STATE FINANCING ACTIVITIES

The RESNA Technical Assistance Project has compiled information on state financing activities, one of the four State Level activities to which states must dedicate a minimum of 60% of their funding under the Assistive Technology Act of 1998, as amended.  That information is found in the following sections:

Background

Section 4(e)(2)(A) of the Assistive Technology Act as Amended in 2004 states the following:

“(A) STATE FINANCING ACTIVITIES - The State shall support State financing activities to increase access to, and funding for, assistive technology devices and assistive technology services (which shall not include direct payment for such a device or service for an individual with a disability but may include support and administration of a program to provide such payment), including development of systems to provide and pay for such devices and services, for targeted individuals and entities described in section 3(16)(A), including--

(i) support for the development of systems for the purchase, lease, or other acquisition of, or payment for, assistive technology devices and assistive technology services; or

(ii) support for the development of State-financed or privately financed alternative financing systems of subsidies (which may include conducting an initial 1-year feasibility study of, improving, administering, operating, providing capital for, or collaborating with an entity with respect to, such a system) for the provision of assistive technology devices, such as--

(I) a low-interest loan fund;
(II) an interest buy-down program;
(III) a revolving loan fund;
(IV) a loan guarantee or insurance program;
(V) a program providing for the purchase, lease, or other acquisition of assistive technology devices or assistive technology services; or

(VI) another mechanism that is approved by the Secretary.”


What Makes a Good State Financing Activity?

State financing activities directly assist individuals with the acquisition of assistive technology devices or services (AT).  This often is done by reducing the cost of AT or developing alternative sources of funding for AT.  State financing activities should adopt a systematic approach to assisting individuals with disabilities in the acquisition of AT and should be activities that are sustained over time.  State financing activities should include the development of systems that:


Description of Ideas for State Financing Activities

The RESNA Technical Assistance Project conducted a series of conference calls with state AT Act Programs to provide a forum for the exchange of ideas on potential activities in Section 4(e)(2)(A)(i) of the AT Act of 1998, as amended that reads “support for the development of systems for the purchase, lease, or other acquisition of, or payment for, assistive technology devices and assistive technology services.”

States shared their ideas and offered potential state financing activities other than the traditional alternative financing program.  Descriptions of some of these programs are included.  The list is not inclusive of all activities being conducted in all the states.  Other than AFPs, some of the activities highlighted by states included:

Other than AFPs, the inclusion of an activity on this list does not imply that the Rehabilitation Services Administration (RSA) has approved of this activity as a state financing activity that meets the requirement of the AT Act.


Cooperative Buying Program (Maryland)

Background

The Maryland A.T. Co-op is a program of AT:LAST, Inc. that provides discounted purchasing and training opportunities to schools, agencies, organizations, and families. With initial funding and support from the Maryland Technology Assistance Program (Governor’s Office for Individuals with Disabilities), the Maryland State Department of Education (MSDE- Division of Special Education), and the Maryland Developmental Disabilities Council (DDC), the Co-op uses the combined purchasing power of Maryland’s schools to make assistive technology (AT) more affordable.

Assistive Technology: Loans, Acquisitions, Services, and Training, Inc. (AT:LAST, Inc.) was formed as a 501 (c)3 nonprofit organization in 1998 by the Maryland Technology Assistance Program (MDTAP) in response to several focus groups which sought to determine why students were not receiving the assistive technologies to which they were legally entitled under IDEA.  The overwhelming focus group response was “the high cost.”  To tackle this issue, MDTAP provided the seed money to establish this nonprofit organization, not dependent on funding from the Assistive Technology Act and free to operate without typical governmental bureaucratic delays and issues.

By March of 1999 AT:LAST had established the Maryland A.T. Cooperative Buying Service to combine the purchasing power of Maryland schools to reduce the high cost of AT.  The rapid success of this service has led to AT:LAST, Inc. being identified as the “MD A.T. Co-op” although it performs many additional services, including a comprehensive training program, short-term device loan program, student evaluations on a limited basis, and public awareness activities.

