Funding AT for K-12

Assistive technology (AT) can change the lives of students with disabilities, helping them reach their full potential. Yet the rubber meets the road when it is time to pay for AT devices and services, and information about AT funding is often hard to find. In this important webinar, Chris Gibbons discusses AT funding sources for children with and without IEPs. He provides information on 3rd party funding, offering specific examples and providing participants with us. Get the slides.
 

Transcript: 

- [Ana] Good afternoon, everyone. It's 4:00, so we're gonna get started. We are pleased to have you all join us for this webinar, Funding Assistive Technology K-12. We're pleased to welcome Chris Gibbons, VP of education and assessment for Smartbox, Inc. We do want to hear from you, at the end of the webinar please fill out our brief survey and you can get a Certificate of Participation for the webinar. I'm gonna go ahead and pass it off to Chris and he can get started, thanks.

- [Chris] Thanks very much, I wanna say hello to everybody that's here this fine afternoon. Please note that I'm calling in from cellphone today because out here in the beautiful Pacific Northwest, we had, what is now being termed Snowmageddon and we're not used to white, frozen stuff falling from the sky, we're used to it being very wet out here, instead. So no one knows quite what to do and means that I'm calling from a remote location. If I drop the call, I promise I'll call right back. Just wanted to let everybody know that I am a real person, I always try to include a little bit of personality when I'm doing these kinds of presentations, and last night I was playing guitar with our oldest.

So I snapped a quick photo to make sure that you know that our lives are all bigger than what we do, even though what we do drives our life. Like all of you here, I'm intensely interested in what happens with assistive technology for people with disabilities and really for all of us, because we all learn from each other so I just wanna thank everybody for being here. As a disclaimer, I will say that I work for Smartbox, as has already been established, and at Smartbox, we design and manufacture software for augmentative communication and for access to environmental controls and a bunch of other stuff. It's a disclaimer just to make sure that if I say anything and you think, "Well, where's he comin' from?" That's where I'm comin' from, even though I'd like to think I'm not coming from there, we all come from where we work, so now you know that part, too.

So today, we are going to discuss assistive technology and funding. And I think importantly, as an umbrella conversation about assistive technology, it's important to revisit, frequently, how much the landscape of assistive technology, worldwide, has changed in just the last decade. It's something we all know, it's something we acknowledge professionally at our conferences, it's something we talk about while we're having a cup of coffee with our friends and colleagues. But it also is something that isn't always easy to navigate concretely when we're in a classroom, or when we're sitting around an IEP table, and especially, I would say, when it comes to decisions about how we're gonna fund assistive technology, because though none of us wish for the past, we'll be having a short discussion today about how much assistive technology used to be a little easier to identify, to describe, interpret what it's functional characteristics, as they relate to the people that were worked with.

And how much our funding environment has really come out of that. And it looks like a whole bunch of people can't hear me, so I am going to try to do something here. Make sure you can hear me. And say yes and no, did everybody just miss the last three minutes of my telephoning? Good audio, yes? Okay. Or if you are hearing me, then not, so remember to make sure that your speakers are plugged in and that you're allowing your computer to stream the audio. If it's not coming through, okay. What I was talking about was, that our assistive technology has changed, so that means the definitions have changed around what can be funded and the onus is on us to continue to educate our funders, and we're gonna talk a little bit about that today as we talk about how we get this stuff funded up in an educational environment.

So I know that, I would hope that we've all seen this before. It's been waved as a flag in front of many different presentations that I've sat listening to and watching. It's a beautiful statement, but I'm gonna propose that it's becoming dated, and I think that's why it's important to admit this was written in 1991, or at least it was quoted. "For people without disabilities, "technology makes things easier. "For people with disabilities, "technology makes things possible." So if we come out of 1991 and move toward 2017, by the way, I'm not suggesting that this funny little picture here has anything to do with assistive technology, I just think it's a nice little photo of how we conceptualize where we are as humans. Well we fast forward to 2017 and we think differently now about technology, because technology isn't reserved for specific aspects of our lives, if you're a person who will be characterized as able-bodied compared to a person who we might label as disabled.

So now we can see that technology is all around us, it's not just solely for people with special needs. And I'm saying, assistive technology is not solely for people with special needs. Assistive technology facilitates learning for every student. And in fact let's just forget the assistive part at times and just say that technology facilitates learning for every student. We are finally, I would say, beginning to digest and leave into what we do, a principle of the universal desire. Not just because we've all believed it for twenty years, but because commercial technology is forcing us to use technology that way and it's a really good thing. As I indicated earlier, however, that's the way we all address our clients, our students, the people that we advocate for.

