Wheelchair Ramps and Medicaid/Medicare: Understanding Accessibility and Health Insurance

Creating a safer, more accessible home environment is essential for individuals who use wheelchairs, scooters, or other mobility aids, especially for those who wish to remain independent as they age. Wheelchair ramps offer a practical solution, providing reliable entry and exit ways not just for daily needs, but also for emergency situations, giving peace of mind to individuals and their loved ones. However, covering the cost of installing these ramps can be challenging, particularly for those on a fixed income. In certain situations, options such as Medicaid and Medicare funding are available, helping individuals access the ramps they need to safely navigate their homes and maintain their independence.

Because there are many different types of wheelchair ramps, there are very specific guidelines about exactly what ramps qualify for assistance. Similarly, because every person's health journey is unique, there are certain scenarios that determine whether or not your wheelchair ramp purchase would qualify for assistance. Fortunately, there are other options to be considered, such as financing, that can be considered if finanicial assistance or reimbursement is not available.

Medicaid

Medicaid is a federal program for low-income seniors and disabled individuals that is administered by each individual state, which means policies for Medicaid distributions vary from state to state. Medicaid can be more favorable toward wheelchair ramp reimbursement than Medicare, especially if the ramp will allow the Medicaid beneficiary to remain safely in their community and avoid more costly institutional care.

These benefits are offered in several ways:

• Standard Medicaid
• Home and Community Based Services (HCBS) Waivers
• Nursing home benefits for long-term care

States’ policies for standard Medicaid will typically follow original Medicare rules for covering the purchase and installation of wheelchair ramps, which means coverage will only occur when it is medically necessary.

There are a number of states that allow HCBS waivers to pay for the cost of ramps, as they are classified as home modifications or environmental adaptations designed to prevent or delay unnecessary emergency are or nursing home placement (which saves the state a significant amount of money).

Obtaining prior authorization then purchasing the ramp

The process of purchasing a ramp with prior authorization from the program typically goes like this:

1. Obtain a document from the physician explaining the medical necessity. It should include the patient's diagnosis and mobility limitations, wheelchair or scooter use, why the reamp is medically necssary, how the ramp will allow them safe access to their home or medical appointments, why alternative solutions won't work.
2. Determine which Medicaid program to contact. Many states cover ramps through separate waiver programs rather than standard Medicaid benefits, including HCBS, Mangaged Long-Term Services and Support (MLTSS), state disability waivers, state assistive technology programs.
3. Contact your Medicaid case manager or managed care plan to ask "Does my plan cover portable wheelchair ramps?", "Is prior authorization required?", "What forms are required?", "Can I use my own supplier?". If you don't have a case manager, you can contact your state's Medicaid office, or Aging and Disability Resource Center (ADRC).
4. Get a quote from a ramp supplier for the portable ramp you choose. Quotes from multiple suppliers might be required.
5. Submit the prior authorization package with all of your paperwork, which will most likely include the physician letter and prescription for the ramp, a functional assessment, the ramp quotes from the supplier, and any additional forms required by your state or plan.
6. Wait for approval.
7. Once approved, purchase the ramp. Depending on the program, there are several ways that could happen. You might have to pay the full cost and submit receipts afterwards, or Medicaid might pay the supplier directly, or a waiver agency might take care of the cost.

Purchasing the ramp then obtaining reimbursement

If you've already purchased a ramp and are interested in being reimbursed through Medicaid, contact your Medicaid plan as soon as possible and ask whether you can submit a reimbursement and what documentation is required. It's typically harder to be reimbursed after purchase, however approval rates vary significantly by state and program.

Medicare

Medicare is a federal health insurance program that covers US citizens over age 65 (or permanent residents that have been in the States for at least five continuous years), as well as US citizens under 65 with qualifying disabilities. While it may be an avenue for seniors to explore to outfit their home with accessibility equipment, there are some strict policies regarding paying for that equipment and other home modifications.

There are several scenarios where Medicare reimbursement is possible, however it is uncommon. Historically, Medicare contractors see wheelchair ramps as facilitating access rather than treating the patient's medical condition and therefore rarely cover it.

Meeting the criteria for Durable Medical Equipment (DME)

Under Medicare Part B, portable/non-permanent wheelchair ramps are considered Durable Medical Equipment, which is reimbursable if it meets the following criteria:

• Serves a medical purpose
• Be appropriate for use in the home.
• Be used by someone with a medical condition, illness or injury.
• Be durable.

Examples of equipment that is covered:

• Wheelchairs
• Scooters
• Walkers
• Patient lifts
• Hospital beds

Examples of equipment that is typically not covered:

• Home renovations
• Stair lifts
• Permanent wheelchair ramps
• Most minor accessibility modifications

Qualifying for a reimbursement

To qualify for reimbursement of a purchased wheelchair ramp, the patient is required to have a physician declare the use of the ramp medically necessary, and/or prescribe the ramp. Some scenarios include if the patient:

• Cannot safely negotiate even a single step due to neuromuscular disease, paralysis, amputation, severe arthritis, stroke, or a similar condition.
• Requires access to medically necessary case such as medical appointments, dialysis, chemotherapy, or rehabilitation.
• Travels frequently for medical treatment and requires a portable ramp to access buildings or vehicles.
• Lives in rental housing where permanent modifications are prohibited and access is limited.
• Is recovering from surgery or injury and needs temporary wheelchair access during rehabilitation.
• Requires a threshold ramp to safely cross doorways inside the home.

