Funding Assistive Technology for Individuals who are Blind to Support

Work and Independence:

Looking to State Vocational Rehabilitation Agencies, other Funding Sources, and other

Funding Strategies to Obtain AT

December 9, 2015

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Today’s Presenters

James R. Sheldon, Jr., Supervising Attorney

National Assistive Technology Advocacy Project

Neighborhood Legal Services, Buffalo, NY

jsheldon@nls.org * 716-847-0650 ext. 262

Ronald M. Hager, Senior Staff Attorney

National Disability Rights Network

Washington, D.C.

Ron.Hager@ndrn.org * 202-253-5252

CUEs

The RESNA Catalyst Project offers CEUs for this webinar session. The RESNA Catalyst Project is an approved

authorized provider for CEU credits by the International Association for Continuing Education and Training (IACET).

You can receive 0.1 CEUs for a sixty to ninety minute webinar. There is a $16 fee to receive credits for each

webinar.

To learn more about CEUs or to apply for CEUs from an archived webinar, contact Paul Galonsky,

pgalonsky@resna.org.

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Upcoming Webinars

• January 27, 2016 – AT and Voting Access

• February 17, 2016 – Update on Cognitive Aids for People with Brain Injury

• March 16, 2015 – Meeting the AT Funding Needs of Older Americans in their Homes and in Facilities

All sessions 2:00 to 3:30 p.m. Eastern & sessions will be archived at http://www.resnaprojects.org/statewide/webedarchive.html

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Services of the NationalAT Advocacy Project

A Technical Assistance and Training Project• Call or email speakers for technical assistance• Any topic covered in the webinars• Any issue related to funding of AT• We can assist you in thinking through funding issues and

appeals

Additional materials available on most topics• Contact us for copies and/or links.

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Format for Today’s Session• Walk through power point (on screen, received via email)• Participants can post questions in question or chat box.• Will attempt to address questions during presentation.• Follow up questions can be emailed to presenters.• Contact presenters for more resources on any of the

content.• Additional resources-This ppt and additional documents

will be posted at http://www.resnaprojects.org/statewide/webedarchive.html– Work, Assistive Technology and State Vocational Rehabilitation

Agencies6

Purpose of This Session

Identify common barriers to successful employment of person who is blind•Computer access•Reading, editing documents•Work-related travel, including lunch meetings

Identify barriers to independent living•Reading mail, prescription labels•Reading online healthcare information•Often, equipment to address employment barriers will also address independent living barriers.

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Purpose of Session: Look at VR Agency, Non-Traditional Funding Sources

Traditional Funder: Vocational Rehabilitation Agency• Can fund range of AT to support work goals.

Look Beyond VR Agency• If working and post-employment services either not an

option or not available to pay for all items• When person has ongoing expenses, a need for regular

upgrades

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Providing Context

for Discussion:

The Case of Winston

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Session About Funding, NotAbout Selecting the Right AT

• Speakers acknowledge the significant input from Steven Mendelsohn, formerly of New York, who works as an independent policy consultant despite lifelong blindness.

• The scenario below and AT sought by Winston is to give context for the funding discussion.

• In the perfect world, Winston would regularly consult with an AT specialist to select appropriate interventions for his work.

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Introducing Winston

Age 51, lives alone, small home in Brooklyn, NY

His disabilities• Legally/statutorily blind – limited functional vision• Progressive arthritis – great difficulty walking

His work - $2,800 gross/$33,600 per year• Currently, self employed writer and editor, online

magazine in New York City• Works from home, some travel to office meetings, to

meet writers in restaurants, to do research at library

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Work History

Full-time with same employer, 2003 to 2007

Progressive arthritis forced change• Has been self-employed, part time since 2007• As self-employed person, past employer has

been only client since 2007• Doing most work at home since 2007

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History of Support fromState VR Agency

NY Commission for Blind Sponsored College

• 1998-2003, goal of writer and editor

• Paid for tuition, books, fees, transportation, AT

VR Agency Supported Move to Self-Employment in 2007

• AT to support work at home despite blindness, arthritis

• Primarily computer-based AT

• AT for time in office supplied by employer

Currently working with 8-year old equipment.

• Now seeks post-employment services for new equipment.