And yet a lot of funding policy, which was heroically written in some cases, 20 years ago and advocated for, now has become difficult to wrap around how we use technology in the classroom for a student. So part of our job is to take a little bit of ownership of that and continue to advocate, not only locally, as we figure it out, but also to continue obviously to work on a policy level to change that. So I've looked at your two minds of AT, and I think again, I'm just trying to hammer this point over the head, because it's so important. When you look at funders, and I'm talking about traditional funders, for now, although I'll add a footnote that I think there are a lot of, what we would call alternative funders. Meaning, private foundations, local nonprofits, who also subscribe to a fairly rigid idea of what constitutes assistive technology.

So funder definitions, it must service specific disability, presumes medical necessity, it needs to be durable, must not be useful in the absence of a particular injury or a labeled disability, and must be specifically configured equipment. In other words, "Was it built in someone's garage "or was it built at a factory specifically "for the purpose of assistive technology." And let's think then, of both definitions, that if they compared to how we all think of the practical definition and what we're trying to accomplish with technology. Which means, we're finding independence, we're enabling participation, physical access, alternatives to learning, augmentative communication language development. That's not an exhaustive list, they're just examples.

But my point is, when we look at that list, think about, in a general ed classroom, how much of the very same definitions could be applied to every student sitting in that desk. And how this might cause a little bit of stress for a funder as they think about the equipment that's being used and why they're having trouble funding it. So one of the things I've done, when I have discussed this particular issue in Washington D.C. with our friends at Medicare and with other state-level and regional policymakers, is they say, "You know, we have to remember that "if we're watching a movie, "it's not a movie because there is "a projector with film running "on a lens that's projecting that onto a screen somewhere. "A movie is sitting in front of any streaming, "computer-based service now, be it Netflix or Amazon, "or whatever." My point being that we get stuck in defining what things are by how they've been made in the past and how we've used them in the past and we forget that it's the functional definition that matters the most.

Feel free to use that when you're talking to funders, by the way, any time. So here's a quote that I just can't help but include, when I say this is possible, just out of the horse's mouth. "We can't fund an iPad for a student with a disability, "because, well, everyone has an iPad, "and, well, you can get one at Best Buy." Direct quote. And doesn't that just illustrate the point? So it's not looking at the function of the tool, it's having trouble wrapping our head around what that tool is doing for that person. I spent a lot of time, a couple of years ago talking to funders all around the country about funding iPad use in said classrooms around the country and what I kept hearing was that they knew what to call the tool, and because they knew it had a name, and Apple was on the back of it, and it was called an iPad, that they were just stumbling over what to do with it.

Whereas, if I'd come to them and I'd said, "Well, here's an assistive technology tool, "it's called a Flapjacker, and this Flapjacker "is gonna enable this child to use this thing "called an app that allows them to participate "in the classroom with a switch, "and answer the teacher's questions, "'cause they are nonverbal or whatever condition, "that this enables them to participate "because they would know it." And then they're all, "Well, then we definitely need "to start funding those Flapjacks." But the problem was they knew to call it an iPad, and they couldn't figure out what to do with it. So part of this language issue is literally the words we use and isn't it funny, not "ha-ha", but that IDEA told us as recently as 2008 that, really, assistive technology is any item, piece of equipment, or product system, acquired commercially or off the shelf, modified or customized, that's used to increase maintain or improve the functional capability of a child with a disability. They got it right. We just need to know how to advocate and make it work for a funded system.

Alright, so I'm gonna move through some of the categories of AT, to just make sure we're all on the same page before I leap into some of the different funding mechanisms and mainly I do this because, again, when we think about bouncing between how we describe assistive technology in very narrow terms, functionally for a student, knowing that sometimes the equipment we're using to get to those functional goals is maybe more commercially allocated generally in the population or is a repurposed this or that. Or maybe it's something very specific, like a finger support for someone working on fine motor goals, but being aware of how we're thinking about the functional utility of the tool and then how that translates to a funder.

So at any rate, these assistive technology categories, again, not exhaustive, but a lot of the categories that we work with for ADL, assistive listening, environmental control, speech generating devices, seating and positioning, alternative access, adapted educational materials, and again, which student in the classroom now does not use what we used to call adapted educational materials and is now just the way we learn? Or obviously orthotics and prosthetics. And I think the challenge here, again, is looking at how we characterize these things. So AT assists with all of these great goals that we're all in this field to accomplish which provides physical interaction with the environment, decrease the receptive/expressive divide.

