Third Party Funding
Let’s face it, medical expenses add up quickly and can be confusing or difficult to manage. Nearly every family asks me, “will my insurance cover any of this?” The short answer is: not really; however, certain types of insurance do cover certain things that Accessible Systems offers. The important thing to note here is that insurance absolutely will not cover it if they do not initiate the request or are not aware of the need.
The long answer is this: most health insurance policies consider any equipment that is installed into the home (i.e. permanently altered, modified/attached to the structure) to be a “home improvement,” and therefore is not something that is included in the policy. Most insurance plans will cover all or part of the cost of associated temporary, portable medical equipment as determined necessary by a doctor. Accessible Systems is currently unable to bill insurance for this type of DME at this time.
Known and accepted types of insurance that covers home modifications and Durable Medical Equipment (DME) installed into a residence:
- Veterans Affairs
- Workers Comp
- Vocational Rehab
- Auto Injury Insurance
- Tricare ECHO
Community Funding Options
There are numerous funding source options available for those who need assistance covering the cost of home modifications. These agencies want families to stay in their home and remain in their community; they will help people do so by making homes safer and more accessible by removing barriers. Local communities have resources available for home improvements, you just have to ask! Here’s what to do:
- Get estimates from 2-3 contractors for the work you’d like done
- Fill out application for funding and attach supporting documentation; estimates, letter explaining need and circumstances and photos if possible
- Contact the agencies below and ask if there is funding available. Submit your request
- Contractor will be selected and notified in writing of approved funding
- Project is scheduled, work can begin or installs scheduled/completed
Community Home Improvement Funding Resources
Colorado Springs Housing Rehabilitation Program
30 S Nevada Ave.
Colorado Springs, CO 80903
USDA Rural Housing:
PO Box 25426
Denver, CO 80225
Pikes Peak Habitat for Humanity:
2802 N Prospect St
Colorado Springs, CO 80907
City of Pueblo Area Agency on Aging
230 N Union Ave.
Pueblo, CO 81003
Options for Veterans (and their families!)
Veterans and their families have unmatched options available to them for funding. Approvals happen fairly quickly and the providers handle most of the paperwork. The process for obtaining funding through the VA and Tricare is as follows:
- Schedule a visit with your primary care doctor at the VA and ask for referral to the prosthetics department or for a HISA consult. Tricare ECHO just requires a prescription and letter of medical need sent to Accessible Systems.
- VA- No bids are required for equipment- they are assigned to VA contractors. Construction projects require 2-3 quotes to be sent to the VA
- A completed request for service can be faxed to 719.325.8985 or emailed to [email protected]
- Accessible Systems will review documents and schedule in-home evaluation and assessment for estimate
- Supporting documents and quote sent to Tricare/VA for approval
- Written confirmation for approved funding is issued
- Accessible Systems can order materials and begin installation/modification
Resources for Disabled Military Children and Disabled Veterans
Tricare/ECHO- Beneficiaries eligible for up to $36,000 per year for durable equipment. Covers: ramps, ceiling lifts, portable patient lifts, hospital beds, sensory swings, vertical platform/wheelchair lifts, home elevators, inclined platform lifts, stairlifts, handrails and more. Does not cover: structural changes within the home.
Prosthetics- Covers modular ramps, grab bars and stairlifts for disabled veterans. No capitation on funding, just whatever equipment is determined necessary by the VA. Does not cover: structural changes or modifications to the home. Contact: Alex Forehead; 303.283.5376; [email protected]
HISA- Minor to moderate structural modifications for disabled veterans, up to $6,800. Covers: door widening, standard bathroom remodel, handrails, wooden or concrete ramps. Does not cover: durable medical equipment installed into the home. Contact: Alex Forehead; 303.283.5376; [email protected]
SAH- Structural remodeling for disabled veterans, up to $85,000. Covers: bathroom and kitchen remodeling, patio and deck renovations, door widening and replacements, wooden, concrete or modular ramp systems, patient lift and transfer systems, wheelchair lifts. Does not cover: anything potentially/potentially being funded by another department within the VA. Contact: Chad Perry; 303.914.2994; [email protected]
Options for Medicaid Recipients
The Medicaid process can be very lengthy but has numerous options for home modifications. Here are the steps you’ll need to follow to get home modifications through Medicaid, now referred to as Health First Colorado.
- Contact your Medicaid case manager and ask to get on one of the Home Modification Waivers
- Your case manager (CM) will add the waiver to your Medicaid plan and request an in-home occupational therapy (OT) assessment of needs
- The OT evaluation will take place and a report is generated stating which products or modifications are recommended
- Your CM will send the OT evaluation and report to 2-3 Medicaid approved general contractors
- You will meet with 2-3 contractors in your home to collect competitive bids, which will be submitted to the CM for review. A “Dummy PAR” (pre-approval, written notice of contractor selection) is issued
- One bid is selected and sent off to the State for final approval. Typically this will be the lowest bid unless you express your preference to one contractor over another. Official PAR is issued
- The contractor can then begin the work. All jobs must be completed within 60 days of the PAR being issued.
Medicaid Case Management Agencies
Rocky Mountain Options for Long Term Care
1645 S Murray Blvd.
Colorado Springs, CO 80916
The Resource Exchange
418 S Weber St.
Colorado Springs, CO 80903
Pueblo County/Housing and Human Services
2631 E 4th St.
Pueblo, CO 81001
Pueblo County/Social Services
201 W 8th St.
Pueblo, CO 81003
Blue Sky Enterprises
115 W 2nd St
Pueblo, CO 81003