The goals of the program are the following:

  1. To see more product, properly used, in the hands of individuals with disabilities.
  2. To train parents and professionals shoulder-to-shoulder in the appropriate use and integration of products.
  3. To make individuals and institutions aware of the continuum of assistive technologies available so that they can properly select technologies that best support individual needs.
  4. To work closely with manufacturers to provide product development feedback and to be sufficiently knowledgeable to answer questions from consumers.
  5. To support its members with accurate and up-to-date information about products, strategies, professional development opportunities, human and AT resources.

Operations

All discounted orders go through the MD A.T. Co-op at rates published twice yearly.

The Co-op serves as a "reseller" to offer the best pricing on certain product lines where margins are small. To bring consumers, schools, and agencies discounted products, the Co-op keeps its overhead low (paying minimal rent, advertising, etc.), and it gets permission from numerous manufacturers to hold "statewide" versions of "district" licenses, allowing small systems to benefit from the purchase levels of large systems.

The Co-op realizes savings for its members by conducting competitive bids, negotiating directly with manufacturers, and entering into a limited number of reseller agreements.  The Co-op attaches a small percentage to the prices it obtains to sustain its operation.  While the Co-op occasionally receives grants from governmental agencies, they are for the performance of particular, time-limited functions and separate from the general operation of the purchasing Co-op.

The success of the cooperative buying function is the clear result of cooperative and collaborative relationships with both its members and with the AT community— manufacturers, vendors, academics, consumers, and practitioners.  It is also a reflection of the unique bidding process

Unlike most governmental or educational entities which seek guaranteed pricing for a period of three to five years, the Co-op seeks pricing for just a six month period.  This protects the bidder from unpredictable manufacturer cost increases and recognizes factors unique to the technology market (i.e. short upgrade periods, declining costs, and rapid new product introduction).  Bids are sought on a range of quantities to accommodate both large and small members (typically <5, 5-24, and 25+). This yields good pricing for members while protecting bidders from offering in anticipation of quantities that may or may not materialize.  A simple and transparent process (bid and return only applicable sheets, no need to provide pictures and product descriptions, no needless pages of “boilerplate,”) reduces paperwork and valuable time completing and returning bids.  Processing is 98% completed the day after closing.  Results are known by winners within a week.  (It takes only one additional day to notify those without any winning bids.)  Bids are advertised in major local newspaper, by fax notification and on the website.  Bids are returned by fax, saving time and registered mail expenses.

Although the easy process, quick notification, and policy of not holding a bidder to a price if the bidder can document a manufacturer’s price increase is reason enough to do business with the Co-op, the Co-op’s position is that it needs to provide more to the participating vendors in return for their offering discounts to its members.  Therefore the Co-op offers the following in return:

  1. All orders are “pre-processed.”  Clarification is sought about platform, cable type, etc.  BEFORE a Co-op PO leaves the office, saving manufacturers/vendors the time and inconvenience of getting additional required information
  2. 100% of invoices are paid within thirty days of receipt of merchandise.  This helps the collaborating merchant avoid cash flow and collection issues since the Co-op waits for the more historically slow-paying school systems
  3. Product catalogs and demo disks are transported and distributed at all Co-op events.  The Co-op does NOT “promote” any product over another; instead it seeks to make the public aware of the continuum of devices and software programs available.
  4. Sample products are displayed at all Co-op events.  Some of these have been purchased by the Co-op as sale or loan inventory. Many of the display items have been donated to the Co-op for the purpose of allowing the public to examine more closely before purchase.  Items are regularly made available by both large and small companies.
  5. Laptop computers are available at Co-op events so participants can try software programs for themselves.  Similarly, the majority of software programs have been donated by manufacturers or vendors.
  6. The Co-op produces and distributes to EVERY Maryland public school, each member of the Maryland Association of  Non-Public Special Education Facilities (MANSEF), and many organizations and agencies a copy of its (now) twenty page Discounted Price List. 
  7. The Co-op exhibits at several statewide conferences each year to make individuals and groups aware of the potential for assistive technologies and of its service for acquiring them.
  8. The Co-op supports the use of the products with trainings and comparative product expos.

What the Co-op Does for Its Customers

Types of A.T. Products Currently Available

Populations Served

Purchasing Procedures

Directions for purchasing are slightly different for parents than they are for agencies and school districts—who already have established relationships with the Co-op.  Parents are directed to first work with their child’s therapist or teacher to get guidance regarding the selection of appropriate AT.  The Co-op does not provide recommendations regarding which AT should be purchased.  Next, the parent completes a quote form.  The Co-op searches for the best price and then informs the parent.  The parent then submits payment to the Co-op via check or money order.