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Winston’s Current ChallengesRelated to Blindness

To read range of material through voice output:• Documents on computer screen, website information• Hard-copy documents, saving some on his computer• Range of material when on the go – bus/subway

schedules, restaurant menus, books and magazines• Paper money to manage purchases during travel• Travel routes – bus/subway schedules, directions from

subway stop to meeting place• Needs periodic reading services in home office

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AT Sought by Winstonfor Work from Home

• New personal computer with software to allow for voice input and voice output. Cost = $1,600 combined

• Stand alone reading machine, reading documents aloud with ability to upload to personal computer. Considering “Sara” from Freedom Scientific. Cost = $1,000 or more

• iPhone 6 or other smart phone/small tablet (cost about $200 with phone plan, $600 or more retail)

• Two-year cell phone service plan (will be self funded)15

Smart Phone/Tablet AppsWinston is Seeking

Many are free or low cost, but needs cell phone service

or wifi connection:• “Next Bus”/similar app from transportation authority - free• GPS apps – e.g., “Look Around Feature” (free)• KNFB Reader – cost = $50 (on-the-go reading) –

converts printed text into high quality speech to provide accurate, fast, and efficient access.

• Look Tel Money Reader app – cost = $9.99 (more practical than separate free device from US Treasury?)

If he were Braille user, could benefit from other AT.16

Winston’s Challenges Related to Progressive Arthritis

Needs mobility assistive device due to arthritis• Significant pain, limited range of motion in knees, legs

• Has used wheeled walker in home for past 3 years

• Seeking either ultra lightweight wheelchair ($1,500) or power scooter ($2,800) for travel outside the home

In addition to AT, Winston will need a paid reader at

$15/hour, 2 hours per week = $120 per month.17

Winston’s Benefits History,Health Insurance Coverage

• Last received Social Security Disability Insurance (SSDI) in 2004, never received SSI

• Last received Medicare in 2011 through a special work incentive. No Medicare or Medicaid currently.

• Has private insurance but wheelchairs/scooters not covered. Did not elect optional rider for durable medical equipment coverage.

• Has $4,200 in bank, $61,000 in combined IRA and 401k.18

Funding Winston’s AT

Funding Through

State VR Agency – Focus

On Post-Employment Services

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Rehabilitation Act First Passed in 1973

• Under Title I, states given money to provide VR services to persons with disabilities

• Some states have one VR agency, some have second agency serving those who are blind.

• VR can fund range of goods and services, including “rehabilitation technology” (AT), connected to vocational goal

• VR services are to empower individuals to maximize employability, economic self-sufficiency, independence and integration into the work place and the community through “comprehensive and coordinated state-of-the-art programs.”

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Workforce Innovation and Opportunity Act (WIOA) of 2014

• Amends Title I of the Rehab Act• Relies more upon AT—requires coordination

between VR and AT Act programs• Makes it harder to find a person ineligible for

services• Adds pre-employment transition services• Will severely limit access to sheltered workshops

in two years

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Basic Eligibility Criteria

• To receive services, an individual must– have a disability which results in a “substantial

impediment” to employment and – require VR services to prepare for, secure, advance,

retain or regain employment

• Any service from the VR system must be connected to employment goal

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Employment Outcomes

• Full or part-time competitive integrated employment• Customized employment—developed in conjunction

with an employer• Supported employment, or• Other employment in an integrated setting such as

self-employment, telecommuting and business ownership

• Must be consistent with person’s strengths, abilities and informed choice

• Not a sheltered workshop, because it does not meet definition of competitive integrated employment

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The Individualized Plan for Employment (IPE)

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IPE - Introduction

• Includes individual’s employment goal and specific services to reach goal

• For students, it may be the projected post-school employment outcome

• Comprehensive assessment as necessary to determine employment outcome, objectives, nature and scope of VR services– To evaluate unique strengths, resources, priorities,

abilities and interests of individual– May include referral for rehabilitation technology

services (AT), “to assess and develop the capacities of the individual to perform in a work environment”

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Informed Choice

• All activities implemented consistent with principles of “respect for individual dignity, personal responsibility, self-determination, and pursuit of meaningful careers, based on informed choice, of individuals with disabilities”

• Reason: Congress’ belief “that a consumer-driven program is most effective in getting people jobs”

