Assistive Technology and Community Living

Introduction

Assistive technology (AT) includes software, devices, equipment and 

products that improve the functioning of individuals of all ages with 

disabilities. For example, assistive technologies such as hearing aids 

can help people improve their communication skills on the job; 

assistive technologies such as an app on a smart phone can help 

someone read with low vision. Assistive technology also includes 

durable medical equipment (DME), such as wheelchairs and other 

mobility aids. 

Assistive technology can affect a person’s well-being by improving their 

ability to walk, eat, bathe, communicate, see, speak and live 

independently. Technologies also can help address social isolation and 

improve quality of life by assisting people with communication, 

mobility, and other daily activities. 

This issue brief discusses: 1) the important role of assistive technology 

in helping people of all ages with disabilities live full and independent 

lives in their communities; and 2) certain sources of public funding for 

the technology, including Medicare, Medicaid, and programs that the 

Administration for Community Living (ACL) manages. While other 

public programs, such as those for Veterans, may fund assistive 

technology, those programs are beyond the scope of this issue brief. 

Role of Assistive Technology

Assistive Technology is any item, device, piece of equipment, or 

product system used to maintain or improve the independence and 

function of people with disabilities of all ages, in education, 

employment, recreation, and daily living activities. Assistive technology

devices can be ‘low tech’ like a built-up handle on a spoon to improve 

the ability to grasp, to ‘high tech’ computers controlled with eye 

movement. These devices can be do-it-yourself, or even consumer 

electronics like home automation solutions that can be more than just 

a convenience for a person with a disability. Assistive technology

includes the services necessary to get and use the devices, including 

assessment, customization, repair, and training. (ACL, 2019)

The range of technologies that support people with disabilities in their 

many daily activities is vast. Examples of categories include devices 

that can help people carry out daily activities like eating and dressing;

K is a 3-year-old boy with a huge 

personality. K’s mother reached out 

to the Oklahoma Assistive 

Technology Program for support as 

this youngster with physical and 

vision disabilities prepared to 

transition to preschool. One of the 

Oklahoma AT Program partners 

created a sensory table and a braille 

board to demonstrate do-it-yourself 

assistive devices that were suitable 

in the home and later at school. K 

made gains in strength and 

endurance in his ability to stand 

while playing at the sensory table. 

He also increased his attention span,

and made improvements in preliteracy skills with the braille board. 

Rebecca, who is in her mid-60s, 

contacted the Arizona Assistive 

Technology Program because of 

problems with her vision. During a 

device demonstration, she tried 

several different video magnifiers, 

including handheld and desktop 

models. She practiced using the 

devices with the activities with 

which she needed assistance, like 

reading her mail, reading her 

favorite magazine, and being able to 

read food labels at the grocery 

store. Once Rebecca decided on a 

model to purchase, the AT specialist 

referred her to local vendors, and 

later helped her complete an 

application for a financial loan from 

the Arizona cash loan program. With 

the technology, Rebecca is able to 

continue to lead an independent life 

without relying on others for daily 

tasks and community engagement.

Stories
hearing, vision, and mobility aids; and computers, home or office environments, and vehicles that are 

accessible (Santana et al., 2016).

Following are some examples from a National Academy of Science, Engineering and Medicine report 

(2017) about how assistive technology can assist people, and considerations about person-centered 

approaches to providing assistive technology:

• Wheeled and seated mobility devices can improve an individual’s function, help them be 

independent, integrate into their communities, achieve and maintain independence, and 

improve quality of life. The process for choosing a device requires understanding an individual’s 

needs throughout the day; their cognition, function, and activities; condition progression; and 

environment. These devices must be fit to the user, and the user must have training on how to 

use their devices. Such personalized approaches to training and adaptation can affect the 

individual’s experience and prevent abandonment of the device. 

• Hearing aids improve audibility and customizing them to users’ needs is important. Researchers 

document greater satisfaction with hearing aids when they are fitted to the user.

• A literature review reveals that the most common application of intelligent assistive technology 

in dementia care is supporting older adults with daily activities, like eating, bathing, and 

dressing. Monitoring is the second most common application, with safety being an important 

feature.

• Word processing-based assistive technology interventions had a large positive effect on writing 

error rates for people with learning disabilities. Text-to-speech systems and smart pens had 

positive effects on reading comprehension.

