Costs and utilization of assistive technology in individuals with spina bifida enrolled in the Washington State Medicaid program

Individuals with disabilities, including spina bifida, can often benefit from the use of assistive technologies (AT). Little is known about the extent of utilization or the costs associated with the use of AT. To examine this issue, we analyzed data from the Washington State Medicaid program on all claims for eligible enrollees with spina bifida for a four year time period (2001-2004). We examined costs and utilization for all individuals, as well as for age subgroups of 0-15, 16-25, and over 25 years. Billed services were categorized into the following AT categories: Manual wheelchairs, powered wheelchairs, wheelchair cushions and seats, wheelchair rentals, wheelchair other, beds, positioning aids, communication and hearing aids, ambulatory aids, bathroom equipment, and orthotics and prosthetics. In total, $563,565 were billed and $434,172 were paid annually for AT for the 848 average annual enrollees with spina bifida, accounting for 3.3% of all costs paid for this population. Only 33% of all users had any type of AT claim on average per year. Of the AT subtypes, orthotics and prosthetics and wheelchair other payments accounted for 56% of all AT related charges. Wheelchair rentals, ambulatory aids, and communication and hearing aids accounted for the least percentage of AT costs, and were used by only 0.9%, 3.3%, and 0.6% of all eligible enrollees respectively. The total AT costs per eligible enrollee were significantly lower for individuals 16-25 compared to the other age groups. Overall, AT costs appear to be minor compared to other health related costs for this population.