Did You Know?
...that Medi–Cal may pay for an electric wheelchair?
An electric wheelchair is considered "durable medical equipment" and will be covered by Medi–Cal if it is prescribed as medically necessary by the beneficiary’s physician. (Title 22 CCR Section 51321.) However, authorization for durable medical equipment is limited to the lowest cost item that meets the resident’s medical needs. (Title 22 CCR Section 51321(g).) It is imperative, therefore, that the physician make a strong argument that the electric wheelchair is medically necessary. The physician should also show that the person does not have the arm strength or mobility to self–propel a heavier chair. (Medi–Cal Policy Statement: 82–11.)
For a Medi–Cal beneficiary in a nursing home, an electric wheelchair may be covered by Medi–Cal if it is "custom made or modified to meet the unusual medical needs of the [resident] and the need is expected to be permanent. A custom wheelchair, either manual or power, is one which has been uniquely constructed or assembled to address a particular [resident’s] individual medical needs for positioning, support, and mobility." (Title 22 CCR Section 51321(h)(2)).
Even if you meet these requirements, Medi–al may deny your request. If this happens to you, you should request a hearing to appeal the denial. If, however, your request is ultimately denied, you may be able to deduct the cost of the wheelchair from your share of cost as a Johnson v. Rank deduction. For more information, contact CANHR (www.canhr.org) or Disability Rights CA (www.disabilityrightsca.org/).