Most medically necessary AT is provided by public or private health insurance, and falls under the term “durable medical equipment” (DME).
Examples of DME include manual and power wheelchairs, catheters, and orthotics. This section provides information on how to pursue your DME needs from insurance sources. It includes information on appealing denials—an often necessary and effective step toward acquiring DME—as well as information on care coordination and advocacy services.
Unfortunately navigating health insurance providers can be a frustrating experience! In certain cases families or individuals may even need (or choose) to pursue other sources of DME funding; specialized loan programs, private charities, and state funded relief programs are also listed here.
Before getting started it’s important to “know the basics” about public and private health providers. The Delaware Assistive Technology Initiative has produced a brief and useful explanation of public and private health insurance and the process for obtaining DME. Get the DATI article, “Public and Private Insurance” at www.dati.org/funding/insurance_basics.html (opens in a new window).
Resources for Medically Necessary AT are organized by the following categories:
Infants and Children
Help accessing services:
- Care Coordination for Children with Special Health Care Needs is available through the Massachusetts Department of Public Health (MDPH) to help families with the difficult task of navigating health services. Read more
- Case Management may be available from your private health insurance provider to help coordinate your child’s care. Read more
- Early Intervention provides services to support the development of infants and toddlers from birth to age 3 (MDPH). Read more
- Universal Newborn Hearing Screening identifies newborn hearing problems and links families with appropriate services. Read more
Funding Sources:
MassHealth (Medicaid)
Federal and state funded health insurance for very low to medium income people living in Massachusetts is available through the various programs of MassHealth. MassHealth can provide health care benefits directly or pay all or part of an individual or family’s health-insurance premium.
- MassHealth Standard
Includes coverage for children under age 19; income restrictions vary (up to 150-200% of the federal poverty level). DME is covered. Read more
- MassHealth CommonHealth
Includes coverage for children with disabilities who are over-income for MassHealth Standard and have no private insurance. There is no upper-income limit or asset test. Premiums are determined on a sliding scale. DME is covered. Read more
- MassHealth Family Assistance
Provides income-eligible children (up to 200% of the federal poverty level) who cannot get MassHealth Standard or MassHealth CommonHealth with access to either private or public health insurance. DME coverage varies by plan. Read more
Children’s Medical Security Plan (CMSP)
CMSP offers state-funded health coverage for uninsured children who meet income eligibility requirements. Covered services include hearing tests, eye exams, and durable medical equipment (DME) up to $200 per fiscal year, with an additional $300 available annually for DME linked to specific medical conditions. Read more
Medicare
Children diagnosed with end-stage renal disease qualify for this federal health insurance. Certain DME items are covered under the “home health” benefit through Medicare Part A, and broader DME coverage is accessible via optional Medicare Part B enrollment. Read more
Private Insurance
For individuals with private health insurance, it serves as the “payer of first resort” for DME expenses. This section provides guidance and resources to help families understand their coverage, navigate the prior approval process, and appeal any denied claims. Read more
Catastrophic Illness in Children Relief Fund (CICRF)
The CICRF program assists families facing overwhelming financial costs associated with caring for children who have special health needs or disabilities. Eligible reimbursable expenses include medically necessary modifications to homes and vehicles, medical transportation, and medical equipment. Read more
The Massachusetts Assistive Technology Loan Program (MATLP)
If health insurance providers determine that a device isn’t medically necessary—even after an appeal—the MATLP offers loans to help families acquire essential assistive technology (AT). Read more
Home Modification Loan Program (HMLP)
The HMLP, administered by the state-funded Massachusetts Rehabilitation Commission, provides low-interest or zero-interest loans for essential “access modifications,” such as ramps or widened doorways, to an individual’s primary, permanent home. If health insurance declines payment for a lift or transfer device, HMLP may provide financial assistance. Read more
Hearing Aid Program for Children (MDPH)
This Massachusetts Department of Public Health program helps income-qualified families who cannot afford hearing aids due to gaps in their health insurance coverage. Read more
Central Bank Special Needs Loans
Central Bank offers special needs loans at fixed interest rates and extended repayment schedules, assisting customers in purchasing necessary assistive technology (AT). Read more
Private Organizations
Various private organizations might offer funding or provide DME/AT-related services individually, determined on a case-by-case basis. Read more
Adults
Help accessing services:
- Independent Living Centers provide peer support and advice. The ILCs are staffed with people with disabilities who have experience navigating health care networks as professional and self-advocates. Read more
Funding sources:
MassHealth (Medicaid)
Federal and state-funded health insurance for very low to medium income people living in Massachusetts is available through the various programs of MassHealth. MassHealth can provide health care benefits directly or pay all or part of an individual or family’s health-insurance premium.