Public Sources of Funding

The public sources of funding for older adults and people with disabilities include Medicare Part B, 

which covers up to 80 percent of the cost of assistive technology for the program’s beneficiaries. The 

technology must meet Medicare’s definition of “durable medical equipment,” which comprises devices 

that are “primarily and customarily used to serve a medical purpose, and generally are not useful to a 

person in the absence of illness or injury.” Original Medicare covers DME when a doctor or other 

treating practitioner prescribes it for use in the home. The equipment must be medically necessary, that 

is, needed to diagnose or treat an illness, injury, condition, disease, or its symptoms. The equipment 

must meet accepted standards of medicine. In addition to mobility devices, Medicare Part B covers 

prosthetic devices (like cardiac pacemakers, enteral nutrition pumps, and prosthetic lenses), orthotic 

items (like leg, neck, and back braces) and prostheses (like artificial legs, arms, and eyes), as well as 

speech-generating devices.

Medicare Advantage plans gained new flexibility to address social determinants of health from passage 

of the Bipartisan Budget Act of 2018. The Act allows Medicare Advantage plans starting in 2020 to offer 

“non-primarily health related” supplemental benefits, such as meals, transportation, and home 

modifications to chronically ill enrollees to address gaps in care, and improve health outcomes for this 

population. So, these plans may choose to cover DME that Original Medicare Part B does not. 

Medicaid serves those with limited incomes and few assets. It covers a wider variety of durable medical 

supplies than Medicare. For example, Medicaid covers hearing aids and doesn’t have as strict 

limitations concerning the number of supplies and use duration that Medicare does. Medicaid tends to 
cover a larger portion of expenses, and often it covers all associated expenses for qualifying medical 

supplies. Many states cover assistive technology to support the functioning and independence of 

Medicaid beneficiaries with disabilities through Medicaid Home and Community Based Services 

programs, Medicaid Managed Care, or Money Follows the Person programs. 

ACL’s Assistive Technology Programs

ACL’s two assistive technology programs are: 1) the State Grant for Assistive Technology Program and 

2) the Protection and Advocacy for Assistive Technology (PAAT) Program. The first program supports 

state efforts to improve access to and acquisition of assistive technology for individuals with disabilities 

of all ages through comprehensive, statewide programs that are responsive to consumers. Each state, 

the District of Columbia, Puerto Rico, and outlying area receives an annual award and must create a 

state plan for the program. The State Assistive Technology Programs carry out activities that promote 

the ability of people with disabilities to know about, have access to, and ultimately be better able to 

obtain assistive technology. The Assistive Technology Act, which funds the State Grant for Assistive 

Technology program authorizes four state-level activities:

a. Assistive Technology Demonstration activities provide opportunities for people to become 

familiar with specific types of technology by comparing devices through hands-on 

exploration that a knowledgeable professional guides. 

b. Assistive Technology Device Loan activities allow individuals to borrow a device for a limited 

time to try it out and determine if it will meet their needs before a purchase.

c. Assistive Technology Reutilization activities support the reuse of assistive technology that 

the original owner no longer needs or uses, and that a new owner can acquire at substantial 

cost savings. 

d. Assistive Technology State Financing activities support the purchase or acquisition of 

technology, through financial loans or other initiatives that directly provide assistive 

technology to consumers at no cost, using dollars from non-Assistive Technology Act 

sources to save consumers money when purchasing the technology. States may not directly 

pay for devices and associated services.

ACL’s Assistive Technology Act Technical Assistance & Training (AT3

) Center assists grantees of the State 

Assistive Technology Programs. The Center: (1) supports quality implementation of state activities, and

(2) develops and maintains a national assistive technology website. The Center provides information and 

support for the following activities: state financing, technology reuse, short-term device loan, device 

demonstrations, training, technical assistance, public awareness and information and assistance, and 

collaborations that improve access to and acquisition of assistive technology.

The second program - Protection and Advocacy for Assistive Technology (PAAT) supports 57 formula 

grants for protection and advocacy (P&A) systems, which provide information, advocacy, 

representation, training, technical assistance, and general guidance to increase access to and provision 

of assistive technology devices and services. The emphasis is on consumer advocacy and capacitybuilding through existing protection and advocacy agencies in the states. Existing P&A agencies are 

authorized under various federal statutes to provide legal representation and related advocacy services, 

and to investigate abuse and neglect of individuals with disabilities in various settings. The P&A system 

is the nation’s largest provider of legally-based advocacy services for persons with disabilities.
The National Disability Rights Network (NDRN) provides technical assistance to PAAT grantees. The 

Network supports its P&A agency members through the provision of training and technical assistance, 

legal support, and legislative advocacy.

