or if you do not qualify for cost coverage of your stair lift, you can also contact your local lender or bank for possible stair lift funding. Furthermore, your local Department of Housing and Urban Development can sometimes offer grants to home modifications such as the installation of stair lifts. Some private health care agencies also cover moderate home care needs that definitely include stair chair lifts, if it is determined to be beneficial or long term to the person.
So, if Medicare will only cover items being purchased that meet the definition of “durable medical equipment” just like power wheelchairs, a potential stair lift buyer has still many options that would answer the most feasible question whether its cost is covered or not. After all, just like using any power wheelchair, installing a stair lift in reality may save insurance companies from having to pay tens of thousands of dollars of medical and hospital charges accrued from falling down the flight of stairs of a system they didn't install. Check your coverage to find out whether your insurance will cover the cost of your stair lift.
5. Be sure to get a Certificate of Medical Necessity from your doctor.
This is a more detailed prescription as the doctor must analyze the individual's physical ability and state the chair is required for medical reasons. There also might be tax deductions for stair lift installation. To get up-to-date and complete information on coverage of stair lifts, we recommend that you visit Medicare's website.
Ohio Home Care Waiver
The OHCW program is designed to meet the needs of financially eligible consumers who have been assessed to require an intermediate or skilled level of care and who are age 59 or younger. Without the services available through the waiver benefit, these consumers are at risk for hospital or nursing home placement. Consumers approved for the OHCW benefit may receive care and services at home.
The OHCW program benefit package consists of nursing services, personal care assistance services and/or skilled therapy services, plus waiver-specific services such as home modifications, home-delivered meals, adult day health care, respite care, supplemental transportation, adaptive/assistive devices, and emergency response systems. ODJFS contracts with a case management agency, CareStar, to provide case management services. Click here for more information.
The application can be found: Form 2399-Application For Waiver
Once you fill out the application and submit it to the local Job and Family Services Agency, they will schedule an assessment. It is recommended someone drop the form off rather than mailing and write down the individual you submitted it to.
7. What is the PASSPORT Program?
PASSPORT is a Medicaid waiver program that provides information to anyone who has questions about long-term care services. PASSPORT offers comprehensive in-person assessments by registered nurses and licensed social workers to help older persons, their family members and caregivers determine what services they need and want. For those seniors 60 years of age or older, eligible for Medicaid**, live in a home or apartment, needs hands-on help with daily activities (i.e. bathing, dressing, meals) to remain at home, the person and her/his doctor agree the care plan health and safety needs can be met by home care services where the entire package of services costs no more than 60% of the cost of Medicaid nursing home care.
For More Information visit the following web site: http://www.psa10a.org/Programs/passport.asp
** PASSPORT can make a preliminary decision that a person meets financial eligibility requirements. However, the county Department of Human Services makes the final determination.
Additional Federal Government resources for Seniors Find government resources for seniors on money, housing, health, consumer protection and more.
For More Information visit the following web site: http://www.usa.gov/Topics/Seniors.shtml
What is Veterans Administration (VA) Home Modification Funding?
The VA has three main grant programs to assist disabled veterans and service members with necessary home modifications. For More Information, Call the VA's Toll-Free 1-800-827-1000 or at http://www.homeloans.va.gov/sah.htm or http://www.va.gov.
1. What Is a Specially Adapted Housing (SAH) Grant?
The SAH Grant is designed to help provide a barrier-free living environment that affords the individual a level of independent living they may not otherwise enjoy, such as creating a wheelchair accessible home. Veterans and service members with specific service-connected disabilities may be entitled to a grant for the purpose of constructing or modifying a home to meet their adaptive needs. This grant is currently limited to $63,780.
The SAH grant is available to veterans and service members who are entitled to disability compensation for permanent and total disability due to:
- Loss or loss of use of both lower extremities, such as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair.
- Blindness in both eyes, having only light perception, plus loss or loss of use of one lower extremity.
- Loss or loss of use of one lower extremity together with (1) residuals of organic disease or injury, or (2) the loss or loss of use of one upper extremity, which so affects the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair.
- Loss or loss of use of both upper extremities such as to preclude use of the arms at or above the elbow.
- A severe burn injury (as so determined).
You can apply for the SAH by completing VA Form 26-4555, Veterans Application in Acquiring Specially Adapted Housing or Special Home Adaptation Grant, and submitting it to your local VA regional office.
2. What Is a Special Home Adaptation (SHA) Grant?
The SHA grant is for modifying an existing home to meet adaptive needs, such as assistance with mobility throughout the home. Veterans and service members with specific service-connected disabilities may be entitled to this type of grant. The grant is currently limited to $12,756. A temporary grant may be available to veterans and service members who are/will be temporarily residing in a home owned by a family member.
The SHA grant is available to veterans who are and service members who will be entitled to disability compensation for permanent and total disability due to:
- Blindness in both eyes with 5/200 visual acuity or less or,
- The anatomical loss or loss of use of both hands or extremities below the elbow, or
- A severe burn injury (as so determined)
3. What Is a Home Improvements and Structural Alterations (HISA) Grant?
Under the HISA program, veterans may receive assistance for any home improvement necessary for the continuation of treatment or for disability access to the home and essential lavatory and sanitary facilities. A HISA grant is available to veterans who have received a medical determination indicating that improvements and structural alterations are necessary or appropriate for the effective and economical treatment of their disability. A veteran may receive both a HISA grant and either a SHA or SAH grant.
The HISA program is available for both service-connected veterans and non service-connected veterans.
Home improvement benefits up to $4,100 may be provided to service-connected veterans.
Home improvement benefits up to $1,200 may be provided to non-service-connected veterans.
You can apply for a HISA grant by completing VA Form 10-0103, Veterans Application for Assistance in Acquiring Home Improvement and Structural Alterations, and submitting it to your local VA medical center.