Medicare Policy Keeps Door Shut on Disabled

By Prema Polit, AlterNet. Posted April 11, 2007.

When someone walks into the wheelchair clinic at Mount Sinai Hospital in New York, Jenny Lieberman begins preparing to say that there is nothing she can do to help. A physical therapist, Lieberman oversees Mt. Sinai's wheelchair clinic and evaluates people with medical equipment needs. The health coverage that many of her clients have is Medicare, the federal health program for seniors and people of all ages with permanent physical disabilities.

But Medicare has strict policies on what durable medical equipment it will or will not cover, including power wheelchairs. Lieberman reads down the standard list of questions, searching for a way to get the equipment that she knows her client needs. Then she gets creative in trying to procure coverage for her patient, from Medicare or another health policy. In the end, though, it boils down to one question: Does the patient need a wheelchair inside the home?

Under Medicare policy, the needs of someone outside the home are negligible. 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. So chances are that if you are walking when you come into Lieberman's clinic, Medicare won't pay for your wheelchair. And it's those days that Jenny Lieberman hates her job.

Lieberman recalls a recent client, a young woman with multiple sclerosis who can walk short distances. She lives with her parents, who are in their 60s, and manages to navigate around the house, even on "bad days." But in order to go anywhere outside, including to medical appointments, she depends on her parents to push her manual wheelchair. Lieberman couldn't figure out a way to justify to Medicare the necessity of a wheelchair for "activities of daily living" inside the young woman's home.

This young woman and her family left the clinic resigned. But often people get upset when they find out that Medicare won't pay for medical equipment that they need. "Some people get angry at me," Lieberman says. "I've had people start crying. They feel helpless -- they can't get out of their homes."

Especially for seniors, this predicament can be disheartening and frustrating. "They've worked so hard all these years, but now can't get the equipment they need to keep living their lives," Lieberman says.

Few are in a better position to know the effect of Medicare's policy than the clinicians who see its problems day after day and struggle to find a solution. The Clinician Task Force, a 3-year-old organization, is a collaboration of experienced and respected clinicians, including physical therapists and assistive technology practitioners and suppliers, who are dedicated to changing the policy.

A co-chair of the Clinician Task Force, Barbara Crane has been a physical therapist for over 15 years, primarily in the area of wheelchairs and seating. "I work a lot with people who need wheelchairs and are covered under Medicare," she says. "I have seen people who I would certainly recommend a different device for, [but] we end up having to go with another one because Medicare won't cover it."

It seems like a no-brainer to many: Why only pay for a wheelchair intended for use inside the home? Isn't outside where someone would need a wheelchair the most? And why does nobody know about this?

Because this particular Medicare policy affects a smaller population than other issues such as prescription medications, it is not as much on the political radar of many advocates, legislators and beneficiaries. "In fact," Crane explains, "most people covered by Medicare are unaware of the problem until they get denied coverage for a mobility assistance device such as a power wheelchair."

For many years, Medicare only paid for wheelchairs if someone was nonambulatory, meaning unable to walk at all. While the Center for Medicare and Medicaid Services revised the guidelines to include the inability to complete an "activity of daily living," the qualifier remained: "in the home."

See more stories tagged with: disabilities, medicare, wheelchairs, disabled, seniors

Prema Polit is an editorial intern at AlterNet.

Liked this story? Get top stories in your inbox each week from Health and Wellness! Sign up now »