1. Funding of Assistive Technology to Support Work and Independence: Looking at Non-Traditional Funding Sources and Funding Strategies to Obtain AT Vision Institute Albany, New York May 21, 2015 1

2. Today’s Presenter James R. Sheldon, Jr., Supervising Attorney National Assistive Technology Advocacy Project Work Incentives Counseling Projects Neighborhood Legal Services, Inc. Buffalo, NY 716-847-0655 extension 262 jsheldon@nls.org 2 2

3. Purpose of this Session Identify common barriers to successful employment of person who is blind Computer access Reading, editing documents Work-related travel, including lunch meetings Identify barriers to independent living Reading mail, prescription labels Reading online healthcare information Often, equipment to address employment barriers will also address independent living barriers. 3

4. Purpose of Session: Look at Non- Traditional Funding Sources Traditional Funder: Commission for Blind Can fund range of AT to support work goals. Look Beyond Commission for Blind If working and post-employment services either not an option or not available to pay for all items When person has ongoing expenses, a need for regular upgrades 4

5. Providing Context for Discussion: The Case of Winston 5

6. Session About Funding, Not About Selecting the Right AT Speaker acknowledges the significant input from Steven Mendelsohn, formerly of New York, who works as an independent policy consultant despite lifelong blindness. The scenario below and AT sought by Winston is to give context for the funding discussion. In the perfect world, Winston would regularly consult with an AT specialist to select appropriate interventions for his work. 6

7. Introducing Winston See more detailed case scenario His disabilities Legally blind – limited functional vision Progressive arthritis – great difficulty walking His work - $2,800 gross earnings Self employed writer and editor, online magazine Some travel to office meetings, to meet with other writers, to do research at library 7

8. 5 Winston’s Functional Challenges Related to Blindness To read range of material through voice output: Documents on computer screen, website information Hard-copy documents, saving some on his computer Range of material when on the go – bus/subway schedules, restaurant menus, books and magazines Paper money to manage purchases during travel Travel routes – bus/subway schedules, directions from subway stop to meeting place Needs periodic reading services in home office Currently working with 8-year old equipment

9. AT Sought by Winston for Work from Home New personal computer with software to allow for voice input and voice output. Cost = $1,600 combined Stand alone reading machine, reading documents aloud with ability to upload to personal computer. Considering “Open Book” from Freedom Scientific. Cost = $1,000 iPhone 6 or other smart phone/small tablet (cost about $200 with phone plan, $600 or more retail) Two-year service plan (will be self funded) 9

10. Smart Phone/Tablet Apps Winston is Seeking Many are free or low cost, but needs cell phone service or wifi connection: “Next Bus”/similar app from transportation authority - free GPS apps – e.g., “Look Around Feature” (free) KNFB Reader – cost = $50 (on-the-go reading) – converts printed text into high quality speech to provide accurate, fast, and efficient access. Look Tel Money Reader app – cost = $9.99 (more practical than separate free device from US Treasury?) 10

11. Winston’s Functional Challenges Related to Progressive Arthritis Needs mobility assistive device due to arthritis Significant pain, limited range of motion in knees and legs Has used wheeled walker in home for past 3 years Seeking either ultra lightweight wheelchair ($1,500) or power scooter ($2,800) for travel outside the home 11

12. Winston’s Benefits History, Health Insurance Coverage Last received Social Security Disability Insurance (SSDI) in 2004, never received SSI Last received Medicare in 2011 through a special work incentive. No Medicare or Medicaid currently. Has private insurance but wheelchairs/scooters not covered. Did not elect optional rider for durable medical equipment coverage. Has $4,200 in bank, $61,000 in combined IRA and 401k. 12

13. Funding Possibilities for AT Sought by Winston Funding Sources Other than Commission for Blind 13

14. Medicaid Could Fund Wheelchair or Scooter Winston Meets Eligibility Criteria for Medicaid Buy-In for Working People with Disabilities Meets SSI definition of disability or blindness. Involved in paid work. Does not matter that he works above substantial gainful activity level for blind, $1,820 per month in 2015. Countable income at or below $2,453 per month. Countable assets at or below $20,000. His $61,000 in retirement accounts exempt. 14

15. What Can Medicaid Fund? Ultra lightweight wheelchair or power scooter OK that need is primarily for mobility outside home. Is there a less costly, equally effective alternative? Smart phone/tablet and apps Medicaid not a likely funding source Will not fund for vocational reason only. If app used to read prescription labels, his mail, can arge this is medical need. Currently, one of challenges in Medicaid program. 15

16. Might Winston Benefit from Medicaid Waiver? New York has 10 or more Home and Community Based Services (HCBS) Waivers – optional programs. They are used to target specific populations and provide some services not available through traditional Medicaid. Winston does not appear to be eligible for a NY waiver. Under federal criteria, a waiver could target blind and offer funding for devices to support employment. 16

17. Using Business-Related Expense Deductions on Federal and State Taxes Winston would file Schedule C with federal tax forms Most if not all of the items he seeks could be business expense deductions. Net value of deductions = reduction of taxes due. Assume $2,860 deductions for computer, software, Open Book reader, iPhone, and selected apps. Assume 15 percent tax rate (combined federal, state). Net tax benefit from purchases = $429 (.15 x $2,860). 17