We see this so often in classrooms with communication. Peer performance, where we're attempting to not just achieve peer relational performance, but engage with peers, even if there's a disparate notion of actual performance, the engagement with a peer, because they're using a similar tool or they're able to share in an activity, we get that peer performance, independence, participation, of course, which I think is an overarching goal of all of this technology. Future vocational potential, this is a really massive goal for all of us and when I talk about is the technology for transition and funding into transition. It's something that I concentrate on, obviously, big time. It starts early, early where we want to be thinking ahead even before the age of 14, thinking ahead to where this person might contribute to society using a variety of assistive aids as appropriate. Concentration, endurance, and obviously social interaction, which I would say participation and social interaction are the scaffoldings for all of these other things.

So, again, briefly, not an exhaustive list, but this is a list that I think fits into that bucket of tools, sort of the old-school tools, we still use them all the time, incidentally, but I think this is, again, how we might conceptualize traditional bits of technology, e-readers, adapted seating, eye control, speech recognition, all this stuff, braillers, arm supports, headsets, mobile tablets. And this huge array of software-based solutions that everyone is using, across educational goals and that has so much to do with how people participate in learning and sharing information now. So to sort of close this topic before we launch into mechanisms for funding, I ask the question, why changes in definition of assistive technology matter. Well I started out with this question. And I think that the important thing that we have for a long time thought that if it wasn't made with a glue gun, then it must not be real assistive technology.

Now, by the way, we should still be using glue guns, and I would hope that all of us still do to make what we need, but this notion that we make them specially for special people with special needs, which in some ways, from a funding standpoint, makes them very easy to identify and categorize. Fits very nicely into these little buckets and pockets that we can then carry forward and say, "Ooh, look, it's right here "and it's worth this much, and it's gonna be used "in exactly this way." And I'm gonna talk about how we can hopefully achieve the same thing talking about function goals a little later with funding. You might be wondering what that photo is, by the way. The photo is actually kind of an interesting tool, I put it on there as an example because that is something called a spica tunt. Fortunately, it's not something that a human would use on their own body, it's for an Alfa Romeo car. It's the thing that was made to try to bring us out of the age of carburetors, into a very primitive notion of fuel injection.

I'm using it as an example, not because we're gonna sit down click and clacking on car talk here, right? I wanted to use it as an example, because it is a specific tool that was made for something that everybody at the time saw and thought, "Oh, this is great, you just gotta take those "Weber carburetors off the side of the engine, "drill this thing on, and now it's gonna "take fuel and inject it right into the engine, "and everything is gonna be great and it's the future." And that's how we looked at assistive technology, so, again, I'm hoping to have hammered this over the head enough that you feel bludgeoned. But that's really what I want to accomplish with this. Someone was asking if we're gonna touch a little more on transitional assistive technology needs, I plan to in a future webcast. It's not built into this presentation today. That is a whole entire webinar of it's own and I'd be happy to do that at some point if people wanted to hear about it.

So we have these blurring lines of technology everywhere in a gen ed environment that we all use and that we're all very familiar with, and that sometimes, pollutes the judgement that we take to the needs for funding, as I say at the end, here because so many benefit from a technology, funders need a little guidance, because they can easily get confused. So when we look at funding assistive technology in schools, it's really important to think as we do, hopefully about a lot of the work we do, which is that it's a system's approach. It's not just the system's approach in terms of knowing the system or systems that are available for funding, but also understanding that it's very much a part of the system itself that we construct, in our local environment around that child, needs to involve a lot of different moving parts. We need to know, by the way, this all is presuming that when we're looking at funding assistive technology, we are going to be organized.

Very scary term for a lot of us, but it really is important to think, up front, that from the first time we think about the assistive technology and limitation process and about funding, in particular, that we start deciding how notes are going to be kept. Who is going to keep them and other levels of organization that I'll talk about later, I have a slide that goes through some of that. And the reason is because we could be talking about changes across the lifespan, not just in performance, on the part of that student, but changes across the lifespan and what that person has available to them from a funding standpoint. Funding itself is going to vary by environment, and as we talk about some of these different funding mechanisms, I will note, that some of them are far more approachable in certain environments, far more successful in certain environments than others. They vary by students' disabilities.

And though none of us appreciates the labels that we are stuck with using, they speak to funders because again, when I'm talking earlier about categorization and fitting people into buckets, which, again, sounds terrible on the surface, is something that funders rely on at times for classification purposes. And that can sometimes change across a student's career K-12, even. It could be local, or regional, or national resources. We're gonna talk about everything from Medicare down to regional resources, state and local as well as private funding sources. And importantly, we'd like to note that they are often combined. In fact, we have done a tremendous amount of funding work the last four or five years now in my professional circle and it's hard to count the times when it is not coming from a combined resource.

