Lack of funding is one of the major barriers to the acquisition of AT. Amendments to the Individuals with Disabilities Education Act (IDEA), the Rehabilitation Act, policy interpretations of Medicaid/Medicare laws and regulations, Title III of the AT Act of 1998, and legal precedents established under the Americans with Disabilities Act (ADA) have all partially contributed to the framework of financial support for technology assistance in the home, classroom and workplace. However, public institutions, employers and individuals remain burdened with expensive AT costs.

Public Institutions

Public agencies serving people with disabilities provide an array of services designed to address the needs of the agencies’ federal mandates. Public institutions purchase AT devices to meet their respective responsibilities. Access to appropriate and effective technology-related assistance is most often dependent upon third party funding and is subject to evaluations, agency requirements, patronizing attitudes and conflicting definitions of disability.

Public School Districts

Public school districts purchase AT devices and services recommended in Individualized Family Services Plans (IFSPs) and Individualized Education Programs (IEPs) of, respectively, infants and toddlers with disabilities and children and youth with disabilities. Special education is financed primarily by local and state governments, and only secondarily by federal funds.

State VR Programs

State vocational rehabilitation (VR) programs purchase AT devices that aid in hiring people with disabilities, who are clients of VR agencies. Principally, the federal government finances 78 percent of matching funds for VR; states pay 22 percent.

SSDI and SSI

Supplemental Security Disability Income (SSDI) is a federal program, whereas, Supplemental Security Income (SSI) is a federal-state program. Both of these benefit programs augment the cost of AT for people with disabilities, yet are relatively limited.

Medicare

Created by Title XVIII of the Social Security Act of 1965, Medicare is a federal health insurance program for people over 65. Individuals who have been disabled for 24 months also are eligible for Medicare. This program pays most costs for “durable medical equipment,” but rarely for AT products.

Medicaid

State governments administer the Medicaid program for those in financial need and receive matching funds from the federal government. This federal-state medical insurance program pays for some AT devices that reduce dependency. Although described as “entitlement programs,” they offer no guarantee that AT will be provided as an entitlement.

Funding Streams Summary:
Falling Short of the Vision

Medicaid and Medicare are limited in scope to provide durable medical equipment like wheelchairs, prosthetic and orthotics and augmentative communication technologies when medically necessary, or to restore functional independence. Most of these public funding systems are “medicalized,” meaning that the person with disabilities is assessed and then the AT is recommended or prescribed by a “professional.” Recommendations are typically limited by how much the agency can pay for particular items, or by categories of AT the agency covers that relate to agency mandates. In many cases after the professional makes a recommendation, there are often additional steps in the review and approval process that can negatively impact timely provision of the AT and information and communication technology.

Despite the positive efforts to change systems at local, state and national levels during the past 10 years, public funding of AT devices and services is not self-enforcing. Additionally, as the number of individuals with disabilities and their need for AT increases, the current strain on available public and private third-party funding sources is likely to worsen.