Considerations

While the Maryland A.T. Co-op initially charged a membership fee to school districts, it no longer does this, due in part to the fact that school districts weren’t used to and didn’t want to pay a membership fee.  Instead, the Co-op attaches a small percentage to the prices it obtains to sustain its operation.  Consequently, schools, state agencies, and consumers can get good prices on AT without paying membership fees.

In addition to providing access to affordable AT, it is essential that training on the use of the AT be provided.

Establishing a cooperative buying program is time and labor intensive.  It also requires a financial “slush fund” (approximately $20,000 when the Co-op first began and now almost $100,000) to cover the expenses of the AT while the Co-op awaits payment from school districts and other customers. 

AT:LAST, Inc has just moved into public space  in May of 2005 to establish a demonstration/resource room and training center in order to support use of the products handled.  It is highly recommended that such a facility be part of a cooperative purchasing plan.

Susan Garber, Executive Director of the Maryland A.T. Co-op, suggests considering partnering with an existing program, such as the Maryland A.T. Co-op, rather than each state establishing their own program.

Contacts/References:

For more information, visit the following website: http://www.matcoop.org/ or contact:

Susan Garber, Executive Director  410-381- COOP, info@matcoop.org
Amanda Cheong, Purchasing Director   410-290-1327 purchasing @matcoop.org
Sarah Poundstone, Communications Coordinator, 410-381-COOP, communications@matcoop.org


Individual Development Accounts (Kansas)

Background

Individual Development Accounts (IDAs) are dedicated matched-savings accounts that provide incentives for low income individuals to build investment assets.

The Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (PRWORA) allows states to create community-based IDA programs with TANF block grant funds.  The 1998 Assets for Independence Act broaden the eligibility of IDAs to non TANF recipients as well as provided federal funding to expand the availability of IDA programs. 

IDAs are managed by community organizations and accounts are held at local financial institutions.  Contributions from low income participants are matched using both private and public sources.  Money set aside in IDAs is disregarded in determining individual assets.  Money provided as match by private sources can often be claimed as a tax credit.  Employers who contribute to the IDA match may receive wage subsidies. 

IDAs are used to help individuals save for

Individuals save a monthly amount that is matched 1:1 or 2:1 or more so that after a time, the amount available for education, home ownership and starting a business is larger than the individual would have been able to save by himself/herself.  For example, if an individual saves $50 a month that is matched 2:1, then at the end of a year, instead of saving $600, the person has accumulated $1800 in the account.

Operations

IDAs have been linked to the purchase of assistive technology. 

Kansas.  Kansas passed a law in 2001 (Senate Bill 332) that allowed for the creation of IDAs to purchase assistive technology.  The individual/family must have an income of less than or equal to 300% of the federal poverty level.  Individuals can contribute up to $5,000 per year, the total in the account cannot exceed $50,000.  Match is allowed from 1:1 to 5:1.  Currently Kansas is seeking match funds to fund the program.  No AT accounts have been started.

Considerations

Over 500 IDAs exist nationwide, with over 10,000 people participating.  Programs take time to start up; it takes additional time to market the programs to individuals who might be interested in participating in the program.  The advantages of the IDA is that an individual can actually save and get a tremendous increase in his/her investment - especially when the match ratio is high.  The disadvantages of an IDA is that the individual has to have the disposable income to allow him/her to actually save a set amount each month.  Given the choice between purchasing food for the month and paying into an IDA account, an individual might not contribute to his/her IDA account that month.

States may not need to have specific legislation that allows for the purchase of assistive technology with IDAs.  If the IDA is for employment - then the AT purchase could be seen as falling under job training.  Likewise AT for education could fall under the education category and home modifications could fall under the housing category. 

