In Alberta alone, an estimated 369,190 individuals live with a disability. These range from mobility concerns to psychological disabilities, each having a serious impact on the lives of the individual. One major concern is the expense. From prosthetics to walkers to specialized equipment, many disabilities come with specific and expensive requirements. However, since the disabled population in Alberta represents 12.5 percent, supply and demand causes the price of these goods to skyrocket.
Additionally, many serious ailments result in the inability to work, putting these essentials even further out of reach. For this reason, the government funds programs like Alberta Aids to Daily Living (AADL). However, many who are actually eligible for this program remain unaware of it, despite the assistance it can supply. By understanding what AADL is and how it works, you can gain the most advantage.
What Is The Alberta Aids To Daily Living (AADL) Program?
The premise of the AADL program is to enable those living with disabilities to remain independent. To do so, it offers funding for essential equipment and supplies to assist in mobility within the community. Qualifying parties must complete a clinical assessment through a health care worker. This will determine the type of supplies you can access through the program.
Keep in mind that the program is done on a cost-share basis, meaning the individual must pay for 25 percent of the equipment cost. Similar to an insurance deductible, this caps out on a household basis of $500 per year. Those who are on income assistance are not required to pay for the cost-share program.
A major benefit of this service is that it is available to those of any income threshold. Regardless of salary, a major overhaul of accessibility services can be an unmanageable expense for any household. This ensures that, per year, the amount caps out at $500, regardless of the level of need for assistance.
However, because of caveats in the eligibility for the program, it means that many individuals remain excluded from its services. To best understand where to turn for assistance, learning the specifics of the AADL coverage is important.
What Is Covered Under The Alberta Aids to Daily Living (AADL) Program?
Mobility equipment is far-reaching, meaning the supplies covered by this plan are fairly far-reaching as well. Accessibility and mobility aren’t exclusive to walking gear and wheelchairs, it extends to hearing aids, burn supplies, prosthetics, injection supplies, customized footwear, and more. The list is extensive, ranging from respiratory gear to specialized pediatric supplies.
Health care needs are assessed on an individual basis and the program covers the basic equipment. In essence, if you would benefit from a wheelchair, but your clinical assessment says a walker would suffice, the plan will only cover the walker.
In some cases, equipment will be second-hand, including wheelchairs, respiratory devices, and patient lifters. Certain items, such as breast prostheses, orthotic braces, prosthetic devices, and ocular prostheses, are available at no cost to all seniors.
What Is Not Covered Under The Alberta Aids To Daily Living (AADL) Program?
There are several serious issues that do not receive coverage under the AADL regulations. This extends to foot orthotics, eyeglasses, prescription medication, dental care, and dentures. However, the site notes that seniors are likely eligible for financial assistance through another program.
How Does The Alberta Aids To Daily Living Program Work?
The AADL program is structured on a cost-share arrangement. It operates in a similar way as an insurance program in the private sector. Instead of clients paying regular premiums, the service is tax-dollar funded and structured so that those who need care, yet don’t have similar insurance, can access it.
How Cost-Share Works
Consider the cost-share as a deductible. The client must pay 25 percent of the cost of the supplies, up to a yearly maximum of $500 per year. This is a household cap, in the event that multiple individuals rely on this type of disability coverage. The fiscal limit updates annually, on July 1. It’s worth noting that clients who wish to upgrade their equipment, must pay the extra cost.
There are exemptions to the cost-share arrangement for low-income Albertans. In order to apply, you must complete and submit the exemption form. Additional accommodations extend to seniors requiring hearing aids. Further, if your financial situation has shifted resulting from an extreme, health-care-related expense, you can apply for a temporary cost-share exemption.
Those who are on any of the following: Alberta Widows’ Pension, AISH, or Alberta Works Health Benefits, must contact AADL directly due to an overlap in the benefits offered by each program.
Appealing Cost Share
If you disagree with the cost-sharing exemption verdict, because it will result in serious financial hardship (ex: missing a utility or rent payment; being unable to afford necessities), you can appeal by submitting a form directly to the AADL.
The AADL offers a limited number of each benefit available per year, measured on a quantity and frequency review process. This is overseen by the Quantity and Frequency Review Committee when your authorized dealer submits a request. The final appeal goes through the AADL director personally, which gives the individual an opportunity to self-advocate.