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Available Services

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Intro – Available Services

• Any services to assist in preparing for, securing, retaining, advancing or regaining an employment outcome

• All necessary services to equip the individual for employment

• Severity of disability or cost of services can have no bearing on scope of services individual receives

• Available services are incredibly broad and varied

• May include benefits planning for recipients of SSI/SSDI

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Required Service Options

• Transportation, including adequate training in use of public transportation, provided in connection with the provision of any other service and needed to achieve an employment outcome

• Transportation may include vehicle purchase• Advanced degrees in science, technology,

engineering, math, law, medicine or business

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Required Service Options

• Rehabilitation technology (i.e., AT), including vehicular modification, telecommunications, sensory, and other technological aids and devices

• Transition services for students with disabilities to facilitate the achievement of the employment outcome or projected employment outcome

• Pre-employment transition services• Supported employment, can now be provided up

to 24 months without extension30

VR Services Policies

• States must develop policies concerning provision of VR services

• Must ensure services are provided based on each person’s individual needs

• May not place “any arbitrary limits on the nature and scope of” VR services to be provided to achieve an employment outcome”

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AT Requirements

• State VR Plan must describe “manner in which the broad range of rehabilitation technology services will be provided,” including training and provision of AT.

• Use of AT permeates VR process– Assessments to determine eligibility– Assessments to determine needs– Available as VR service to meet goal– VR agencies must coordinate with AT Act Projects to

promote access to AT for individuals and employers

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Post Employment Services

Provided after person has achieved an employment outcome.

Services must be necessary for the individual•To maintain, regain, or advance in employment.•Services not intended to be complex or comprehensive.•Limited in scope and duration.

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Financial Need Criteria

• Need not have a financial need, or financial contribution requirement

• Must specify which services will be subject to financial need

• Must take into account disability-related expenses

• Must not be so high as to effectively deny an individual a necessary service

• SSDI and SSI recipients (includes 1619(b) Medicaid) are exempt from requirement

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Comparable Benefits

• VR agencies are considered payer of last resort for many services.

• Will not pay for a service if similar or comparable benefit available through another provider.

• For example, if person qualifies for services through Medicaid, VR will not provide them.

• Must be available at time needed.• AT exempt from comparable benefits.

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Resources that are not Comparable Benefits

• Student loans, which must be repaid

• Scholarships and awards based on merit

• SSI’s Plan for Achieving Self-Support (PASS)

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Winston’s Eligibility for Post Employment Services

Why is the AT needed?•To maintain, regain, advance in employment?

Will he meet any financial need requirements?•He could be required to share cost of AT.•Meets financial need if getting SSDI or SSI – can he get SSI with blind work expenses, or if using PASS?

Must seek comparable benefits – Medicaid for wheelchair?

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Funding AT for WinstonAs Post Employment Services

• Personal computer, software for voice input/output. Cost = $1,600 combined

• Stand alone reading machine. Cost = $1,000 or more

• iPhone 6 or other smart phone/small tablet ($200 with phone plan, $600 or more retail)

• Two-year service plan

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Post Employment Services –Smart Phone/Tablet Apps

“Next Bus”/similar app & GPS apps – e.g., “Look Around Feature” are free.•What if better apps become available for $30, $50 or more each?

KNFB Reader – cost = $50 (on-the-go reading) – converts printed text into high quality speech to provide accurate, fast, and efficient access.

Look Tel Money Reader app – cost = $9.99 (more practical than separate free device from US Treasury?)

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Post Employment ServicesAT for Mobility

Ultra lightweight wheelchair ($1,500) or power scooter ($2,800) for travel outside the home•What if Medicaid denied saying it will not pay for wheelchair or scooter only needed for work activity?•Must Winston appeal before VR agency considers?

What if Winston seeks ramp, at cost of $3,200, to allow him to come and go from home with wheelchair?•If Medicaid routinely denies funding for ramps, must Winston still seek ramp from Medicaid first?

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Funding Possibilities for AT Sought by Winston

Funding Sources Other than State VR Agency

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Medicaid Could FundWheelchair or Scooter

Can he qualify for Medicaid with $2,800 earnings?•Most states have federal option, Medicaid Buy-In for individuals with disabilities who work.•Typically for person ages 16 to 64, who work.

