Leveraging and Reporting Additional Resources
State AT Programs should continuously surveil the landscape within their state for opportunities to engage with other public and private agencies to expand access to and acquisition of AT through leveraged resources. The small core federal AT Act funding is simply insufficient to support truly comprehensive services across most states and territories without significant partnerships that leverage additional resources.
The basic steps in successfully leveraging funding include:
Identifying who could provide leveraged funding and for what specific purpose(s)
Conceptualizing and sharing what the State AT Program can provide that will deliver jointly beneficial outcomes to both the potential partner and State AT Program (this may include estimated costs and anticipated return on investment)
Being persistent and flexible in working toward a mutually beneficial agreement
It is critical for every State AT Program director to have a clear idea of what their program has to offer that is valuable to others, along with a realistic view of their program capacity. For example, does your program have the administrative capacity to expand services and directly provide AT via an application process? Do you have the physical space to expand device inventory and double the number of device loans processed each year? Is your program easily able to restructure (recruit/add qualified staff or reassign staff duties) to accommodate additional funding for specific activities, even if only for a limited time period?
There are two basic types of funding that State AT Programs leverage, entering into agreements for a set of services/deliverables with prescribed total payment or establishing a fee schedule for services provided on an as needed/requested basis. There may be hybrid approaches that use features of each.
The following provides an overview of these two types of leveraged funding and how they are typically implemented:
Service Agreements — Contracts/MOUs or other agreements for specific services.
Scope and volume of services to be provided is for a set time period
Can be one-time agreement or can have renewal periods to support long-term implementation
Total payment amount is specified, supports budgeting with predictable income
Most typically used to implement targeted activities within an area (e.g., AT for post-secondary, open-ended loan project or administering a telecommunications equipment distribution program)
Fee-for-Service — Piece-rate schedule of payments for specific services.
Ad hoc volume based on need/requests
Can be one time or ongoing
Individual service amount is specified; creates need to project volume for budgeting; history of past usage is helpful to accurately estimate income for budgeting
Most typically used for individual client services (assessments or consultations) or requests for specially-developed training with fees set to cover all associated expenses
Types of Leveraged Resources
State AT Programs support statewide AT access and acquisition across all ages and all types of disabilities, which creates a wide array of opportunities for leveraging funding. The following areas are those most frequently providing leveraged funding opportunities for State AT Programs.
Special Education
The major federal funding stream for special education is the Individuals with Disabilities Education Act (IDEA), Part C for children with disabilities birth to age 3 and Part B for children with disabilities age 3–21. IDEA Part B funding is allocated to the state education agencies according to a formula. In most states, about 75% to 80% of IDEA funds are allocated to local school districts under a formula, and the rest are retained by the state for discretionary uses. IDEA does include a requirement for coordination and collaboration with the State AT Program. Federal special education funding is actually quite small compared to state and local special education funding in almost all states, creating additional options for leveraging funding. Examples of AT Act-authorized services that could be provided using leveraged special education dollars include:
Implementing state financing activities such as administering an AT purchasing program for the state education agency or doing volume buying to reduce costs for certain types of AT
Coordinating reuse services across school districts or for a particular high-cost type of AT, or implementing a comprehensive Part C reuse system statewide
Implementing a targeted device loan program specifically for team decision-making with a goal of reducing individualized education program disagreements about AT
Offering AT assessments, consultations, or training in a fee-for-service or cost recovery model specifically designed to assist local education agencies in meeting the needs of students with disabilities
Employment
