Pennsylvania’s Department of Human Services (DHS) has amended the state’s Medical Assistance plan to cover removable medical equipment for children and adults with mobility impairments. Removable medical equipment includes certain items necessary to the health and wellbeing of individuals with disabilities that can support activities of daily living and help an individual enter or exit their home, facilitating greater engagement with their community. The full State Plan Amendment (SPA), including a list of what is now covered, can be found here.
The new coverage is part of a settlement in a class-action lawsuit filed by Disability Rights Pennsylvania on behalf of a class of children in the state’s Medical Assistance program. The plaintiff class alleged that DHS violated the Social Security Act by denying requests for removable medical equipment. Further, the suit alleged that DHS failed to inform the plaintiff class of the availability of such equipment under Medicaid and even led youth, hospitals, equipment vendors, families, advocates, and others to believe that such devices were not covered. As detailed in the resulting settlement, the state’s Medical Assistance plan has updated the definition of covered home health services to explicitly include wheelchair lifts, ceiling lifts, stair glides, metal accessibility ramps, and other such equipment that can be reused and removed without damage to the item.
The amendments, which are applicable to all Medical Assistance recipients regardless of age, have been approved by the Centers for Medicare and Medicaid Services (CMS) for coverage retroactive to April 1, 2020. Considering this, PHLP encourages individuals who have previously applied for and been denied removable medical equipment to reapply for approval with an updated letter of medical necessity from their physician. For those who denied after April 1, 2020 but have since paid out-of-pocket for removable medical equipment, this amendment may open the door for individuals to submit a claim for reimbursement from the state.
While this update increases access to necessary devices for individuals with mobility impairments, there are still gaps in coverage. Although the update includes coverage for certain elements of the installation process of these devices, the Pennsylvania Medical Assistance program does not cover home modifications outside of waiver services. This means that when a structural change to the home, like electrical updates or demolition of existing structures, is required for proper installation of removable medical equipment the beneficiary will have to pay for that service as separate from the installation.
For more information on the new Medical Assistance coverage and questions about how to apply for removable medical equipment, please call PHLP’s Helpline at 1-800-274-3258 or email us at firstname.lastname@example.org.
For more information about the lawsuit and settlement agreement, contact Disability Rights Pennsylvania by calling 1-800-692-7443, Option 6, or sending an email to email@example.com.