Data on ACL Assistive Technology Programs

Federal law requires ACL’s State Grant for Assistive Technology Program grantees to report data on 

their activities and provide annual progress reports to ACL. To assist in data collection, ACL funds a

Center for AT Act Data Assistance (CATADA), which provides technical assistance and support to state 

programs as they report their data. The website provides annual data on grantees’ major program

activities for fiscal year 2008 through the present. The following data from states that reported them

indicate the efficacy of ACL’s Assistive Technology programs in Fiscal Year 2018.

• State Device Demonstration Programs provided about 38,709 demonstrations, which 72,559 

individuals attended. Ninety-nine percent were highly satisfied or satisfied with the 

demonstrations. 

• State Device Loan Programs loaned 49,721 devices and 99 percent of people were highly 

satisfied or satisfied with the device loans. 

• State Device Reutilization Programs exchanged 2,141 devices, realizing a savings of $1,411,324 

for consumers. The programs refurbished 68,532 devices and saved consumers $26,664,449. 

One hundred percent of participants were highly satisfied or satisfied with their exchanged or 

refurbished devices. The graph below shows cumulative consumer savings through device 

reutilization programs over an 11-year period from 2008-2018.

Source: CATADA data, 2008-2018 for all programs reporting data

• State Financing Programs (SFA) enabled 908 borrowers to obtain financial loans totaling 

$7,867,423 to buy 933 devices in FY 2018. In addition, 3,359 individuals acquired 4,859 devices 

valued at $3,722,993 from other state financing programs that directly provide AT using external 

funding sources. Finally, 2,190 recipients acquired 2,333 AT devices with a savings of $712,610 

from other state financing activities, such as cooperative buying programs.

• State Training and Information Activities involved training 107,658 people and providing 

information and assistance to 221,175 individuals. 

$14,000,000

$64,000,000

$114,000,000

$164,000,000

$214,000,000

$264,000,000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Year

Cumulative Consumer Savings on 

Exchanged + Refurbished Devices, 

2008-2018
These programs use federal funds to leverage other sources of funding to provide services that increase 

access to and acquisition of assistive technology. In FY 2018, the 56 AT programs received $28,165,621 

in federal funding and garnered additional funding of $21,106,708.

According to ACL’s FY2017 Report on Grantees, the PAAT Program:

• Served 1,808 individual clients in Fiscal Year 2017

o 42 percent of individual clients were living independently and another 33 percent were 

living in family homes

o 15 percent of individual clients were aged 65 and older

• Provided 9,911 information and referrals services 

• Provided case work services to individual clients who received 1,905 AT Services Devices; 25 

percent of cases related to mobility devices, and 12 percent to communication devices. 

Seventy-four percent of individual cases were resolved in client’s favor.

• Provided 1,224 training sessions attended by 42,133 individuals

Conclusion

About 32 percent of Medicare beneficiaries (KFF, 2019), or about 20 million people, have at least one 

functional limitation and assistive technology might be helpful to them. State assistive technology 

programs are already reaching 500,000 individuals with functional limitations. Partnerships with Centers 

for Independent Living, Area Agencies on Aging and other organizations in the Aging and Disability 

Network could extend the State Assistive Technology programs’ reach to additional older adults and 

individuals with disabilities. 

Medicare Advantage and Medicaid policies can also expand access to assistive technology. Medicare 

Advantage plans are able to offer targeted supplemental benefits to certain enrollees and in 2020, plans 

may offer a broader range of supplemental benefits, including health-related assistive technology. State 

Medicaid waivers are increasing access to assistive technology as a part of home and community-based 

services. As more states develop approaches to address the social determinants of health, assistive 

technology can address social and functional needs of individuals with disabilities and thus improve their 

ability to thrive in the community. 
References

ACL Report, P&A AT FY2017 Data, information downloaded June 26, 2019.

Center for Assistive Technology Assistance Act Data Assistance, information downloaded on May 1, 

2019.

KFF (Kaiser Family Foundation) Issue Brief: An Overview of Medicare, February, 2019. 

National Academies of Sciences, Engineering, and Medicine, 2017. The promise of assistive technology to 

enhance activity and work participation. National Academies Press.

Santana, Fábio Evangelista, Ivo Rodrigues Montanha Junior, Márcio Fontana Catapan, Vilson João 

Batista, and Fernando Antônio Forcellini. "Opportunities and challenges on assistive technology 

innovation: A systematic literature review on people with disabilities." International Journal of 

Knowledge Engineering and Management (IJKEM) 5, no. 11 (2016): 92-115.