- MassHealth Standard
Includes coverage for adults with disabilities (all SSI recipients), pregnant women, parents and other caretaker relatives of children (all TAFDC recipients); income restrictions vary by category (up to 200% of the federal poverty level). DME is covered. Read more
- MassHealth CommonHealth
Includes coverage for adults with disabilities who are over-income for MassHealth Standard and have no private insurance. There is no upper-income limit or asset test. Premiums are determined on a sliding scale. DME is covered. Read more
- MassHealth Family Assistance
Includes coverage for income-eligible adults (up to 200% of the federal poverty level) who cannot get MassHealth Standard or MassHealth CommonHealth. Provides access to either private or public health insurance. DME coverage can vary by plan. Read more
- MassHealth Basic
Provides long-term unemployed adults who are clients of the Department of Mental Health (or on the waiting list for services), and people receiving Emergency Aid to the Elderly, Disabled and Children (EAEDC) cash assistance, with access to very basic public or private health insurance. DME is usually covered. Read more
- MassHealth Essential
Provides long-term unemployed adults who are not eligible for MassHealth Basic (not clients of the Department of Mental Health, and not EAEDC cash recipients) with a stripped-down package of MassHealth insurance benefits. Only prosthetic and podiatrist services (but not equipment) is covered. Read more
Commonwealth Care
State-subsidized health insurance is available to adult residents of Massachusetts (US citizens, nationals, and legal aliens) who are uninsured and meet income guidelines (up to 300% of the federal poverty level). DME is a covered benefit: co-pays and premiums vary by plan type. Read more
Medicare
This federal program includes limited health insurance benefits to some SSDI recipients (disabled adults), and all people with end-stage renal disease, in addition to seniors. Some DME is covered under “home health” through Medicare Part A, and more DME benefits are available under the optional Part B coverage. Read more
Private Insurance
Private health insurance is the “payer of first resort” for DME, if you have it. Advice and resources are provided here for understanding your coverage, obtaining “prior approval,” and appealing denials. Read more
The Massachusetts Assistive Technology Loan Program
If a health insurance provider does not consider a device medically necessary (even after appeal), the MATLP is a loan program than can help families purchase needed AT. Read more
Home Modification Loan Program (HMLP)
This state funded MRC program provides low-interest and no-interest loans for people who need “access modifications”—like ramps and wider doorways—to their primary, permanent residence. If a health insurance provider won’t pay for a lift or transfer device, the HMLP is a way to help purchase it. Read more
Central Bank Special Needs Loans
This Central Bank loan program provides fixed rate loans with longer repayment terms to help customers with special needs purchase AT. Read more
Private Organizations
These private organizations may provide AT/DME funding or services for individuals on a case-by-case basis. Read more
Elders
Help accessing services:
- Executive Office of Elder Affairs: Aging Services Access Points (ASAPS) provide coordination services around the state, including help accessing needed AT/DME through state and federal funding sources. Read more
Funding sources:
MassHealth (Medicaid)
Health insurance for very low to medium income people living in Massachusetts is available through the various programs of MassHealth. MassHealth can provide health care benefits directly or pay all or part of an individual or family’s health-insurance premium.
- MassHealth Standard
Includes coverage for people over age 65 with incomes up to 100% of the federal poverty level. There are additional asset tests for seniors. DME is a covered benefit. Read more
- MassHealth CommonHealth
Includes coverage for working seniors with disabilities who are over-income for MassHealth Standard and have no private insurance. There is no upper-income limit or asset test and premiums are determined on a sliding scale. DME is covered. Read more
Commonwealth Care
State-subsidized health insurance is available to adult residents of Massachusetts (US citizens, nationals, and legal aliens) who are uninsured and meet income guidelines (up to 300% of the federal poverty level). DME is a covered benefit: co-pays and premiums vary by plan type. Read more
Medicare
This federal program includes limited health insurance benefits for people 65 years of age and older. Some DME is covered under “home health” through Medicare Part A, and more DME benefits are available under the optional Part B coverage. Read more
Private Insurance
Private health insurance is the “payer of first resort” for DME, if you have it. Advice and resources are provided here for understanding your coverage, obtaining “prior approval,” and appealing denials. Read more
Home Modification Loan Program (HMLP)
This state funded MRC program provides low-interest and no-interest loans for people who need “access modifications”—like ramps and wider doorways—to their primary, permanent residence. If a health insurance provider won’t pay for a lift or transfer device, the HMLP is a way to help purchase it. Read more
The Massachusetts Assistive Technology Loan Program
If a health insurance provider does not consider a device medically necessary (even after appeal), the MATLP is a loan program than can help families purchase needed AT. Read more
Central Bank Special Needs Loans
This Central Bank loan program provides fixed rate loans with longer repayment terms to help customers with special needs purchase AT. Read more
Private Organizations
These private organizations may provide AT/DME funding or services for individuals on a case-by-case basis. Read more
Veterans
Help accessing services:
- Veterans Agents are available in every city and town in Massachusetts to help veterans access state and federal veteran’s benefits. Read more
- Veterans Services Organizations are available to help veterans access services, file claims with the Department of Veterans Affairs (VA), or help file an appeal to a VA claim. Read more
- US Wounded Warrior Program provides seriously disabled soldiers with free, expert, special advocacy help. Read more
Funding sources:
Veterans Affairs
The VA is the largest single medical care system in the United States and it is one of the largest purchasers of assistive technology for people with disabilities. Access to eligibility and benefits information is provided here. Read more