Shifting Administrative Burdens: An Examination of Iowa's Medicaid Payment Rules on Specialized Wheelchairs for Nursing Facility Residents

Abstract

This white paper describes research done in the University of Iowa College of Law Clinical Law Program on Iowa's Medicaid payment rules for assistive technology for nursing home residents. Customized power wheelchairs provide elderly and disabled nursing facility residents with the freedom of independent mobility. Without this specialized equipment, residents may be bedridden, reliant on facility staff for mobility, and at risk for developing painful and dangerous pressure ulcers. In Iowa, and in other states with the minority rule, DHS Medicaid rules place the initial burden of paying for this expensive equipment on the nursing facilities. Often, facilities refuse to pay or simply cannot afford to do so, leaving residents without medically necessary life-improving equipment. Minnesota’s rule, on the other hand, allows a Medicaid recipient to receive direct reimbursement so long as the requested item is medically necessary and will be used exclusively by that recipient. A majority of states have adopted a rule like Minnesota’s. The majority rule is more efficient and avoids creating an adversarial relationship between the care giving facility and the resident. Medicaid recipients in Iowa nursing facilities can receive direct reimbursement only after applying for an exception to the default policy. Iowa DHS should embrace the exception as the rule and improve its Medicaid wheelchair reimbursement policy for nursing facility residents by adopting the superior majority payment rule.