Durable Medical Equipment: How to Get Wheelchairs, AAC Devices, and Adaptive Equipment Covered

Your child needs a power wheelchair. Or an AAC communication device. Or adaptive seating, a standing frame, a hearing aid, or a specialized stroller. The equipment exists. The need is clear. And then the process of actually getting it funded begins — and it feels like hitting a wall from every direction.

Insurance denials, school district disputes, Medicaid authorization battles, and funding gaps are all common. But the families who get the equipment their children need are the ones who understand the systems, document thoroughly, and know how to appeal when the first answer is no.

Here is how to do it.

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What Counts as Durable Medical Equipment

Durable Medical Equipment (DME) is a category of medical equipment that is designed for repeated use, primarily serves a medical purpose, and is appropriate for use in the home. For children with disabilities, DME commonly includes:

• Manual and power wheelchairs and scooters
• Adaptive strollers and positioning equipment
• Standing frames and gait trainers
• Augmentative and alternative communication (AAC) devices
• Hearing aids and FM systems
• Orthotics and prosthetics (braces, splints, custom footwear)
• Hospital beds, patient lifts, and transfer equipment
• Continuous glucose monitors and other medical monitoring devices
• Nebulizers, oxygen equipment, and ventilators

The funding source for DME depends on your child's age, insurance coverage, school enrollment, and the primary purpose of the equipment.

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The Three Main Funding Sources

1. Private Health Insurance

Private insurance is typically the first funding source pursued for DME. Under most plans, DME is a covered benefit — but coverage is subject to prior authorization, medical necessity documentation, and often significant out-of-pocket costs.

The process generally works like this:

• Your child's physician or therapist submits a Letter of Medical Necessity (LMN)
• The insurer reviews the request and issues a prior authorization (or denial)
• If approved, you work with a DME supplier in the insurance network
• If denied, you have the right to appeal

Denials are common — and many are overturned on appeal. Do not accept a first denial as final.

2. Medicaid

Medicaid covers DME for eligible children, and in many cases covers equipment that private insurance will not — including power wheelchairs, complex communication devices, and custom orthotics. Medicaid's DME coverage is generally broader than private insurance.

If your child is enrolled in Medicaid (either as a primary payer or secondary payer), submit DME requests through Medicaid as well as private insurance. Medicaid can cover costs that private insurance denies or only partially covers.

Medicaid Home and Community-Based Services (HCBS) waivers may also fund certain assistive technology and adaptive equipment, particularly items that support independence and community participation. Ask your child's service coordinator what equipment may be fundable through your state's waiver program.

3. The School District (for educationally necessary equipment)

Under IDEA, if a piece of assistive technology or adaptive equipment is necessary for your child to access their education — to participate in the curriculum, communicate, access the physical environment, or benefit from their IEP services — the school district is required to provide it at no cost.

This applies to:

• AAC devices used during the school day
• Adapted keyboards, switches, and computer access technology
• Positioning equipment needed for classroom access
• FM systems and amplification devices for students with hearing loss
• Adaptive physical education equipment

The key word is "educationally necessary." The school's obligation is to provide equipment that allows your child to access their education — not necessarily the same equipment they use at home for medical or daily living purposes.

If assistive technology has not been formally evaluated and addressed in your child's IEP, you can request an assistive technology evaluation in writing. The district must conduct it at no cost and must consider AT for every child with an IEP.

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The Letter of Medical Necessity: Your Most Important Document

For insurance and Medicaid funding, the Letter of Medical Necessity (LMN) is the foundation of every successful DME request. A strong LMN from your child's physician, physiatrist, or therapist makes the difference between approval and denial.

A strong LMN includes:

• Your child's diagnosis and how it functionally limits them
• A description of the specific equipment being requested and why it is medically necessary
• Why less expensive alternatives are not appropriate or sufficient
• How the equipment will be used and what functional outcomes it will support
• Why the equipment is medically necessary (not just convenient or preferred)
• The prescribing physician's credentials and direct experience with your child

Work closely with the prescribing provider to make sure the LMN is detailed and specific. Generic letters that could apply to any patient with the same diagnosis are more likely to be denied. The letter should describe your child specifically.