And by the way, I'm talking, not just about multiple items, especially a person who has high specific technology needs, they might have a constellation of funding opportunities for the array of tools that they're using, but I'm talking even within a single item. Then right in line with that it may cover only a portion of the total cost, and it's important to know, up front, that it is very possible that even with combined resources, only a portion of the total cost is going to be covered. Those of you who are a little longer in the tooth, as am I these days, but not ridiculously longer in the tooth, but you know, life marches on, may remember some of the page-turners of years gone by, and page-turners pre-digital publishing, used to be these gangly, awkward-looking mechanisms. Rollers and little sticky pieces of gum that would launch across the, hopefully, target page and grab on to it and pull it over. And they were fabulously expensive, there were about four or five manufacturers in the world that made these things and god, they were a ball to watch at conferences because they worked about 18% of the time really well, and about half the time they worked okay, and the rest of the time you were either putting more sticky stuff on them, to make them work, or they just flat didn't and you'd end up with a wrinkled book or magazine shoved into the corner of the device.

My point bringing this up as an example, that you have this three or five thousand dollar page turner, just so this person can sit and do the thing that we all wanna do, which is to read. And yet, who's gonna cover that? It's not something that allows for them to You're stuck with using either private money or a benefactor of some kind, or a local organization who might come in and pay for a portion of that, they might have an old, broken loaner laying around and hopefully we can fix it. My point, using the example, this is the role of assistive technology. We're always bringing to bear a lot of different resources. I would challenge us all to find the fun in that. And I mean that, I think that part of our job, because we don't live in a perfect world, because we don't live in a country that devotes significant amounts of resources to providing tools for people with disabilities and carte blanche, our work, a big part of our work is to not just advocate for funding for people, but to recognize that there just isn't always adequate funding.

And so part of what we do then, is we become kind of the Macguyvers of the situation in terms of pulling together all the resources and making something work for them. So I want to challenge us all, that actually this is fun and that it's important to pull ourselves up from bootstraps every once in a while when we get a little depressed and say, "No, actually, this is my work. "My work is to make this happen for this person." And then the last item I just want to mention here, of course, is that we do have trouble covering training, and I'll say outside school funding. So SPED programs typically offer at least the opportunity for training and that is kind of built into a lot of that funding. We don't always get that privilege in other funded environments. There's lots of different ways we can talk about funding, I have decided to kind of break it up for purposes of discussion in terms of different funding mechanisms.

And then we can kind of break each of those down and I've got some case examples at the end that I'm hoping will highlight how they might work for certain types of kids, but as we think this through and again, not an exhaustive list, different ways to do this, but one way is to think in terms of just school-based funding, what I'm lumping into as regional, which by the way, might also be school-affiliated or possibly is a regional education district or maybe is a regional organization that is a tech organization, state Medicaid, federal funding, which for the population we're talking about today is limited. Unless you lump Medicaid dollars into that, which we could, but I think that's sort of splitting hairs if we think of Medicaid as different. But federal funding in a traditional sense, is very, very rarely available with the exception of Tricare, and I'll talk about Tricare, which is the military insurance.

Private insurance, which I find is not frequently used enough, in my opinion in K-12. People forget, I think there is a tendency to say, "Well, this is a special ed, departmental funding "obligation and I'm going to stick with that "and we're going to get legal involved, "we're just going to take it as far as it goes," forgetting that there is a possibility, again, the sort of Macguyvers, maybe that's not the best term. The resource puller togetherers, which is what so much of our job is, we can be looking around and help steer and advise the stalemate that we're working with to look at other places, too. And to not get hung up on the fact that maybe there is resistance in one area and we're forgetting to look somewhere else.

So I say that because I think often times private insurance, which in some cases with the exception of Cygna, has more flexibility than you think for products that you wouldn't traditionally think of them as funding. Diagnosis specific foundations, we'll talk about some of those, and alternative funding, which again is really reaching into your community, and lots and lots of communities have very rich resources that hardly get discovered because we get so distracted thinking of more traditional funders. So I use this little circular pattern for PowerPoint to put this here because we really need to remember as we're sitting in those meetings, as we're beginning to get frustrated, because we've been denied coverage for an item from one source, that it is possible to look other places. And the deeper we dig, oftentimes the more we uncover. Use your colleagues, use other people who've have gone through the system before you.