Medicaid Buy-In (MBI) Income Limits•250 percent of federal poverty level (FPL) in most states, but some states allow higher income.•250 percent of FPL = $2,453 countable income (after all SSI based exclusions) – less than half of earnings count.•Some may qualify for MBI at $50,000 or more in wages.

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Medicaid Buy-In – What AboutSavings, IRA and 401k?

States have leeway to set resource limits• New York, where Winston lives, has $20,000 limit.• Other states have higher or lower limits.

States can go beyond SSI resource exclusion rules• Must exclude what SSI excludes (e.g., home, vehicle

used for transportation, burial reserve).• Although SSI does not exclude retirement accounts,

New York does exclude them.• Texas, Oregon, Minnesota – examples of other states

that exclude retirement accounts.43

What Can Medicaid Fund?

Ultra lightweight wheelchair or power scooter• OK that need is primarily for mobility outside home.• Is there a less costly, equally effective alternative?

Smart phone/tablet and apps• Medicaid not a likely funding source• Will not fund for vocational reason only.• If app used to read prescription labels, his mail, can

argue this is medical need.• Currently, one of challenges in Medicaid program.

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Might Winston Benefit fromMedicaid Waiver?

• Each state has one or more Home and Community Based Services (HCBS) Waivers – optional programs.

• They are used to target specific populations and provide some services not available through traditional Medicaid.

• Purpose: to allow targeted populations to receive extra services to avoid institutionalization.

• Waiver could target blind or physically disabled and offer funding for AT to support work and/or independent living.

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Using Business-Related Expense Deductions on Federal and State Taxes

Winston would file Schedule C with federal tax forms • Most if not all of the items he seeks could be business

expense deductions.

• Net value of deductions = reduction of taxes due.

• Assume $2,860 deductions for computer, software, Sara reader, iPhone, and selected apps.

• Assume 20 percent tax rate (combined federal, state, FICA).

• Net tax benefit from purchases = $572 (.20 x $2,860) for the year.

• Should consult tax professional for best use of deductions.

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Can Winston Use SSI’sBlind Work Expenses (BWEs)?

Can reduce countable income to determine SSI

payment. For Winston, could include his cost for:• Federal, state and local income taxes• Social Security and Medicare taxes (i.e., FICA)• Transportation to and from work sites• Wheelchair, even if not related to blindness (only if he

pays for item)• Computer, software, reading device, iPhone• Recurring costs – cell phone service, internet

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Winston’s Use of Blind Work Expenses - Assumptions

• SSA multiplies annual net income from self employment, $33,600 by .9235 to account for employer share of FICA, reducing income to $31,030 ($2,585 per month).

Has the following BWEs for year (since using BWEs, cannot also use as IRS deductions):

• $2,000 federal and state taxes

• $2,387 FICA (half not declared as business expense)

• $2,860 for computer, software, reading machine, iPhone, and apps.

• $1,200 cell phone, internet service

• $700 transportation – subway, bus, taxis

• Total = $9,147 ($762 per month)48

Winston’s Monthly SSI Budget with BWEs

Earned income $2585.00General income exclusion - 20.00Earned income exclusion - 65.00

$2500.00 Additional 50% exclusion - 1250.00

$1250.00Blind work expenses - 762.00Countable income $ 488.00SSI rate (living alone) $ 733.00Countable income - 488.00 SSI payment $ 245.00

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Compare – Using BWEs Versus Business Expenses

Business expenses:• Using $2,860 of deductions, 20 percent combined

tax/FICA rate, savings = $572.

Blind Work Expenses:• $762 monthly BWEs resulted in $245 monthly SSI• Annual benefit from SSI = $2,940• And makes Winston automatically eligible for Medicaid.• BWEs a better deal this year, but next year will not have

all the major purchases.

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Oops – Missed a PotentialBlind Work Expense

Winston must pay reader $120 per month.• Since the example above has him getting $245 SSI

payment …• Value of any additional BWEs will increase SSI dollar-for-

dollar. SSI increases to $365. • Once person has at least $1 of SSI, SSI payment

increases by $1 for every $1 of additional BWEs.

