Wednesday, March 16, 2011

Medicaid and the iPad

File this one under example #873242 of how the federal government gets things wrong.

As you may or may not know, kids with special needs often can qualify under Medicaid (where their parents do not), or a Medicaid waiver, to cover certain medical and therapeutic expenses that would otherwise be prohibitive.  One example that I'm personally familiar with is an AAC device (which stands for Alternative Augmentative Communication).  An AAC device is any kind of assistive technology that helps a child (or, perhaps an adult who has suffered a stroke) communicate to others.  Examples include low-tech PECS boards and run all the way to dedicated picture-based "talkers" like the Dynavox or Vantage Lite.  (If you're really interested you can learn more at Dynavox and Vantage Lite).  Note that these dedicated devices - which look like archaic throwbacks to computers in the 1970s, btw - cannot do any other type of function.  And for the privilege of getting one, you can expect to pay somewhere in the neighborhood of $7-9,000. 



Interestingly, with the advent of tablet computing, some lower cost alternatives have emerged.  App developers created software programs that mimic the function of the Dynavox/Vantage Lite for the iPod and iPad.  Even though this software is expensive (around $200 for Proloquo2go), you could still buy the software, an iPad, an iPad cover, and the extended warranty for less than $1000.  Big cost savings to the average consumer, wouldn't you say?

You'd think that the good folks who administer Medicaid would realize "Hey, we could save a LOT of money if we reimburse for AACs like the iPad."  Here's the problem: Medicaid won't reimburse for iPad because it's not a dedicated AAC.  That's right, *because* the iPad can be used for other purposes, *because* it's a device with multiple, flexible uses, no reimbursement.

Add to this irritating situation the fact that many older kids with communications difficulties are resistent to using the "traditional" AAC devices because they do look like they're from the 1970s, they're heavy, and the kids don't want to be embarassed.  However, as I have heard from multiple parents, those same kids are delighted to use the iPad: because it's cool.

Hmph.

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