Okay, school-based funding, when we think about, what again, what I'm going to loosely lump into what I'm gonna call school-based funding, we have early intervention, as programs. These are very differently prescribed, if you will, in different states and different regions, so I'm not gonna get into some of the gory details, but I'm putting these in general terms. Early interventional, if the child has an IFSP or a Head Start program, they're opening up to some funding, there's IDEA, which is really SPED funding, if a person qualifies, and has an IEP with assistive technology goals written into it. Section 504, which in some districts is just fabulously used to help fund assistive technologies for kids who don't necessarily qualify by disability to be on an IEP, or maybe they even do, I mean, could technically, but they're not because the team or the parents, everybody's realthat they don't, but they're just not on that IEP. But there a 504 is a vehicle for funding for that student. District technology funding and program-specific funding.

So a lot of these programs, the district technology funding mechanisms, again vary widely by state, there are states that have been very reactive. I'm gonna use California as an example. Constricted state funding flowing into technology for students overall. So districts have taken it upon themselves sometimes with benefactors in mind, sometimes because they decide to allocate their resources that way, where they are willing to fund technology through the district in a way that is program specific, or that comes straight out of the district in kind of a bank system for students that allows them to get very diverse technologies included that probably even Medicaid would not fund. So when we look at special ed funding, we know that the student needs to qualify for special services and, I'm appreciating these comments, and I'm taking a timeout here to read as you're writing, and I love the fact that people are putting in these comments about what I'm saying, so keep doing that.

Um, student has to qualify for special services, they need the IEP to provide their rationale and roadmap for AT, that's just part of their work. Part of this of course means that the handler of assistive technology is gonna determine what that student can do with it. Obviously any SPED program is gonna want to do, their primary goal is to make sure they are opening up the world of education to that student and providing the least restrictive learning environment. But that doesn't always translate into that technology going home with that student, even though as clinicians and as people who advocate for total participation for people with disabilities, we would like to see them using that technology everywhere. So we just need to be aware that that is something that may or may not exist. And then I think also, again, we're not talking about transition in any detail, but be one of the biggest points in a student's life is when they're either aging out or graduating out of school and they leave behind this huge cupboard of technology that has really enabled them to participate in ways that they're unable to carry forward because it literally stays at the school. So just things to keep in mind as we think through this level of funding.

When we look at our tech programs and our telephone access programs, by the way tech access programs, there's one funded in virtually every state and territory. The degree to which they are able to provide assistive technology varies by state. Many of them are really an evaluation center and provide information and resources, others have a very robust capacity to both recommend and even assist with third party funding for assistive technology. Telephone access programs do exist in about 28 states or so, and these are programs that are funded by the local utility. Each telephone that's purchased, there's a portion of it that goes into a mandatory pot for the state, and they fund the adaptive equipment for the people who need access to the telephone. Used to serve primarily folks with hearing impairment and now in many states it has broadened to include other speech technology, and even in some states, more than that.

So this is something, whatever state you're coming from, look to see if they're part of a telephone access program. And different states have different names for them, in Oregon it's TDAP, in Texas it's called STAP, but it's telephone access, and there are lists that you will find, a quick Google that will tell you exactly whether or not your state participates. University-based grant funded AT programs, and again, I think the key here is that something else upfront, who's gonna own that equipment, what kind of training and support is gonna be provided, and whether or not it is a loan versus owned, or strictly an evaluation tool. State Medicaids are hugely variable, and I think the important thing to note here is that state Medicaid subscribe to the specific definitions and funding of assistive technology that I was alluding to earlier, so they're, usually, with the exclusion of a few of our more assistive technology progressive states like Colorado and Minnesota as examples who have assistive technology funding programs that look quite seriously at commercially available technology, and there are others that are going to follow in those steps. What I'm really talking about here in specifics is an iPad, and not just iPads by the way, but I'm gonna use it as an example, a specific example.

So there are programs funded by state Medicaid, sort of a subsidiary program in the state of Colorado, that will fund an iPad and an app on it. In other words, they don't only fund equipment that could be maybe qualified as durable medical equipment, which is a very restrictive definition of some types of assistive technology. The key though in state Medicaids is that they're all different. They all have different rules and regulations. Some follow Medicare, some do not. There is a rigorous application process in some states. In Washington, it requires video to prove that the technology is appropriate. Because, because they just do. And so that becomes a stumbling block for many people. Compensation is variable, there are states that fund AT, at 30 or 40 or 50 percent of what the manufacturer has set as the price. There are other states that will fund it 80 or 100%. And the thing to not is that if the state doesn't pay very much for something, it's possible that that technology's not gonna be available, even if you've done the full evaluation and you think it's the best thing in the world for your student. One advantage is that for Medicaids, almost all the time, and almost for all states, if it's funded, the student owns that equipment.