Contact/References

References (provided by Sara Sack)

Flacke, T., Grossman, B., & Jennings, S. "Individual Development Account Program Design Handbook: A Step-by-Step Guide to Designing an IDA Program," (1999). Corporation for Enterprise Development, 777 North Capitol Street, NE, Suite 410, Washington, D.C. 20002, (202) 408-9788/

Sherraden, M., Page-Adams, D., Johnson, L. (1999). Down payments on the American Dream Policy Demonstration: A National Demonstration of Individual Development Accounts, Start-up Evaluation Report. St. Louis, MO: Center for Social Development at Washington University.
See also gwbweb.wustl.edu/csd/asset/idas.htm

Additional References

Kansas Senate Bill 332, from the 2001 Session establishing Individual Development Accounts for Assistive technology available at http://www.kslegislature.org/bills/2002/332.pdf

IDA Network Web site - http://www.idanetwork.org
This web site sponsored by the Corporation for Economic Development is a clearing house for IDA information.  It links to IDA conferences and training sessions, directory of IDA programs, and an IDA toolkit.  It also has links to the IDA technical assistance provider.

Washington University, St. Louis, Missouri - gwbweb.wustl.edu/csd/asset/idas.htm
Provides a brief overview of what IDAs are and the prevalence of IDAs across the country as well as summaries of research into IDA effectiveness.


Partnerships for Coordination of Agency Services (Nebraska)

Background

The Nebraska Assistive Technology Partnership was formed in 1997 and today includes   nine agencies (see Table 1). The program was started under the direction of Mark Schultz who directs the federally funded state grant on assistive technology.  The original state grant on assistive technology (AT) was written by the state’s Department of Vocational Rehabilitation in 1989.  Vocational Rehabilitation began assigning some of their technology-related activities to the assistive technology project because of the expertise of the staff.  The Department of Health and Human Services (HHS) became aware of the cost savings with Vocational Rehabilitation and partnered with the Assistive Technology Project, earmarking $540,000 for assessment services in addition to paying for devices needed by Health and Human Service consumers. Thus the Partnership was born. 

One of the advantages of the Partnership is that it has a broad mission and purpose that can encompass assistive technology from all environments, including employment, education, independent living, housing, and information technology. The Partnership is able to leverage funds from many funding sources and provides a comprehensive approach to meet an individual’s needs. The expertise of staff ensures needed and appropriate services that are delivered in a timely manner (inappropriate solutions are not purchased or need to be replaced resulting in a cost savings) and consumers participate in the process of identifying their needs and solutions. 

Operations

Partnership services include:

Funding for the cost of home modifications, technology, or services needed by consumers who experience a disability are provided by numerous programs. The guidelines and eligibility requirements of programs vary widely and would be overlooked by those who are unfamiliar with how to access them. To maximize resources, the Partnership worked with various agencies in Nebraska to develop a Service and Device Application Form. The information provided by consumers includes their technology and home modification requests and their financial status. This information is used to coordinate funding between 19 agencies and organizations. The application includes a release that allows the agencies to share the information.

Technology Specialists average 120 assessments per year. A Technology Specialist does an on-site assessment, identifies solutions and a contractor to do the modifications, and monitors the project to make sure it is done correctly. Resources are maximized by identifying solutions that will meet the needs of the consumer and are cost effective. For example, in situations in where an elderly person is living in a rental property the Partnership will recommend an aluminum modular ramp, instead of building a wooden ramp. The modular ramps are more expensive initially, however, they can be recycled by removing them and using in another location.

Another advantage of the Partnership is the ability to recycle equipment purchased by one system and make it available to a consumer who is eligible for another system. The  cost of assistive technology and home modifications for an individual can be recaptured in two months by preventing institutionalization. 

Considerations

Advantages

Disadvantages

Contacts/References

For more information on the Partnership, call 402.471.0734 or visit its web site at: www.nde.state.ne.us/ATP/

Table 1. Agency Partnerships in Nebraska

AGENCY

AMOUNT

PURPOSE

DESCRIPTION

NE Health and Human

Services

$540,000

In-home assessments for AT and

home modifications

This is a collaboration of a number of Health and Human Services programs including the Home and Community Based Waiver, Medically Handicapped Children’s Program, Disabled Children’s Program, Disabled Persons and Family Support Program, Economic Assistance, Subsidized Adoption, Child Protective Services, and Adult Protective Services. ATP provides assessments and authorizes work to be done as recommended. The program is focused on providing appropriate assistive technology and home modification solutions to help keep an individual with a disability in their home, living independently, and preventing institutionalization.

