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Time to Act for Independence
July 27, 2006 • Volume 6, Issue 30This week marks the 16th anniversary of the Americans with Disabilities Act (ADA), a landmark legislation that has knocked down physical and legal barriers that prevent people with disabilities from enjoying a full life in their communities.
Medicare, by providing health coverage to people with disabilities that private insurers will not provide, has prevented many illnesses and accidents from imposing a death sentence on millions of Americans. The ADA has helped ensure that the health care people with disabilities receive does not impose a prison sentence—warehousing in an institution or confinement within the four walls of a home.
But Medicare still needs to incorporate some of the principles of the ADA in how it treats people with disabilities. In particular, coverage for a manual or power wheelchair must no longer be restricted to those who need the device to move about their home but denied for those who need it for essential activities in their communities. This restriction means, for example, that people who can inch their way to their kitchen and bathroom by holding on to the wall, but need a wheelchair to go to work or visit the doctor, cannot get wheelchair coverage from Medicare. Even people living in apartments too cramped to accommodate a wheelchair cannot get coverage for one, thus barring access to a device that would allow them a full life in their community. For many people with disabilities, particularly those surviving on limited Social Security disability income, wheelchairs are prohibitively expensive without Medicare coverage.
The “in-the-home” restriction results from a misreading of the Medicare statute by the lawyers at the Centers for Medicare & Medicaid Services (CMS), who have interpreted a provision meant to distinguish coverage for residents of a nursing home or other institution from coverage for those who live at home as preventing coverage for uses outside the home. CMS has stuck to this interpretation despite pleas for reconsideration from over 100 members of Congress and protests from thousands of people with disabilities.
Faced with this intransigence, a bipartisan group of lawmakers led by Senator Jeff Bingaman, Democrat of New Mexico, and Senator Rick Santorum, Republican of Pennsylvania, has introduced a bill that lifts the “in-the-home” restriction for wheelchairs and other mobility devices. This bipartisan initiative recalls the spirit that led Congress to pass the ADA and for President George H.W. Bush to sign it.
Introduction of this legislation is an important effort to bring Medicare’s coverage in line with common decency and common sense and lift an arbitrary restriction that prevents many people with disabilities from taking full advantage of medical technology that can lift their confinement to the home.
Medical Record
“CMS’s restrictive coverage policy for mobility devices is contrary to the medical standards that have evolved in recent years. Researchers have found that home confinement and activity restriction are associated with depression, reduced social and leisure activities, lower life satisfaction, greater use of home health care, and malnutrition. Isolation and lack of community connection are associated with higher levels of morbidity and mortality…Studies show that removing environmental barriers and implementing effective treatments of mobility impairments can improve access to health care and quality of life” (“Forcing Isolation: Medicare’s ‘In the Home’ Coverage Standard for Wheelchairs,” Medicare Rights Center, March 16, 2004).
“Wheelchairs make it possible for otherwise homebound individuals to have the freedom and opportunity to get around outside their homes,” Bingaman said. “This bill allows people with disabilities to live independently in their community and I hope my colleagues in the Senate support it” (“Bingaman Introduces Bipartisan Legislation to Provide Medical Equipment Not Currently Covered Under Medicare,” press release from office of Senator Bingaman, July 17, 2006).
“The efforts of Senators Bingaman and Santorum on this issue have been extraordinary. With over 6 million Medicare beneficiaries under the age of 65, many of whom have mobility impairments, this legislation will provide access to some of the basic tools required for independent, community living. We look forward to working with the bill’s sponsors to ensure its passage” (“ITEM Coalition Lauds Introduction of Legislation to Fix Medicare’s ‘In the Home’ Restriction on Mobility Devices,” ITEM Coalition press release, July 18, 2006).
***** The Medicare Rights Center (MRC) needs to hear about all the problems with the Medicare Part D benefit, whether they happen to you or someone in your community. With this information, we will be armed with the needed evidence to push for a Medicare-administered drug benefit.
Fast Relief: Part D Monitoring Project
Submit your story at www.medicarerights.org/partdstories.html
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