Federal funding, just a note that obviously Medicare is not something that is going to be very relevant for most K-12s, it is important to note that Medicare in this country pretty much defines, it gives a lot of structure around how we think of assistive technology that is then used by the states and by many third party payers. Not by our special ed programatics, not typically by a lot of regional foundations, but when we're talking about private insurance, as I did earlier, there I was, you know, saying "Oh, we should use private insurance more often." Again, it takes some upfront research to know whether or not that private insurer subscribes to the definition set by Medicare or Medicaid, because that could be hugely restrictive.

Tricare is the one I wanted to mention though. And Tricare is a military insurer. Based on Medicare's definition of those things, so you gotta take that with a large grain of salt upfront, but they do fund reliably for kids who are the kids of serving military personnel and sometimes they will just rent equipment, but oftentimes they will pay for it outright and the student then would own that. The good thing about our military families is that for them, because they're often moving so much, we can get something funded fairly quickly and reliably. If they're say, based in San Diego for a time, and then they're moving to some other part of the world, or some other place in the United States, they can take that equipment with them, and be using it hopefully, functionally as they go around so it lessens the barrier there. And question about insurance, yes, I'm talking about private health insurance. And yes, there is, at times, costs to the family for sure, and it depends on... It's actually beholden to, well, okay.

So manufacturers that make stuff that then gets funded. Whether it is commercially based, and some private insurers can be convinced to purchase, and by the way, much more so in the last four years than ever before. They will look at the equipment that is technology based but with it described as being functionally useful to that student in very concrete terms, out in the world, they are, surprisingly at times, willing to fund that. But there of course is likely gonna be a copay associated with that. It is not legal for manufacturers who agree to have their equipment funded to waive that copay. It can be done in certain circumstances, it cannot be common practice to do that. So that's very frustrating. It's frustrating to companies because they would like to do it more, and it's frustrating for people who are privately insured because they're stuck with coming up with another 20% on what might be a very expensive piece of equipment, or more.

But it is one of those sort of nasty realities that it's not possible to--that's a really important point. And as far as that, every policy is different there are literally hundreds of thousands of policies across the Unites States for private insurance. And different insurers have very different attitudes towards assistive technology, like I just said, Cygna, and I hope if anybody works for Cygna, no personal tests. They're very difficult to work with, as a general rule, and this is just a policy, a decision, maybe we shouldn't hold it against them, it's just something that they're not known for working with easily, and so I'm using them as an example that way. Cygna, just as a blanket policy does not fund AT, and they tend to really fight if you come after them from an advocacy and legal standpoint to get funded, even some very clear cut cases. And the way some companies get around that is they'll have policy exclusions written in very tiny font, you know, I wear glasses, but I'd need a microscope for some of these policies when it comes to actually reading the fine print, but that would be after I took about 13 naps, because of course reading an insurance policy is probably one of the least stimulating things you can do in your entire life, but regardless, you get down to the fine print, it'll say somewhere in there that various types of assistive technology, which will be qualified and classified by them, are disqualified from any type of funding and that's why when we work for a company or we work for an agency and they're providing insurance on our behalf, they're buying a plan, they haven't read the fine print probably, either.

They're looking for the best deal that covers as many employees as possible, and it's up to the insurance companies to write this stuff creatively so that they cut certain aspects of it out. But, again, I reveal my vice, but at the same time, I just want to make sure people are aware they need to find that out ahead of time. The easiest way to do it is to call with your policy number, and when I've worked in a funding capacity, and I did until very recently, work very actively in a funding business, what we did is we would get people's information and immediately call the insurer. The family can do it, too. They don't often have the time, nor do they always have the skills. And sometimes it's just the skill of confidence to know that you need to call and find out.

But again we take this on as part of our role as providers, and we would call and just ask, and then you have call the family, as the bouncing ball. It is true, incidentally, Jill mentioning that parents not only give permission, but do a lot of leg work for utilizing private insurance. Usually the legwork is, there's two ways to go about it. One is, yes, they may indeed be asked to make those phone calls and chase down specifics in the policy. Or they can provide the front and back of their insurance card to an advocate or to hopefully the person who would be processing their funding. And say, "I would like to find out if I am eligible," or if my son or daughter is eligible for this with insurance. And that usually can be answered. The caveat there is that there are insurers who will say, we're not gonna, we do every one of these as a one-off, and we're not gonna pass judgment until we say it's definitive, and then we'll let you know whether or not we're gonna fund it, oh and we're also gonna let you know at that time how much we're gonna pay for it. That is not uncommon, and so that is part of the risk of private insurance.