Instead of a lottery system, the Alberta government uses a first-come, first-served arrangement. That means the sooner you submit your appeal form, the better. There is a limited quantity of the service available, and the program uses years of accrued data to determine the median expectation for material use over time.
Take hearing aids as an example. If the average household goes through one every year, yet you are going through them quarterly, you could be denied coverage. It is to ensure that only those with extenuating circumstances, get the extra funding.
Who Is Eligible For The Alberta Aids To Daily Living (AADL) Program?
Eligibility for the AADL program requires the individual with a disability to be an Albertan resident with a current Alberta Health Care card. To qualify, the person must also have a long-term disability or chronic illness, defined as an issue extending beyond six months. To this accord, the underwriting also includes coverage for those with terminal illnesses, in the event that the prognosis precedes that duration.
In effect, the eligibility criteria are fairly broad, assessed on an individual basis through a health care professional. However, there are barriers to the program in many situations, leaving many with chronic illnesses and long-term disabilities without necessary care.
Who Is Not Eligible For The Alberta Aids To Daily Living (AADL) Program?
Any individual who is otherwise eligible for the same or similar benefits is ineligible for the program. First, those with private insurance cannot access this service. However, the exceptions are further reaching.
Restrictions extend to those dealing with Veterans Affairs, and anyone claiming through the Workers’ Compensation Board. However, according to a CBC report, there are many “bureaucratic barriers” in the access to care within the system for veterans, a nationally regulated program. A separate report by CBC notes that the changes which took effect on April 1, 2021, within the Workers Compensation Board suggest a “rollback for injured workers”.
Others who are excluded from the AADL program include any individual accessing benefits through the Non-Insured Health Benefits (NIHB) Directorate, a program established for First Nations and Inuit individuals and families. These restrictions extend to those who technically have treaty status, whether on or off-reserve.
However, since the first source is the NIHB, with the AADL as a backup, there is plenty of opportunity for bureaucratic delay. Ultimately this results in those requiring the mobility equipment being unable to access it in a timely manner, if at all. This is highlighted in the logistical issues of the healthcare supply chain as it relates to Alberta First Nations during the COVID vaccine rollout.
How To Apply For AADL Benefits
In order to give yourself the best opportunity for approval, applying for AADL should be done exactly by the book. Ensure that you have proof that you lack other coverage in writing, from an official source. Equipped with this information, you can move on to the application process.
First, get assessed by a healthcare professional. This will determine whether you are eligible under the terms of the program. It will also dictate what basic medical needs you have which should be covered. Keep in mind that this program offers no refund for supplies bought before said assessment. You must have specific authorization to access the program. For those who require any of the following: orthotics, oxygen, prosthetics, or hearing aids, a specialty vendor is required.
In order to finalize the process, you can contact the AADL program directly, speak to hospital personnel, or go through a health care center. Since mobility coverage is different for each individual, the arrangements differ on an individual basis. The aim is accessibility. If you are getting certain items, you must go through approved vendors. The professional authorizing your account will supply you with three companies in your area. You may also use the approved vendor list.
If the equipment is larger (like a hospital bed or wheelchair), the AADL purchases it directly and delivers it to you. The most important aspect of this program is to get explicit, written authorization of your purchase, from the AADL. Ensure that you stick exclusively to the list of vendors as well.
Can I choose an upgraded product with AADL?
Can I get my equipment or supplies from any vendor under the Alberta Aids to Daily Living (AADL) Program?
How do I gain access to my AADL benefits?
The first step to getting benefits through the AADL is the clinical assessment. You must get this completed by an approved Specialty Assessor or AADL Authorizer. You can contact Alberta Health Services directly using 1-866-408-LINK (5465). Alternatively, go directly through the Alberta Aids to Daily Living Contact List. Write down who you speak to and take notes on your conversations. The professionals working through the program will direct you through the proper channels.
Final Notes On The AADL
Programs like AADL, when accessible and understandable to those who need them, are a terrific facet of a socialized health care system. However, the communications process through the AADL, the amount of bureaucracy attached to the assessment program, and the limits to the approved vendor list, are features that inherently cause delays.
Though low-income individuals are eligible to avoid cost-share, those with Treaty rights, those dealing with WCB, and those with Veteran’s Affairs are boxed out of the process. While many issues are rectified over time, the system, as it is, addresses serious concerns at a delayed pace. While it can take significant time and effort to access the benefits themselves, the program does facilitate the access of medical equipment to Albertans.
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