For those types of situations, the physician must document the diagnosis, the mobility limitation, why the patient's wheelchair or scooter is medically necessary and why a ramp is needed to safely use the mobility device.

 

Medicare Advantage Plans

Certain Medicare Advantage plans can also cover the cost of wheelchair ramps. An announcement in 2018 stated MA plans could be used to cover certain home supplemental healthcare benefits. This could be interpreted to include items intended to prevent injury or reduce need for emergency care. A wheelchair ramp is one such example of this sort of equipment.

Some scenarios where a physician could deem a ramp a medical necessity include:

• When a patient needs to be safely discharged from a hospital or rehabilitation facility following a hip replacement, knee replacement, stroke, amputation, major trauma, spinal cord injury or similar condition. Prescribing a ramp directly impacts care transitions and readmission risk, especially if the patient cannot safely enter or exit their home due to steps and it will delay discharge or institutional placement.
• When a wheelchair-dependent patient uses a manual or power wheelchair and needs to leave their home for medical treatment such as dialysis, chemotherapy, physical therapy or similar appointments. Prescribing a ramp facilities access to those healthcare services.
• When a patient is a fall risk due to a severe balance impairment, neurological disease, progressive weakness, or has a history of falls. Prescribing a ramp helps to mitigate the significant risk of fall injury, which is a major cause of hospitalizations.
• When a patient wishes to remain in their home rather than be placed in an assisted living or skilled nursing facility. Prescribing a ramp prevents institutionalization and helps to reduce long-term care costs while supporting aging in place.
• When a patient has a progressive neurological condition such as multiple sclerosis, ALS, Parkinson's disease or muscular dystrophy and is expected to decline over time.
• When a patient is recovering from a surgery or an injury such as a fracture, joint replacements or non-weight-bearing orthopedic procedure and needs safer access due to temporary wheelchair use.

MA plans are also able to provide special supplemental benefits to people with chronic illnesses. Certain chronic illnesses can result in the use of a wheelchair or scooter, which would mean wheelchair ramps would apply for coverage under those stipulations.

For every situation, coverage decisions are made on a case-by-case basis, and plans will evaluate whether the ramp improves health outcomes, reduce hospital readmissions, reduces fall risk, supports independent living, avoids high-cost care settings and addresses a physician-documented functional limitation.

Understanding reimbursement versus payment plan options

Keep in mind that when if looking at a reimbursement for the cost of your portable wheelchair ramp, you still have to pay the cost of the ramp at the time of purchase. Because wheelchair ramps can be expensive, especially larger modular wheelchair ramp systems, some companies offer payment plans that allow you to pay an affordable amount multiple times over a longer time period, allowing you to split up the total cost so that you're not hit with a large deficit all at once. This is great for individuals on a fixed budget, or who want to keep their monthly costs down. Instead of saving up over time and buying the ramp, they are able to buy the ramp now and pay a fraction of the total sell price, use the ramp as soon as it arrives.

Example: You broke your hip after a fall, and now it's medically necessary to use a wheelchair at your home. You need to purchase a modular ramp so that you can navigate the steps of your house when traveling to and from your follow-up appointments. The modular wheelchair ramp you need is priced at $1,000, which is out of your current monthly budget.

	SAVING UP OVER TIME	TOTAL PAID PER MONTH	PAYMENT PLAN	TOTAL PAID PER MONTH
Month 1	Saved up $200; no ramp to use	$0	Purchased the ramp and paid initial $200; start using ramp	$200
Month 2	Saved up $400; no ramp to use	$0	$200 Payment; still using ramp	$400 plus interest
Month 3	Saved up $600; no ramp to use	$0	$200 Payment; still using ramp	$600 plus interest
Month 4	Saved up $800; no ramp to use	$0	$200 Payment; still using ramp	$800 plus interest
Month 5	Saved up $1,000; purchased ramp; start using it	$1,000	Paid off total amount of $1,000; still using ramp	$1,000 plus interest
Totals	Used ramp for less than a month	$1,000	Used ramp for almost 5 months	$1,000 plus interest

Discount Ramps partners with Affirm to bring afforable financing to everyone

We offer all of our customers the option of a payment plan through our partner, Affirm. Every product page has a link to a quick "Buy now, pay over time" calculator that allows you to see exactly what you'd pay over 3 months, 6 months or 12 months. Checking your eligibility does not affect your credit, giving you the agency to determine if a payment plan is right for you before committing.

Alternative ways to acquire a wheelchair ramp for your home

There are a variety of other options for potentially getting funding for the purchase of wheelchair ramps for a residential setting. There are various financial assistance programs including veterans’ assistance, elder care loans, state-specific home modification loan programs, and a variety of nonprofit organizations and programs that specialize in helping seniors age in place and improve home accessibility.

Veteran assistance programs

• Home Improvements/Structural Alterations (HISA):Covers medically-necessary improvements to entrances at a primary residence
• Disability Housing Grants for Veterans: Covers purchases, builds, or changes to a permanent home if you have a service-connected disability.

Our industry-leading wheelchair ramp experts are here to help

Our tenured team at Discount Ramps has been helping customers shop for portable wheelchair ramps, threshold ramps, modular ramps and more for over 25 years. Call us at 888-651-3431 or contact us today and allow us to help you identify what type of ramp you need, what factors will go into choosing a ramp, and identifying affordable options to help you get the access you need to be safe and comfortable in your space.