How To Get An iPad (or other AT/AAC device) Funded
For many people with autism, iPads literally give them a voice. Unfortunately, iPads aren’t cheap. For families who are already financially strapped due to enormous out-of-pocket medical expenses, even the least expensive iPad is unaffordable. Fortunately, iPads are considered a viable Alternative and Augmentative Communication (AAC) modality, so there are a number of ways to get them funded. Those options include the public-school system, private insurance, Medicaid, grants, and scholarships.
In order to get an iPad funded through your school district or insurance company, you will need to prove that it is necessary. However, the term necessary is relative, the meaning of which depends on who you’re talking to. Your insurance company will be looking for medical necessity and your school district will be looking for educational necessity. For example, an insurance company would deem an iPad necessary if your child’s verbal speech is limited due to a medical condition such as apraxia. Your school district would deem an iPad necessary when it allows your child to participate in a Free and Public Education (FAPE).
This is who SHOULD be providing your child’s iPad – or any other AAC device.
The process with an iPad as an AAC modality is the same as it is with any Assistive Technology device:
- In writing, ask for an Assistive Technology evaluation from the school.
- Specify that the evaluator should be experienced in AAC, with the use of iPads as an AAC modality (and has access to one for the evaluation - it's astounding how many don’t). Many will evaluate a low tech, a medium tech, and a high tech, and report how your child does with each.
- When the evaluation comes back that your child qualifies for an iPad as an AAC modality, then you add it in the Individualized Education Program (IEP) with training for you and your child, replacement warranty, and all the applications you will need, all to be provided by the school.
NOTE: the evaluation should define the applications that best fit your child’s individualized needs. This is an important part of the evaluation process and needs to be in the final document.
- All of your applicable IEP goals should be rewritten to include the phrase "with verbal output" so that they are using the iPad in class and everywhere your child goes with the staff.
- Make sure you state that s/he needs the device 24 hours a day, 7 days a week, all year, so that she takes it home and keeps it with her, because a child should be able to communicate all of the time, not just in certain circumstances.
- Also read PrAACtical AAC's How I Do It: AAC in the IEP
Private Insurance and Health Savings Accounts (HSA)
I have seen hundreds of people be successful obtaining much need communication tools, such as iPads, from the schools but only a handful through private insurance. The insurance companies are still playing the "it's too new" game and are not covering it for the most part, but it’s worth a try if you are unable to get one from public school.
Contact your insurance company to find out about applying for one as part of their DME – Durable Medical Equipment. There will be special forms and processes unique to your Insurance plan. The insurance company can direct you to get the forms, what coverage you may have for DME and how to apply.
If you have a Health Savings Account (HSA) check to see if it will cover an AT device, as I know several people who have gotten it paid by their HSA. More on HSAs here http://tacanow.org/family-resources/health-savings-accounts/
Letters of Necessity
My Insurance and Medicaid filing required 3 letters of recommendation, one each from his primary care pediatrician, the speech pathologist that performed the Assistive Technology evaluation and provides ongoing therapy and State Medicaid asked for a letter from his behavioralist. I sent all three along with a cover letter in my request. (Click here to view Sample Letters of Necessity below.)
If you have both private insurance and Medicaid, you MUST apply to your private insurance and be denied before you can apply to Medicaid because Medicaid is always payer of last resort.
If you only have Medicaid, you will likely only be required to provide letters of necessity from your Medicaid-provider speech and primary care physicians. Your Medicaid caseworker can walk you through the process of applying for a AT/AC device under Durable Medical Equipment (DME).
Sample Letters of Necessity
Below are sample letters you can model when applying for Private insurance or Medicaid to cover an AT/AC device.
Letter sample from Speech Therapist:
December 24, 2011
To Whom It May Concern:
I am writing on behalf of Johnny Jones. Johnny is a 15 year old male, with diagnoses of autism and apraxia that has been involved in speech therapy at our facility since 2004. Focus of therapy includes increasing functional communication through verbal and cognitive tasks. Johnny is a delightful young man and participates well in therapy. His verbal expression is characterized by 1-2 word responses to questions with very limited initiation. He is able to speak in complete sentences, however typically needs prompting or a verbal model to do so. Given this communication level and Johnny’s interest and motivation with electronic devices, it was decided Johnny would benefit from an augmentative and alternative communication assessment. Over the course of treatment sessions, I have evaluated Johnny with several different forms of augmentative communication. The PECs system (low-tech), a Dynavox high-tech device and most recently Apple’s iPad (high tech) with Tap to Talk communication application.
Given Johnny’s functional gross motor and fine motor coordination, Johnny was able to manually access the electronic devices without difficulty. He manipulated a 6-cell screen independently and was able to communicate wants/needs instantly with both devices. For example, when given ‘Wh’ questions (i.e. What would you like for lunch today? He accessed the food page and made his selection among a field of 6 with 100% accuracy). Johnny was able to utilize the touch screen keypad on both the Dynavox and the iPad to spell 5-10 letter words independently and to produce structured sentences with cues. After typing the words or sentences he is able to independently press the prompt cue to have the words spoken on the devices.
