It is important that as prescribers we understand the funding criteria and can articulate both the clinical justifications and how these can or cannot be met within the funding framework. Why do some applications fail to get approved and what are the options in these circumstances? Sometimes a person’s equipment needs may not fit within the funding requirements. In other cases it’s that a clear picture of the needs hasn’t been articulated.
Either way, not getting funding approval for Assistive Technology (AT) doesn’t mean it’s not needed. In fact, if we have assessed and identified a specific need and identified a feature as a necessary part of a solution, we need to ensure that the end user understands the why’s and how to’s to inform future decision making. Today’s blog discusses some of these options and challenges.
Funding not approved for essential equipment needs
If a funding application has been declined and you feel it fits within the funder’s criteria and has been clinically justified through assessment, most funding processes have ways to appeal and this should be considered. In these situations, we initially need to understand why. Is it a mis interpretation of the criteria or has the justification not been clearly articulated? Consider what reasoning and feedback was provided by the funding body.
Not meeting funding criteria
Both New Zealand and Australia have really good funding systems. In fact, when compared to other countries around the world we could say we have some of the best funding opportunities for AT internationally. But funds are not infinite and to ensure that essential needs for more people are met there are certain limitations within each system. This can be difficult for someone to understand who has needs and requirements viewed from the perspective of their lived experience. As such we do need to be able to have clear, open communication around what can be funded. Whilst we may still identify a need there may be an ethical requirement to seek alternative options.
When prescribing AT it is important that we understand the criteria of the funding body. If someone is not going to meet the criteria, then we need to have the discussion early on and support the user to make an informed decision about their options. There are often options in this scenario such as co-funding where certain features are not fundable. But if the provision of the AT or a feature is essential to the user you may need to seek alternative funding.
In communities where equipment is routinely funded it is sometimes hard to have conversations around self funding. We shouldn’t assume that someone doesn’t want or can’t financially contribute to their equipment. If a colour choice or accessory is not within the criteria but important to the user they may wish to self fund the up charges. It is important they are aware of the options and choices around this. As a mum I would have definitely considered paying for light up castors for my child’s wheelchair for the annual school disco, but as a therapist this would have been something I potentially wouldn’t have felt comfortable justifying.
Crowd Funding and Fundraising
Self funding also doesn’t necessarily mean someone has the financial means to pay themselves. A popular fundraising movement of crowd funding has seen communities come together to help raise funds through online and digital platforms which often reach beyond a person’s community. Others may opt with more conventional fundraising through local events, family and friends.
There are many charities that contribute to assisting people financially. These also often have criteria and some prioritise equipment needs not funded by government funding agencies. Knowing these organisations and requirements can help us to identify potential options. Most require a supporting letter or application from the therapist involved. Is the user involved in any local organisations that may have funding or sponsorship opportunities?
Local support groups and associations for specific disabilities or impairments may also be an avenue to consider as a resource of financial support and advice in relation to equipment needs.
As mentioned earlier we are fortunate with our funding systems across Australia and New Zealand. The take home message is that if something is assessed and will assist someone in living their best life we should consider all options and know the funding parameters and alternative options available.
If you are wanting to know more about funding in AU and NZ, we are currently running a webinar series on this topic. The feedback and response shows how important a part of the AT prescription process this is! Part 3 is live next Thursday, 10th December – don’t forget to register here. If you missed Part 1 and 2, don’t panic! These were recorded so you can keep an eye out on the replay schedule here.
Clinical Education Specialist
Tracee-lee Maginnity joined Permobil Australia in July 2019, as a Clinical Education Specialist. She graduated Auckland University of Technology with a BHSc (Occupational Therapy) in 2003 and has since worked in various roles related to seating and mobility including assessing, prescribing and educating.
Tracee-lee is passionate about maximising functional outcomes with end users and the importance of education within the industry.