When Medi-Cal pays for durable medical equipment (DME), like a wheelchair or a scooter, the recipient actually gets the device from a DME vendor. Vendors are independent businesses that contract with the state of California to provide DME to Medi-Cal recipients. Sounds simple, right?
It gets complicated when we start talking about repairing the devices. Since Medi-Cal only replaces most DME every 5 years, it may be necessary to fix equipment like wheelchairs in the interim.
Sometimes the repairs are covered by the item’s warranty. That’s easy.
But it gets tricky when repairs need to be paid by Medi-Cal. Medi-Cal currently reimburses the vendor that procured the device to fix the equipment upon approval, but only if the vendor still accepts Medi-Cal as a form of payment. And vendors that don’t contract with the state to provide DME to Medi-Cal recipients don’t even qualify.
Many durable medical equipment (DME) vendors around the state are no longer accepting Medi-Cal as payment for equipment repair, especially for items like wheelchairs and scooters. This is a problem when a Medi-Cal recipient receives DME from a vendor and then the same vendor stops accepting Medi-Cal. Another scenario occurs when people move out of the area where they received a device. In either of these situations, when DME breaks, getting it repaired becomes difficult.
Where do you go?
We have talked to many Medi-Cal recipients in just this situation, and they commonly decide to:
- Pay out of pocket
- Wait it out until they qualify for a new device again
- Ask for Medi-Cal to approve another Medi-Cal contracted DME vendor to approve (uncommon for Medi-Cal to approve)
- Call Ability Tools toll-free line and ask for gently used equipment
None of the options above are ideal. Medi-Cal has a responsibility to repair the DME devices they initially purchased.
Even when repairs are eventually approved, the process is long. If a new part or accessory needs to be ordered, then the approval process may take a new twist and the user is often stuck with nothing in the interim.
Clearly the system is broken.
But there is hope.
Medicare found itself in a similar situation and has since “fixed” its repair policy. In November 2014 Medicare lifted its repair restriction that included reviewing the initial medical justification of the device, and now Medicare recipients can have their DME repaired by any contractor that accepts Medicare.
We need Medi-Cal to follow Medicare’s lead and ease their DME repair restrictions.
This is where you come in. To encourage Medi-Cal to change its current policy, we need to show how the current repair policy is affecting Californians.
Share Your Story
We need to hear your story. If you or someone you know is a Medi-Cal recipient who has not been able to get equipment repaired by a local DME vendor, please email me at firstname.lastname@example.org.
Please include the following details in your email:
- Your name
- Your email and/or phone
- Type of device (power wheelchair, scooter, etc.)
- Name and address of the vendor who denied repair service
- Name and address of the vendor from whom the chair was purchased
- The payer who purchased the chair (e.g., Medi-Cal, private insurance, other)
- Health plan involved
Collecting your stories is an important step to improve DME repair options in California.
Please spread the word.