Funding A Computer For Forrest

By Jean Isaacs

This article is reprinted from the A.T. Quarterly, Volume 2, Number 6 (1991).

At age 12 months my son Forrest suffered anoxic brain damage due to a near drowning. After resuscitation Forrest was back at the beginning of a different life. After months of therapy he was still unable to use his body in any functional manner, or produce sounds to communicate.

Refusing to accept the cards we had been dealt, I knew there were answers elsewhere. In October of 1986, I took my son to Denver Children's Hospital, where we were shown an Apple II Computer with an Adaptive Firmware Card. With a single switch my son controlled his environment for the first time. We needed more information regarding computer systems, software and possible funding sources in order for Forrest to benefit from the technology resources that we were introduced to in Denver.

When we came back to Lexington, in my pursuit of knowledge, I enrolled in August 1987 in the Technology in Special Education Program at the University of Kentucky, where I learned how to make the computer work as a language teaching tool. At that time my son was 3 1/2, his eye gaze was not accurate enough to make choices between two objects and his occupational therapist, physical therapist and speech pathologist and I felt he was not ready to use any of the available electronic communication devices. However, we felt that with the appropriate software the computer could be used to scan between two items to make a choice. With the computer this choice could be reinforced with both graphics and speech.

Through reading magazines such as Exceptional Parent, I came to understand that electronic devices used to communicate could be considered a prosthetic device which could be paid for by private insurance companies. In April of 1988, we submitted an application requesting an Apple IIGS, Adaptive Firmware Card and Echo Speech Synthesizer to Blue Cross/Blue Shield.

The first application was sent regular mail and never arrived at the Blue Cross Claims office. The second letter was sent registered mail. In May of 1988, Blue Cross/Blue Shield paid for a computer system for Forrest as a communication prosthesis.

Forrest started using a computer via switch with cause and effect and motor training software. He quickly graduated to making choices between two screens using software such as Where is Puff from the UCLA Early Intervention Program. Today he is using a chin activated switch to select letters from an enlarged scan to identify letters, numbers and words. The same chin switch is used along with other switches to drive his motorized wheelchair. Next year he will be mainstreamed in four subjects in a regular first grade classroom. Forrest again has control over his environment!

Since Forrest had insurance at the time of his accident, we were able to purchase a communication device as a prosthesis. The computer has been a tremendous tool to aid him in his acquisition of language, but it cannot go to McDonalds with him to assist him in placing his order, and limits him where he can express himself. The next step was to go back to the funding well for a portable communication device.

We knew that our only option was to use a Prentke Romich Light Talker. We were unsure about obtaining funding for the device through Medicaid. Kentucky Medicaid had never funded an augmentative communication device.

In January of 1991 an application was submitted to Medicaid of Kentucky for a Light Talker. Our biggest concern was how to apply through the Medicaid system. We phoned Prentke Romich's helpful funding people and found that they were not listed as a vendor with Kentucky Medicaid. In the past they had applied, but were turned down. We discovered that we needed to go through other agencies such as Home Health Agency or Durable Medical Equipment (DME) Supplier. Upon our first inquiry, Home Health Agency was not interested in helping us. The DME agreed to submit the claim. I had a price quote from Prentke Romich for the Light Talker which I gave to the DME along with letters stating medical necessity from myself, Forrests' medical doctor and speech pathologist. The claim was submitted for prior authorization.

Within a month Medicaid contacted the DME. Medicaid authorized the DME to submit an invoice for a two month rental of the Light Talker, which could then lead to permanent purchase. The DME did not feel the Light Talker would be funded by Medicaid when I originally approached them. They had not checked on the price quote or a profit margin. When they realized that this was going to go through they immediately began checking and discovered the price on the quote is the same price that anyone would pay. There was no profit margin, even though they would only be handling the paperwork. There was no set-up or maintenance or warranty work. All that would be handled by Prentke Romich Company. The DME still wanted 15 percent profit on the sale of the device, so they phoned Prentke Romich Company and Medicaid and tried to get the sales price of the device changed. The DME and Medicaid agreed to purchase the device instead of renting for two months since Forrest has been using a Light Talker on loan from the Bluegrass Technology Center. Prentke Romich Company currently has an application with Medicaid of Kentucky to become a Medicaid Vendor for future sales.

In May of 1991, Medicaid of Kentucky approved a claim for the purchase of a Light Talker to be paid for through the Early Periodic Screening Diagnostic & Treatment (EPSDT). There are nine routes identified by RESNA as possible funding resources for assistive technology through Medicaid. "EPSDT is not a service per se, but a provision enabling children below the age of 21 to receive services from the state's Medicaid program." (Assistive Technology: A Funding Workbook RESNA Press, 1991, page 18.)

"In addition, and of greatest importance to states that have minimal Medicaid programs, or which have attempted to limit provision of assistive technology, the Omnibus Budget Reconciliation Act ("OBRA 89") mandates that as of April 1990, states must provide all 'treatment' for which federal reimbursement is available, whether or not such services are covered under the State Plan." (Assistive Technology: A Funding Workbook RESNA Press, 1991, page 19.)

The speech pathologist that works with Forrest had the chance to hear Lew Golinker at the American Speech-Language Hearing Association (ASHA) Conference last year. Information that was shared at that presentation led us to apply to Medicaid. We also feel another contributing factor to our funding success story was a change in Medicaid personnel.

Forrest has been using a Light Talker for several months; due to the complexity of the device we are both still learning. When we first introduced the Light Talker to Forrest he would cry when we turned it on. Now he pouts when its turned off for the evening. Forrest is only 7 years old but has a very bright future with his new voice.

The A.T. Quarterly was a newsletter developed by the RESNA TA Project under a contract with the National Institute on Disability and Rehabilitation Research (NIDRR), U.S. Department of Education (ED). The content, however, does not necessarily reflect the position or policy of NIDRR/ED and no official endorsement of the material should be inferred.

RESNA TA Project
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