Medicare and mobility assistance

Medicare is a United States government funded health insurance program that is set up to cover people who are either age 65 and over, or who meet other special criteria, including permanent physical disabilities. Yet the criteria set up for the program is enforcing strict policies that are denying power wheelchairs to those who need them.

Under the National Coverage Determination (NCD) for Mobility Assistive Equipment, people who can move around from room to room within their home, but can not independently run simple daily errands outside the home, are not qualified for a power wheelchair.

Most people, even those covered by Medicare, are not aware of this strict policy, until they are in need of a power wheelchair and get turned down for mobility assistance by Medicare.

In past years, Medicare only covered power mobility assistance for those unable to stand or walk without assistance. After the case Olmstead vs. L.C. in 1999, the Supreme Court held that the unnecessary segregation of individuals with disabilities in institutions may constitute discrimination based on disability. The court found that the Americans with Disabilities Act (ADA) required states to provide community-based services rather than institutional placements for individuals with disabilities. This was a major step for those with disabilities, allowing them to stay in their homes and remain active in their communities.

Since then, the Center for Medicare and Medicaid Services (CMS) has revised these guidelines and determined that if one can self sufficiently complete daily living activities inside their home, they are not qualified for mobility assistance.

Taking it even one step further, they have tightened up the guidelines and now categorize people by types of diagnoses, instead of looking at the patients as individual cases with varying degrees of disability.

The Clinician Task Force, composed of experienced and respected seating and mobility clinicians working to improve Medicare coverage guidelines for mobility devices, is expressing much discontent with Medicare's coverage denial. They are working diligently to change these policies and are asking for individual clinical assessments to determine power wheelchair coverage.

They are also asking that each clinical assessment include the individual's medical history, physical abilities and needs, functional abilities and needs, seating and positioning abilities and needs, home accessibility, currently used assistive devices, as well as environmental considerations.

The Clinician Task Force states on their website:

"It is important that the right equipment gets to the right people - those who need it to meet the mobility needs arising during the course of typical daily activities. The Medicare coverage policy needs to be revised for that to happen." ~ Barbara Crane, PhD, Co-Chair of CTF.

Although these guidelines seem rigid and indifferent to the needs of those who have a physical disability, The Center for Medicare and Medicaid Services may have changed guidelines to stop people from making fraudulent claims.

In the 1990's CMS saw a large increase in claims for power wheelchairs, pointing to the idea that the paperwork trail was too small and the guidelines too relaxed. Many people were using the high dollar mobility equipment as a money scheme. In addition, manufacturers began marketing their products and making consumers aware that they could get reimbursed through Medicare.

The Clinician Task Force remains convinced that fraudulent claims can be stopped, while still taking care of the needs of those who need and deserve mobility assistance.

Return to Social Security Retirement Questions.