See Blind Work Expenses At-a-Glance, www.nls.org/files/At%20a%20Glance%20Advocate%20Info%20Sheets/Blind%20Work%20Expenses%202015%20Final.pdf

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Alternative Financing Programs- Low-Cost Loans to Fund AT

An AFP can make a loan available by:

• A revolving loan fund

• A loan guarantee

• An interest buy down

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Most Common Items Purchased with Loan Funds

• Vehicles modifications• Computers, costs for computer access• Mobility equipment, such as wheelchairs, scooters• Equipment for daily living, like environmental control

devices• Hearing aids, vision aids• Home modifications

See http://resnaprojects.org/allcontacts/allafpcontacts.html

for AFP information in 40 States.

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AFPs - Advocacy Tips

The AFP loan: Excellent way to cover out-of-pocket costs related to AT purchase:• Amounts that exceed the payment limitations of private

insurance• Medicare Part B 20 percent co-payment• Share-of-cost requirement charged by a state VR

agency • AT-related costs exceeding amount available under

SSI’s Plan for Achieving Self Support (PASS)• Amounts not otherwise covered by charity payments• Pending an appeal

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Winston’s Use of Equipment Loan

• Borrows $1,000 to purchase stand alone reading machine.

• Will inquire whether the following can be included in loan: smart phone or tablet, apps, JAWS or similar software for computer (assume $600 more)

If we assume $70 monthly repayment on 2 year loan:• Payments could be business related expenses on taxes.• Or, payments could be blind work expenses.• Cannot be used for taxes and as BWEs.

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What if Winston is a Veteran?

Department of Veterans Affairs (VA) could fund AT for

blind in many cases:• Generally, injury must be service connected.• May be an inability to pay criteria.

Categories for funding AT for blind:• As electronic equipment for blind or visually impaired.• As vocational services, employment services, or

independent living services.• For more information, see the Veterans Benefits section

of VA website, http://benefits.va.gov/benefits/

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What if Winston is Victim of Violent Crime?

• Operated by each state through a federal grant, is authorized by the Victims of Crime Act of 1984 (VOCA), as amended, 42 U.S.C. § 10601.

• Authorizes federal financial assistance to states (up to 40 percent reimbursement for approved expenditures) for the purposes of

– compensating and assisting crime victims,

– funding training and technical assistance, and

– serving victims of federal crimes.

See links for federal crime victims site, http://ojp.gov/ovc/ and to state

crime victims sites, http://www.nacvcb.org/index.asp?sid=6.

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Crime Victims – Compensable Expenses

Mandated expenses• States must award compensation for a list of expenses

when they are attributable to a physical injury resulting from a compensable crime:– Eyeglasses, other corrective lenses, dental services,

prosthetic or other devices (no definition of "prosthetic and other devices" appears in the law or guidelines)

– Mental health counseling and care

– Lost wages

– Funeral expenses

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Crime Victims – Compensable Expenses

Optional Allowable Expenses:• May offer compensation for other types of expenses as

authorized by state law, regulation, or established policy.• These include "[n]ecessary building modification and

equipment to accommodate physical disabilities resulting from a compensable crime." VOCA Guidelines, part IV.B.2.(b)(ii). (No definition for terms.)

• Compensation program is the payor of last resort "with regard to federal or federally financed programs."

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Association of Blind Citizens AT Fund

• Can cover 50% of retail price of adaptive devices, software.

• Goal - allow blind and visually impaired individuals access to products that will have a significant impact on improving employment opportunities, increase independence and enhance their overall quality of life.

• The products covered must retail for a minimum of $200 with a maximum retail price of $6,000.

• Persons eligible must have a family income of less than $50,000 and cash assets of less than $20,000.

• Application available on website, www.blindcitizens.org/assistive_tech.htm

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Other Funding Ideas

• SSI’s Plan for Achieving Self Support (PASS)

• Flexible Spending Accounts, Health Reimbursement Accounts

• Worker’s Compensation claims

• Other ideas?

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Thank you!

Please use your chat box to ask questions

James R. Sheldon, Jr., Supervising Attorney

jsheldon@nls.org * 716-847-0650 ext. 262

Ronald M. Hager, Senior Staff Attorney

National Disability Rights Network

Ron.Hager@ndrn.org * 202-253-5252

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