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When Insurance Denies the DME Request

Insurance denials for DME are extremely common — particularly for power wheelchairs, AAC devices, and complex adaptive equipment. Here is how to fight back.

Step 1: Read the denial letter carefully. The denial will specify the reason — not medically necessary, experimental, not covered under the plan, prior authorization not obtained, etc. Your appeal must directly address the stated reason.

Step 2: Request the internal review criteria. Ask the insurer for the specific clinical criteria they used to make the denial decision. You have the right to this information. Review it against your child's LMN and identify the gaps.

Step 3: Submit a strong internal appeal. Your appeal should include:

• An updated or expanded LMN that directly addresses the denial reason
• Clinical evidence supporting the equipment (published guidelines, research studies)
• Functional evaluations from therapists documenting the need
• A direct rebuttal of the denial rationale

Step 4: Request an external review. If the internal appeal is denied, request an independent external review. External reviewers overturn DME denials at a meaningful rate, particularly for mobility equipment and communication devices. The insurer must accept the external reviewer's decision.

Step 5: File a complaint with your state insurance commissioner. If the insurer is applying the wrong criteria, missing deadlines, or denying without proper basis, file a complaint with your state's insurance commissioner. This is free and creates regulatory pressure.

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AAC Devices: Special Considerations

Augmentative and alternative communication (AAC) devices — speech-generating devices, communication apps on dedicated tablets — are among the most frequently denied and most successfully appealed DME requests.

Key points for AAC funding:

Insurance must cover AAC devices as DME. Most private insurance plans and Medicaid cover speech-generating devices as DME when they are medically necessary for a person who cannot rely on natural speech.

The evaluation matters. An AAC evaluation by a licensed speech-language pathologist who specializes in AAC is essential. The evaluation documents your child's communication profile, why natural speech is not sufficient, and why the specific device is the appropriate match.

"Dedicated device" requirements. Some insurance plans require that the device be a dedicated communication device — not a general-purpose tablet that also plays games. Be aware of your plan's requirements and work with the AAC evaluator to recommend the appropriate device type.

The school district must provide AAC for educational access. If your child uses AAC to communicate and participate in their education, the school district must provide appropriate AAC through the IEP. This is separate from the medical/insurance funding for a home device.

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Funding Gaps: When Insurance and Medicaid Are Not Enough

Even with insurance and Medicaid, families often face funding gaps — deductibles, co-pays, items that fall outside coverage, or equipment the insurer will fund but at a lower level than what is clinically appropriate.

Options for closing the gap:

• Nonprofit equipment lending programs — organizations like the Christopher and Dana Reeve Foundation, United Cerebral Palsy, and many regional disability organizations provide equipment loans or grants
• Diagnosis-specific foundations — many foundations (Autism Speaks, Cerebral Palsy Foundation, etc.) offer equipment assistance grants
• State assistive technology programs — every state has an assistive technology program funded under the AT Act that provides device demonstration, lending, and in some cases funding assistance. Find yours at ataporg.org
• Medicaid waivers — if your child is enrolled in a waiver program, adaptive equipment may be fundable as a waiver service
• Crowdfunding — families successfully fund adaptive equipment through platforms like GoFundMe, particularly for high-cost items like power wheelchairs

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Document and Persist

Getting DME funded is rarely a one-step process. It requires thorough documentation, strong clinical letters, persistence through the appeal process, and knowledge of multiple funding sources. The families who get the equipment their children need are almost always the ones who kept pushing after the first denial.

The Insurance Appeal Letter Templates include professionally written letters for appealing DME denials — including wheelchairs, AAC devices, orthotics, and adaptive equipment — ready to customize and submit.

The Government Benefits Checklist helps you identify every Medicaid, waiver, and state program that may fund equipment and assistive technology for your child.

The IEP Template & Guide Pack includes tools for requesting assistive technology evaluations through the school district and ensuring AT is addressed in your child's IEP.

Your child needs this equipment. The funding is out there. Keep pushing.

See all resources at Special Clarity →

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The information in this post is for general educational purposes only and does not constitute legal or financial advice. DME coverage, Medicaid policies, and school district obligations vary by state and plan. If you need help navigating a denial, contact your state's Parent Training and Information Center (PTI) or a patient advocate.