However, I would say, again, it's a risk worth taking in many cases. And incidentally, when I talk about private insurance, again, this is also the time to think broadly about how we're approaching, excuse me, why we're approaching funding for this kiddo. So what I mean by that is that we're either gonna work within the district funding mechanism and fight for that as being the only way we're gonna get things funded, and I'm not saying that's bad. I'm saying there are also risks associated with that, first of all, the district might not have the financial capacity, especially some rural districts that I've worked with over the years. I'd have principals call when I was working clinically and say, "Please don't put that report in. "We don't have-- "Our budget, we can probably do it next year, "but this year we've got two power wheel chairs "to pay for and we're blowing our budget." Those offline conversation started then.

And what a sad state to be in, but I guess importantly is that the district might not have the capacity to fund that, and they might say, well, this isn't our job right now. Or, also keeping in mind that it could be the district's gonna own that piece of equipment, kids can't take it where they would want to. Reaching out to private insurance might mean justifying its use in somewhere other than exclusively an educational environment, but that should be easy, because I can hardly ever think of times when the assistive technology that we use for educational purposes is not appropriate outside of the classroom, it's hard to think of many circumstances, creatively, where that would be the case. So I think we can often make a compelling argument to private insurers that this isn't a strictly educationally based tool, it has to do with the quality of life of this individual in some very big ways.

Okay, so. There are more and more companies, private insurers that are seeing the value of adapted commercial equipment. And I think that's important, in fact, more and more we are seeing private insurers saying, well, we would like to, I deal primarily in the world of augmented communications, so I'm gonna use an example here, where they'll say, well, we're not interested in paying $6,000 for this machine when we could get a tablet and we'll pay for the software on it, and it's gonna cost us a lot less. I like that, I really think that's important for us, as long as we don't lose the support side of things, so this is a conversation I have with many of my colleagues, which is that we don't want to, we don't want to lose funding for support, which is partly what we pay for when we pay for assistive technology and it seems expensive, but at the same time, as part of this revolution of consumer equipment, we want to encourage our funders to think creatively, too, because that's gonna force us to look at how we support these things differently.

Anyway, that's a whole other conversation that I don't want to get too far into. Foundation funding is usually disability specific. These are excellent ways to get tertiary funding. Its not always enough for primary or secondary. A lot of times it's a way to get a loan of equipment, but very, very good resources. And what I'm calling alternative funding, which has to do with looking around us, and again the challenge I had at the very beginning of this talk about thinking of our role as being one that looks positively around and says, where are all the different connections that I have professionally? In fact, a big part of our work is to stay connected to our local community so that we can connect our clients and our students with other resources, so local chapters and organizations, local benefactors, people that are having fundraisers or nonprofit foundations in the local area. And we could even, depending on how much gumption we have, assist with those local private funding events. Some of us have the time, and many of us don't. I'm not saying you should have that time. I'm just saying that these are options, and when we're connected, that they are there in many communities. John just mentioned something about California with Ability Tools, that's an excellent resource. So I've got a couple case examples I want to get to in our closing minutes but before that I wanna make sure I had mentioned a couple funding tips.

Again, I've said this a few times already, but what I have found in my experience is that when families and professionals know all of their funding options upfront and agree that they are all valid, and that there isn't a bad attitude about one, or negativity associated with another, but that the job that we are taking on by being in our professional milieu, or that has been foisted upon us as a parent or as a teacher, is that a big part of our job is to look out into the world positively what all of those options are, and be willing to engage with all of them. Part of that means we do a little bit of that research, or we inspire the people we're working with to do the research on finding out, well, what is the funding option with this private insurer, what is the special education department willing to bring to the table if this ends up as part of the IEP? Is it gonna be the thing we really want, can we walk around with it outside of the school? Will it follow this person through transition, et cetera, et cetera.

Maybe that's the only option, and that's as good as we're gonna get for now, but in the meantime, we're gonna look at other options, too, that will either be longer term, or we're gonna start a little account that we're saving for, or whatever it is gonna be a real forward thinking plan. Keeping well organized notes. It sounds ridiculous, but it's so true. Finding competent evaluators. Assistive technology is a very underserved professional area, there's huge need and very few experts. But there are a lot more people that know a lot more about it now than there used to be. I think the real advantage we have again is how is the U.S., or excuse me, how has the funding environment changed in the last about 15 years. Well, part of that is that we all know a lot more about technology than we used to. Now, I remember way, way back, you know in 2007 or 8 when iPads came around, and no one understood how to use an app or what an app was, and we were all scared, shaking in our boots. And now it would be difficult to find someone who would be intimidated if they were handed an iPad or an Android device and said, "Figure out how to change the screen on this "so that we can use it for this reading program, "or this digital book."

