Ryan Wilson, like many other Medicaid and Medicare patients, has spent most of his life facing medical challenges that have made independence and mobility difficult or impossible. With the aid of a power wheelchair, Wilson is finding his independence again. Unfortunately, many Medicaid and Medicare patients are unable to get a power wheelchair due to ever-changing red tape.
For Ryan Wilson, who has spina bifida, life took a drastic change five years ago when he developed a decubitus ulcer. His mobility became severely restricted from the ulcer, and had to quit his job after doctors cautioned he could die from infection. He went from someone who walked into work to someone who struggled to make his wheelchair move. Over time, his shoulders gave out, and he was unable to accomplish basic tasks of daily life, such as moving around his house on his own.
The downward spiral of Wilson’s life reversed the minute Medicare approved his power wheelchair.
“My shoulders have just about given out and the power chair has brought me back into society. Especially after the ulcer, I was basically bedridden and couldn’t get around my own house. If I wanted to go out, someone would have to push me, because my shoulders quit. With the power chair, the shoulders are not an issue. I can go until the battery quits,” said Wilson, “and being able to leave my house, go up and down the street on the sidewalk, walk the dog, and go outside and spit in the yard, just simple things that I would need help with, now I don’t.”
Wilson is like countless other Medicaid and Medicare patients across the country that truly depend on a power wheelchair to live safely and independently. For many, it is the power wheelchair that keeps them from being forced to reside in a nursing home. Many aren’t getting the wheelchairs they need, thanks to ongoing policy and regulation changes by the Centers for Medicare & Medicaid Services (CMS).
At a glance, you might think the reason for the lack of power wheelchairs would be the cost of the chairs. However, studies show that power wheelchairs reduce government health spending because Medicare patients have fewer falls and ER visits with power wheelchairs. They also significantly delay placement into nursing homes, the cost of which is a huge burden to government healthcare.
“Senior citizens and people living with physical disabilities clearly benefit from power wheelchairs, but CMS and Congress repeatedly adopt policies that restrict use of the Medicare power mobility benefit,” said Tyler Wilson, who is president and CEO of the American Association for Homecare. “This increases government spending by driving Medicare patients into expensive nursing homes and other care facilities. The government has to get smarter about health care policy.”
The new regulations and policies that have gone into place over the last nine years by CMS have made qualifying for a power wheelchair more difficult. The latest CMS plans to implement a demonstration program involving very subjective documentation guidelines to a prior authorization process for a period of three years in California, Florida, Illinois, Michigan, New York, North Carolina, and Texas will only make getting power wheelchairs more difficult in these states, where over 50% of power mobility is prescribed every year.
“We remain concerned that the program CMS has designed has the potential to eliminate the Medicare benefit for power mobility devices for individuals who reside in one of the seven states where the program will be implemented,” Billy Altom, executive director of the Association of Programs for Rural Independent Living (APRIL), warned in a recent letter to CMS. APRIL is among the many advocates that are speaking out against the CMS.
What do you think will happen as a result of this?