The major federal funding stream for employment of individuals with disabilities is vocational rehabilitation (VR) funding in the Rehabilitation Act section of the Workforce Investment and Opportunity Act (WIOA). Federal VR funding is allocated to state VR agencies who provide employment services for eligible individuals with disabilities either directly or through purchase of service agreements with community providers. Federal VR funding requires a state match, and VR dollars are allocated to the state according to a formula. VR funding is primarily used for individual client services but can also be used for “services for groups of individuals” in which WIOA specifically authorizes the “establishment, development, or improvement of assistive technology demonstration, loan, reutilization, or financing programs in coordination with activities authorized under the Assistive Technology Act of 1998 (29 U.S.C. 3001 et seq.) to promote access to assistive technology for individuals with disabilities and employers.” WIOA also includes a requirement for VR to coordinate with the State AT Program, with particular emphasis on VR professional development activities. Examples of AT Act authorized services that could be provided using leveraged VR dollars include:
Implementing volume buying of AT to reduce cost to the VR agency, partnered with open-ended loan reuse to ensure that AT no longer needed by clients is refurbished and reassigned to the maximum extent possible
Implementing a targeted device loan program specifically to support individual employment plan goals
Providing coordinated device demonstrations to determine the AT needed for a specific employment goal or for a specific employment setting
Offering AT assessments, worksite consultations, or training on a fee-for-service basis specifically designed to meet client AT needs for employment or the professional development needs of the VR workforce
Health Care
The major health care funding streams used to pay for assistive technology are Medicaid, Medicare, and private health insurance. The majority of AT covered by these funding sources is durable medical equipment (DME) used for mobility, communication, and daily living functions. Unlike special education and employment, there is no federal statute, regulation, or guidance under Medicaid, Medicare, or private insurance that supports coordination or collaboration with the State AT Program.
Despite this, some states have forged partnerships in the area of health care, securing Medicaid leveraged funding to operate reuse programs that refurbish devices (mostly DME) purchased with Medicaid funds or otherwise donated devices and place those devices with eligible recipients (including but not necessarily limited to Medicaid beneficiaries). These Medicaid-supported reuse programs have a tremendous return on investment and ensure cost-effective use of Medicaid funding for AT. Other states have developed agreements with Money Follows the Person programs to provide AT that ensures individuals can move from congregate care settings into the community. Fee-for-service work for health care funding sources will have myriad requirements to address, including enrolling as a provider with health care service networks; meeting federal, state and/or insurer/funding source specific credentialing requirements; obtaining a national provider identifier; working under the direction of or under orders from a qualified medical provider; and obtaining malpractice insurance.
Community Living
A number of public funding streams provide AT needed for community living, with many focusing on populations such as people who are aging or people with intellectual and developmental disabilities, or on specific functional areas such as independent living, emergency preparedness, and financial literacy. Assistive technology is typically a small portion of the overall mission of organizations who focus on community living outcomes. Examples of AT Act-authorized services that could be provided using leveraged dollars from agencies working in the area of community living include:
Implementing a collaboration with an aging agency that includes providing a set of low-tech AT devices to be used by senior centers for device demonstration purposes, along with training staff at those centers to provide such demonstrations
Obtaining a grant from the state developmental disabilities council to design a pilot project using AT to help move individuals from sheltered to competitive employment
Entering into an agreement with emergency management entities to coordinate efforts to replace lost AT through reuse activities
Obtaining community development financial institution (CDFI) funding to expand access to financing for assistive technology
Reporting Leveraged Funding
Section 4 grantees report leveraged funding that the State AT Program receives to support implementation of authorized AT activities in the Annual Progress Report (APR). These must be “real dollars” received by the AT Program (not in-kind contributions) and are reported by amount and source, with selection of the authorized activities that the dollars support (e.g., state financing, reuse, device loan, demonstration, training). For all leveraged dollars reported, the associated data for the activity supported will be reported in the corresponding APR section. For example, leveraged funds that support demonstration will have APR demonstration data that was generated by this additional funding availability. The APR does allow for leveraged funding to be reported without associated data in the activity area supported with an explanation of why the data could not be reported. With new (perhaps opportunistic) leveraged funding, the State AT Program might not have been able to implement comprehensive data collection for the first year. Or it might be only a one-year project and not worth investing in data collection for such a short-term.
Last updated January 2023
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