ATP provides 800-1,000 assessments per year and authorizes just under $2,000,000 per year of Aged and Disabled Medicaid Waiver funds for the purchase of assistive technology and home modifications. The ATP contract is based on an $850 per assessment fee. ATP bills monthly, in advance, adjusting each billing to reflect the difference that month’s actual expenditures and the previous advance. The contract amount is currently capped at $540,220.

Vocational

Rehabilitation-Part B

$200,000

 

Financial assistance to

purchase AT and home

modifications

Funds provide direct financial assistance for the purchase of assistive technology and home modifications for 80-100 persons each year to allow individuals to live more independently. Primarily used as gap financing when no other resources are available. Authorized purchases are direct billed to VR. The entire amount of $200,000 was used for direct purchases of AT and home modifications for consumers.

Vocational

Rehabilitation

$235,000

Work-site assessments for AT

and modifications for

employment

Vocational Rehabilitation Title I evaluations are funded through Solutions On Site for employment-related needs of Vocational Rehabilitation consumers with a disability. This can include work-site modifications, computer equipment, software and hardware adaptations, as well as home modifications necessary to allow a person to get out of their home to get to work. Worksite assessments are provided for 125-160 persons each year. Actual expenses for the provision of services (including salaries, benefits, rents, operating costs, phone, etc.) is direct billed to VR. ATP provides the recommendations to VR staff who then authorize the purchase of services and equipment. VR reports spending $647,333 for rehabilitation technology services (purchases of equipment and services) in the last fiscal year.

Educational Service Unit #10

$30,000

To provide for recycling

of at and computers via Tech Connectors

ATP collaborates with Nebraska Educational Assistive Technology to operate the eastern Nebraska recycling site and assist with the implementation of TechConnectors recycling/equipment loan on-line database. Funding provides for .5 FTE. The entire amount of funding is drawn down and available for use upon approval of the contract.

Housing Developers Association

$12,750

To conduct home

assessments for accessibility

Assessments are conducted in support of Making Homes Accessible (maximum of $15,000 deferred loan for home modifications) and Homeownership Program (providing up to $25,000 for down payment assistance, closing costs, rehab and accessibility modifications, and principal buy-down). Current year: 16 MHA projects will be provided  $190,000 in financial assistance for home modifications and 8 individuals will receive $195,000 for homeownership assistance through these programs. Assessment and support are billed at the completion of the project at a fee for service rate of $850 per project

Nebraska Department of Education, Childfind

$70,000

To operate a toll free information hotline

ATP operates Nebraska Childfind, serving as a toll free information resource and providing outreach to parents and families with children with disabilities. The contract includes funding for ATP’s toll free hotline. The toll free number receives 7,200 calls/year. Expenses are direct billed to the Department of Education.

Nebraska Department of Education, Special Populations

$25,000

To assist with marketing

materials for persons with traumatic brain injury

As a collaborating partner, ATP provides support in the design and creation of marketing materials for Nebraska’s TBI grant. ATP also is responsible for development and support of a consumer network under the TBI grant. The consumer network has more than 200 individuals from across the state. The cost of support is direct billed to the Department of Education.

Nebraska Health and Human Services, HOPWA

$52,000

To provide housing assistance through a Housing Resources Coordinator

Funding provides for a full time Housing Resources Coordinator to provide Housing Quality Standards inspections for a tenant-based rental assistance program, tracking of affordable and accessible housing, and support for individuals with disabilities who are looking for housing assistance. Cost for this service is billed one month in advance to HHS (annual cost/twelve).

Veterans Affairs Vocational Rehabilitation

$150,000 (projected0

Assessments for AT and

modifications for

employment and independent living

ATP provides technical assistance and on-site assessments for Veterans who are eligible under the VAVR program. We are in the first year of the program and VAVR estimates that they will be referring around 100 individuals/year. ATP provides an assessment and recommendation to VAVR who then approve the expenditure of VAVR funds. The funds are actually provided to ATP and we authorize and pay for the equipment or services that are recommended. ATP monitors and inspects the projects. At completion, ATP follows up to ensure that the Veteran is satisfied with the project. Initial assessment is billed at the time a recommendation is made at a flat rate of $1,000 per case. An additional $500 is charged after completion of the consumer satisfaction survey at the end of the project. Any additional training costs beyond the scope of the initial assessment are billed on an hourly rate. Funds for the payment of project costs are billed to VAVR after they approve the recommendations so that funds are on hand to pay for equipment or services upon their completion.


