Thursday, April 12, 2007

Medicare and power wheelchairs

There is an interesting article posted on
Medicare keeping the door shut on the disabled.

The gist of the article concerns Medicare and its policy to either pay or not pay for power wheelchairs. The answer lies in the results of a strict checklist. The bone of contention is that “it boils down to one question: Does the patient need a wheelchair inside the home?”

According to the article, “If you can limp 10 feet to the bathroom, or move from the refrigerator to the sink to make dinner, then Medicare will not cover a power wheelchair, even if you can't walk down the block to the grocery store for the food in the first place.”

This approach seems almost like a silly argument, one that makes no sense in the broader scope of individual needs. If a person is barely functional in their home, but can manage just a little bit, then Medicare says, “Well then…you certainly don’t need a power wheelchair,” even though providing such an assistive device may enable the person to get out of the house and get a job.

Compound this with individual pride and the innate quality of people trying to show they can do as much as they can, demonstrating their will to be strong in light of a disabling condition, even when this demonstration of will is at the reviewing athority who will report their findings of the individual's ability/disability to Medicare? When showing they can walk ten feet, no matter how much is done with a limp or the level of pain they endure when doing this, will be the very deciding factor that will shoot that person in their all-------too-able foot.

Wouldn’t it make sense to empower a person by providing the tool that would give him the potential to go to work and have private employer-provided health insurance, getting him off of Medicare as a result?

I don’t consider myself a liberal, nor a bleeding heart, but I am a passionate defender of rights of people with disabilities. However, I am also a tax-paying citizen and also understand the need for Medicare to protect its budgetary constraints, carefully scrutinizing the criteria for incidents when they will pay for a person’s expensive piece of assistive technology. However, there should be a more common sense review to consider when Medicare will fund these items.

The article illustrates clearly that items such as this which Medicare reigns over with a tight fist often goes unnoticed by legislators, as it is not a big hit on the political radar screen. In time, though, I believe this will change with the graying boomer population and the effects of this aging bringing on a variety of disabling conditions. Medicare’s ability to be so stringent in its governance for power wheelchairs may change as does the age of our population.


mleita said...

Mr. Graham,

Your April 12th posting is one of many public outcries regarding this strict "in the home" interpretation from the Medicare program. I find it unfortunate that many who often need assistance inside the home usually go without because they cannot receive the appropriate technology to become a greater part of society outside the home.

For several years, members of Congress have tried to work with the Medicare program to lift this restrictive interpretation because that is all that it interpretation by the Medicare program. In fact, to alleviate any confusion, there have been many legislative acts introduced to help those who need assistive technology outside the home. The latest bill, the Medicare Independent Living Act (H.R. 1809) was introduced by Congressman James Langevin (D-RI) and Congressman Jim Ramstad (R-MN). Both head up the Disabilities Caucus in Washington and are very active on this issue. Senator Jeff Bingaman (D-NM) has introduced the Senate companion bill.

The good thing is that many groups are working harder than ever to push this legislative effort over the goal line. I know Henry Claypool, the gentleman mentioned in the article and he has been working on this effort for a number of years. He has also worked side by side with the ITEM Coalition to further educate legislators as well as the Medicare program on this issue. It is unfortunate that Medicare feels the benefits of lifting this restriction would be exceeded by the dollars needed to help those in need outside the home. In reality, the actual tax dollars would be minimal and the overall outcome would be a very positive one for all. People living with disabilities who are in need of power mobility (power wheelchairs) for example, would become a greater contributor to their community, require less healthcare and healthcare related expenses, and would be able to get back into the workforce. In fact, a study conducted by an economics group (RRC, Inc) found that those who require a power wheelchair to conduct their activities of daily living actually save the federal government over $10,000 compared to those who do not have a power wheelchair. With the average cost of a power wheelchair around $4,400, that's a sound ROI.

My blog will begin to focus on the issue surrounding not only the "in the home" restrictions, but the access issues that have resulted from the governments policy changes. If you get a chance, come read more about it.

Thanks for your insight!

Mark Leita

Anonymous said...

We need to form a lobbyist group. I have been disabled for 10 years, 41 years old, single mother and have to live with my folks. I worked 15 years, made good money and paid taxes. Now I am poor and bed ridden most the time. Someone needs to find out what are Congressmen insurance policies are like. Here's the catch: Our taxes pay their wages and I bet you their medical coverage is ten times better than my medicare coverage. If they had medicare they would do something about it. People like Tedd Kennedy has been in Congress most his life and we pay his wages, etc. This is all so backwards. These law makers will reap the seeds they sew. They are all going to grow old and need help and may the Lord help them.