18. Can Winston Use SSI’s Blind Work Expenses (BWEs)? Can reduce countable income to determine SSI payment. For Winston, could include his cost for: Federal, state and local income taxes Social Security and Medicare taxes (i.e., FICA) Transportation to and from work sites Wheelchair, even if not related to blindness (only if he pays for item) Computer, software, reading device, iPhone Recurring costs – cell phone service, internet 18

19. Winston’s Use of Blind Work Expenses - Assumptions $200 monthly business expenses, unrelated to BWES below reduces taxable income to $31,200 ($2,600 per month). Has the following BWEs for year: $2,000 federal and state taxes $2,387 FICA (half not declared as business expense) $2,860 for computer, software, reading machine, iPhone, and apps. $1,200 cell phone, internet service $700 transportation – subway, bus, taxis Total = $9,147 ($762 per month) 19

20. Winston’s Monthly SSI Budget with BWEs Earned income $2600.00 General income exclusion- 20.00 Earned income exclusion- 65.00 $2515.00 Additional 50% exclusion - 1257.50 $1257.50 Blind work expenses- 762.00 Countable income $ 495.50 SSI rate (living alone) $ 820.00 Countable income - 495.50 SSI payment $ 344.50 20

21. Compare – Using BWEs Versus Business Expenses Business expenses: Using $7,147 of deductions that could be BWEs (not using tax/FICA expenses). Using 15 percent combined tax rate, savings = $1,072. Blind Work Expenses: $762 monthly BWEs resulted in $344.50 monthly SSI Annual benefit from SSI = $4,134 And makes Winston automatically eligible for Medicaid. BWEs a better deal this year, but next year will not have all the major purchases. 21

22. Oops – Missed a Potential Blind Work Expense Winston must pay reader $120 per month. Since the example above has him getting $344.50 SSI check … Value of any additional BWEs will increase SSI dollar- for-dollar. SSI increases to $464.50. See Blind Work Expenses At-a-Glance, www.nls.org/files/At%20a%20Glance%20Advocate%20Info% 20Sheets/Blind%20Work%20Expenses%202015%20Final.pdf www.nls.org/files/At%20a%20Glance%20Advocate%20Info% 20Sheets/Blind%20Work%20Expenses%202015%20Final.pdf 22

23. 23 New York’s Equipment Loan Fund - Source of Low-Cost Loans to Fund AT Operated through Commission for Blind Serves full range of disabilities. Minimum loan $500, maximum $4,000. Repay in 2 to 8 years, current interest rate of 4 percent. Wheelchairs, devices to allow blind to discern printed material included in covered equipment. For more information call 518-474-0197 or see http://ocfs.ny.gov/main/cb/equiploanfund.asp http://ocfs.ny.gov/main/cb/equiploanfund.asp

24. Winston’s Use of Equipment Loan Borrows $1,000 to purchase stand alone reading machine. Will inquire whether the following can be included in loan: smart phone or tablet, apps, JAWS or similar software for computer If we assume $70 monthly repayment on 2 year loan: Payments could be business related expenses on taxes. Or, payments could be blind work expenses. Cannot be used for taxes and as BWEs. 24

25. What if Winston is a Veteran? Department of Veterans Affairs (VA) could fund AT for blind in many cases: Generally, injury must be service connected. May be an inability to pay criteria. Categories for funding AT for blind: As electronic equipment for blind or visually impaired. As vocational services, employment services, or independent living services. For more information, see the Veterans Benefits section of VA website, http://benefits.va.gov/benefits/http://benefits.va.gov/benefits/ 25

26. What if Winston is Victim of Violent Crime? State Crime Victims Board Brochure available at http://www.criminaljustice.ny.gov/pio/crimevictims/cvb_br ochure.pdf http://www.criminaljustice.ny.gov/pio/crimevictims/cvb_br ochure.pdf Operates under federal Victims of Crime Act (VOCA). Under VOCA, New York must serve innocent victims injured through terrorism or driving while intoxicated. New York adds crimes such as unlawful imprisonment, kidnapping, and stalking. Victim expenses to be covered must result from physical injury. 26

27. Crime Victims Compensation – What Expenses Covered? Federal law mandates coverage of “medical expenses” for “prosthetic or other devices” but does not define terms. State brochure includes under compensable expenses: Medical and counseling expenses, occupational and vocational rehabilitation Lost wages or lost support up to $30,000 If Winston’s blindness is related to a compensable crime, the equipment/AT that allows him to work could be covered under these provisions. 27

28. Association of Blind Citizens AT Fund Can cover 50% of retail price of adaptive devices, software. Goal - allow blind and visually impaired individuals access to products that will have a significant impact on improving employment opportunities, increase independence and enhance their overall quality of life. The products covered must retail for a minimum of $200 with a maximum retail price of $6,000. Persons eligible must have a family income of less than $50,000 and cash assets of less than $20,000. Application available on website, www.blindcitizens.org/assistive_tech.htm www.blindcitizens.org/assistive_tech.htm 28

29. Other Funding Ideas SSI’s Plan for Achieving Self Support (PASS) Flexible Spending Accounts, Health Reimbursement Accounts Worker’s Compensation claims Other ideas? 29

30. Thank You Contact National AT Advocacy Project for Technical Assistance - 716-847-0655 Marge Gustas, ext. 256; mgustas@nls.orgmgustas@nls.org Jim Sheldon, ext. 262; jsheldon@nls.orgjsheldon@nls.org Check Out Our Website – www.nls.org/Disability/NationalAssistiveTechnologyPr oject www.nls.org/Disability/NationalAssistiveTechnologyPr oject 30