Last Resort Fund (Virginia and Illinois)

Background

Virginia:  In 1992, the Virginia Disability Commission, a General Assembly appointed bi-partisan commission representing individuals with physical and sensory disabilities, made a recommendation to create a “last resort” fund of grants for persons with physical or sensory disabilities.  The Consumer Service Fund (CSF), which receives an annual appropriation of approximately $500,000 from the State, is administered by the Assistive Technology Loan Fund Authority (ATLFA). The CSF is used to help consumers achieve specific planned goals (obtain employment, live more independently at home, or eliminate a move to a nursing home).  Examples include special equipment or supplies, assistive technology, short term PT/OT services, and home or vehicle modifications; however, the majority of the CSF funds is used for the purchase of assistive technology (AT). 

Illinois:  About three years ago, Illinois’ alternative financing and telework programs, TechConnect Low Interest Loan Program, submitted a grant application to the Illinois Office of the Attorney General for monies to support a Fund of Last Resort for individuals with disabilities who need assistive technology (AT).  The State Office of the Attorney General had received funds from an anti-trust settlement.  Of these monies, the program was awarded $470,000 which could be spent over a period of three years.  The funds run out on June 30, 2005.  The program is currently in the process of securing funding from other sources so that the Fund of Last Resort will continue beyond June 2005.

Operations

Virginia:  Any individual with a physical or sensory disability can apply to the fund and any state agency or disability organization in the state can refer individuals with physical or sensory disabilities to the program.  Applicants must live in Virginia, have a demonstrated physical or sensory disability, and must demonstrate that their disability-related needs cannot be met by other agencies.  Applicants are also screened to assure that all appropriate resources have been explored, including a guaranteed loan from the ATLFA, if feasible. Applicants must provide persuasive justification of their need by conveying the difference this will make in all aspects of their lives.  The Assistive Technology Loan Fund Authority recommends that a human services advocate, case manager, counselor or social worker assist the consumer with completing the application and submitting the request.  If an applicant has been previously funded through the CSF, the waiting period is two years before he/she can reapply.

Applications are reviewed quarterly by a panel of consumers and interagency representatives.  Applicants must demonstrate that all appropriate financial resources have been exhausted (Medicare, Medicaid, private insurance, vocational rehabilitation or special education.)  Funding is based on demonstration of critical need, CSF priorities, and provision of supporting documentation.  Unfortunately, many requests are not approved as the CSF receives many more requests for devices than it can purchase with its limited funds.

Because the amount appropriated by the State has varied from year to year and because some years have been leaner than others, modifications have been made at times to what can be funded by the Consumer Service Fund.  Assistive technology devices and home modifications can generally be funded; however resource limitations often prevent awards for consumers to obtain vehicles with modifications.

Illinois:  The Fund of Last Resort is not advertised or marketed.  Information about it does not even appear on the TechConnect website.  TechConnect staff refer applicants who do not qualify for the low interest loan program and/or the telework program to the Fund of Last Resort.  Willie Gunther, the Illinois Assistive Technology Program’s Executive Director, and her staff review each application and make the final decision on whether an applicant should be funded by the Fund of Last Resort.  The cap for each applicant is $40,000.  Applicants are required to demonstrate that they have exhausted all other funding options.  Fund of Last Resort monies are distributed on a first come, first served basis. 

The Application

Virginia:  The application requires the following:

Illinois:  The Fund of Last Resort used the same application that is used for the low interest loan program.

Population Served

Virginia:  People of any age living in Virginia who have a demonstrated physical or sensory disability are eligible for funding if their disability-related needs cannot be met by other agencies.

Illinois:  The fund covers all disabilities and is statewide. 

Considerations

Contacts/References

Virginia.  For more information on Virginia’s program, including the application form, visit the following website:  http://www.atlfa.org/csf.htm

Illinois.  For more information on Illinois’ TechConnect Low Interest Loan Program, visit the following website:  https://www.techconnect.iltech.org/Home.aspx