Johnny benefitted from both of the high tech devices over the low tech PECs system because of the ability of the high tech devices to produce verbal output based on Johnny’s selection. Johnny verbally repeated the devices output messages which is exciting to watch this type of cueing unfold. I was impressed with Johnny’s ease and ability to manipulate the Apple iPad with very little instruction. His inquisitive mind and familiarity with electronic devices assisted in his ability to work the device without difficulty.
I am recommending the Apple iPad with TapToTalk and Prologuo2 augmentative communication application for Johnny. This device will benefit Johnny’s communication as detailed above as well as academically through the many education applications available for download to the device. The iPad is superior to Dynavox and the PECs system for Johnny’s needs, in the diversity of the device, the growth potential through a variety of applications available as Johnny’s abilities and interest change. The iPad 64GB 3G (so that Johnny can utilize when he travels as well) runs approximately $899 versus the Dynavox devices that run between $6000-$8000. I strongly believe that the iPad will enhance Johnny’s expressive and receptive language skills and home programs and significantly improve Johnny’s quality of life through a valuable communication approach and educational opportunities.
If you have any questions, please feel free to contact me at 717-555-1212 or via e-mail at email@example.com
Mary Clark, SLP MA-CC
Licensed Speech-language Pathologist
Sample letter from behavioralist:
To Whom It May Concern:
This letter is in reference to Johnny Jones. Johnny is currently involved with Youth Behavioral Services, Inc. and works in five general goal areas. Johnny is supported with his Environmental Comprehension, Social/Communication skills, Self-help/Awareness skills, Safety, and Behavioral Management skills. Two of the most prominent barriers we are facing are constant self-talk and limited communication skills (both receptively and expressively). Through utilization of an iPad, Johnny can enhance in all goal areas and overcome the barriers that impeded his progress.
The user-friendly applications and the immediate response time the iPad provides are big motivating factors that increase the success of the iPad in comparison to other devices. With the ability to download almost unlimited programs, we are not committed to the use of one single program which may or may not meet all of Johnny’s needs. The recommendation is for the use of an iPad 3G, so it can be used out in the community, that has 64gb to support the applications needed for his goals. With this device, we can address all goal areas and gain generalization and cohesion with our goals.
Through the use of the iPad, Johnny will have the ability to appropriately communicate with those around him, both expressively and receptively. He will enhance his quality of life and he will be able to participate in his community as a functional member.
If you have any questions or would like more information please feel free to contact me at 717-555-1212 or via e-mail at therapist@YBS.org
Jill Scott, MS
Sample letter from Pediatrician (who is also a Medicaid Provider if you are going to apply for an iPad through Medicaid if insurance denies):
December 24, 2011
Re: Johnny Jones
I am writing to request authorization for payment for an augmentative/alternative electronic communication system (AAC) for Johnny. Johnny has Autism and Apraxia, which has caused a severe disability affecting his speech and language. I recently had the pleasure of seeing Johnny following an extensive Augmentative Communication Evaluation at Speech Therapy Center Inc. This evaluation was conducted to examine some of Johnny’s communication impairments related to Autism and Apraxia. A copy of the AAC evaluation recommendation is included with this letter.
Johnny has never used an AAC device in the past. Several different AAC devices were tried with Johnny as part of the evaluation and one device was found to be the most appropriate for him in order to improve his communication ability. The recommended device is the Apple iPad, a speech output communication system. Johnny has sufficient receptive language skills and the use of this device will help him further his expressive language abilities.
This AAC device is medically necessary in order for Johnny to be able to indicate his physical and health status (such as giving details about how he is feeling when he is ill or in pain), letting others know of his personal needs and wants, and to request help (especially in emergency situations when Johnny is in the community or with caregivers who may not be familiar with Johnny’s poor and limited speech).
The Apple iPad device is durable medical equipment. This and similar devices have been classified as such by many insurance carriers in most states, such as Blue Cross-Blue Shield, Aetna, and Medicaid. It is a Speech Generating Device in the Centers for Medicare & Medicaid Services classification system. Cigna’s HCPC Code for this device is E2500-2511. Specifically, the iPad is medical equipment because: it is directly related to Johnny’s medical diagnosis; replaces the abnormal functioning of a body function (verbal speech); is expected to be used for a long-term; and, it is appropriate to improve Johnny’s current and future language to assist him in his activities of daily living both at home and at school (or other programs). (See report from the Augmentative Communication Evaluation).
Thank you for your assistance in making this equipment available to Johnny and his family and helping to improve his health care and functional abilities and independence. Please call me at (717) 555-1212 if I can provide any additional information or contact me by email or regular mail.
Carol Kennedy, M.D.
Small Town Pediatrics
National Organizations Who Offer AAC Grants
*Please note that grant availability can change and is dependent on funding. This is not an exhaustive list. These are just some suggestions to get you started on your search.