So we don't have a lot of competent evaluator specialists, but we have a lot more general knowledge about technology in general, and how we all use it. And then being realistic. There are few funders who fund 100% of anything, and I would even stretch that to mean, there are few funding environments in which you might get 100% of what that student really needs. So we need to have the comprehensive view. We need to be thinking about alternatives and how we're gonna close the gaps to funding for this stuff. I do wanna spend just the last closing minutes of case studies, I think it helps illustrate the point. The first case study is a person, Amy, diagnosed with pervasive development delay, nonverbal communication, self injurious behaviors, in an inclusion classroom, on an IEP, which includes communications for sensory regulation, fine motor and behavior modification goals. And what we have is a situation where there's a trial of an iPad communication app, it has resulted in positive communication and behavioral improvements.

And the evaluation team that was bringing this in, and they're part of a, more of a regional service district, coming in, sort of swooping in, parachuting, helicoptering, whatever you want to call it, in to make recommendations, has made this recommendation for an iPad and specific app to address this little girl's needs. So they're thinking, well it would be great to have this thing as something that this kid owns, we're gonna, say well, the SPED program budget, we're gonna write her a funding request and submit it to Medicaid. And it's denied. And so the question is, why? Well, in most states, we're just gonna take, one of the few now that have specific codes for iPads as educational apps, or communication apps or whatever it happens to be. It doesn't in this particular state qualify for Medicaid coverage, because Medicaid in this particular situation, only covers a speech generating device. And after all, it's an iPad, with a communication app, so it can't be a speech generating device, even though every speech generating device since 1999 or earlier has been a tablet computer with software on it, but we haven'twhat a tablet is, and it might have a fancy box around it. It doesn't qualify because it's not a speech generating device.

So what is gonna happen? Well, the team in this case should proceed by saying, "Well, we are going to find "a company like Ablenet or Forbe's Rehab Solutions "or one of the other many companies, "like Talk To Me Technologies in the United States "that build communication devices "using an iPad as a tablet." And we're gonna resubmit our funding request as a speech generating device, and in that case, in all likelihood, it would be successful. So this next one is a case study of a little guy by the name of Mike, fourteen years old, Duchenne Muscular Dystrophy. Just like so many of these little kiddos, I guess 14 isn't a little kiddo anymore, but getting weakness towards the end of the day. Not on an IEP, but does have issues with fine motor and vocalizations, very common, this is a very common situation for students that I've seen. So, certainly a good candidate for voice application, text input, voice recognition software, adaptive reading material, it might only be used for the few hours of the day, but that's okay, it's extremely important to keep this person participating and take the stress out of the front part of the day of, "Oh my goodness, I'm not gonna be able "to do this in a few hours, "because I'm gonna be too tired." S

o in this situation we might look to a 504 plan team to get involved so that we can get this guy the technology needed. And it would be very surprising to me in any educational setting that a 504 plan would not cover this type of technology. Importantly, though, we want to involve the student, family, peers, fair professionals if necessary, and make sure there is that team environment that I emphasized earlier. But importantly I guess my point is that it's not a matter of reaching out saying, "Oh, we need to convince the private insurer or Medicaid to pay for this stuff." what we really can look for is an internal mechanism that will cover.

And then finally this 9 year old with autism, echolalic, limited array of two-step commands, and requests using text and visual support, I've had apps for time management, scheduling, communication, choice making, adaptive desk and chair, and one-to-one paraprofessional IEP calls from multiple assistive technology supports to accommodate this person. And here's where, there's enough going on that we have the opportunity to be that hub of connectivity to which I referred earlier. We look at different types of resources. What does the tech program have available? Obviously it's written in the IEP, so we're gonna be working through that mechanism, but just because it's an IEP doesn't mean we have to fund it all through the school.

Part of the law dictates that the school make available the resources to acquire the appropriate technology for the student to reduce those barriers. And that can also mean looking at funding outside the district itself, and in fact it is possible for that toolbase evaluation team to write their report and make those recommendations and not have to do it on their own time outside of school hours, because it happens to be going through a private insurer. They're using the school resources to make the appropriate recommendations to acquire the appropriate equipment for that student. S

o my point here, and I know that we're out of time, but just I wanna make sure that you realize, this is a constellation of resources and bringing to bear all those different resources to dispatch the technology for this student. Okay, and we are at the top of the hour, are there other questions or comments that I can help answer? 504 funding, what funding resources given for 504 in our county all fall to-- well, okay, it does at times fall under the same said funding umbrella, it's a different way of getting into that funding mechanism. So it's really the entry into that funding budget, that 504 in some districts, others set aside money for that. And I see that there is a link to the feedback. I will thank you all in advance for taking that survey, and I wanna thank all of you for being available today and sharing in this topic.