Equipment and home modifications

The short answer

Most equipment is prescribed, not bought. A therapist assesses, a doctor prescribes, and insurance or Medicaid pays, usually after a letter of medical necessity.

The two things that speed everything up are asking early and writing the right letter. Waiting lists and approval cycles mean a piece of equipment ordered today may arrive in months.

The numbers, up front

How funding usually works: A therapist assesses, a physician prescribes, and the funder requires a letter of medical necessity explaining why this specific item is needed ¹
Medicaid waivers: Home and community based services waivers can cover equipment, home modifications and personal care, and in many states qualify a child on their own income rather than the family's ¹
Waiting lists are real: Many state waiver programs operate waiting lists, so the date you apply can matter more than whether you qualify today ²
School equipment is separate: Equipment a child needs to access their education is provided by the school district under the education plan, which is a different pot from medical equipment ³
Powered mobility early: Evidence supports offering powered mobility early rather than as a last resort, because independent movement supports development ⁴
EPSDT for children on Medicaid: Medicaid's early and periodic screening, diagnostic and treatment benefit requires coverage of medically necessary services for children, which is broader than adult Medicaid coverage ⁵

What equipment exists, roughly by age

Infant and toddler

Supportive seating for feeding and play.
Ankle-foot orthoses and other braces.
A stander, to get a child upright.
A supportive bath seat.
A car seat that provides more support than a standard one.
A feeding pump and supplies, if there is a G-tube.
A gait trainer or walker.

Preschool and school age

A wheelchair, manual or powered.
A powered mobility device, which can be trialled earlier than families expect. ⁴
Classroom seating.
A communication device. ⁴
A toileting or shower chair.
A hoist, for transfers, once lifting becomes unsafe.
A therapy tricycle or adapted bike.

Later

A larger hoist and ceiling track.
A hospital-style bed.
Vehicle adaptation.
Environmental controls.

Ask your therapist to sketch out what is likely over the next two years. Planning ahead beats reacting.

How to get it funded

The sequence

A therapist assesses and recommends a specific item.
A supplier quotes and often does a trial fitting.
A doctor prescribes.
A letter of medical necessity is written, usually by the therapist.
The funder reviews and approves, denies, or asks for more.

The letter is the whole thing

A letter that says "patient requires a wheelchair" gets denied. A letter that works says what the child can and cannot do, what happens without the item, why a cheaper alternative will not work, and what specific features are needed and why. ¹

Ask to read the letter before it is submitted. Ask for anything vague to be made specific.

If it is denied

Denials are common and appeals often succeed. Ask for the denial reason in writing. Ask the therapist to address that specific reason in a revised letter. Use the funder's appeal process, and note the deadline.

For a child on Medicaid, the early and periodic screening, diagnostic and treatment benefit requires coverage of medically necessary services for children, and it is broader than adult coverage. It is worth citing by name in an appeal. ⁵

Your state parent center and Family-to-Family Health Information Center help with this for free. ⁶ ⁷

Home modifications

The changes that matter most are usually about getting in, getting to a bathroom, and getting a child in and out of bed.

Common changes

A ramp or a level entrance.
Widening doorways.
A bathroom that can be rolled into, with a wet room floor.
A ceiling track hoist, which prevents years of back injury.
A downstairs bedroom, or a through-floor lift.
Flooring that a wheelchair can move on.

Funding

Medicaid waivers cover home modifications in many states, usually with a cap. ¹ ²
State programs for children with special health care needs. ⁸
Charities and local organizations, which fund specific projects.
Where a legal case is resolved, home modification is normally part of a life care plan.

Practical advice from families

Think two sizes ahead. A child grows. A bathroom built for a 4 year old will not work at 12.

Get the hoist before your back goes. Lifting injuries in parents are common and preventable.

Do the bathroom first if you have to choose. It is the change families consistently say made the biggest difference.

Equipment at school

Equipment a child needs to access their education is the school district's responsibility under the education plan, and it is a different pot from medical equipment. ³

That can include classroom seating, a standing frame at school, a communication device for school use, adapted technology and access equipment.

Write it into the IEP. If it is not in the plan, it is not owed.

Ask who is responsible for maintenance and charging. A communication device that lives in a bag, uncharged, is not being provided.

Ask about transport, which is a related service and can be part of the plan.

See IEP and 504 plans.

Things nobody tells you

Equipment takes months. Assessment, quote, prescription, letter, approval, order, delivery, fitting. Start earlier than feels necessary.

Trial before you commit. A chair that looks right on paper may not suit your home, your car or your child.

Measure your doorways before choosing a wheelchair.

Ask about a second set for school, so equipment is not being moved daily.

Keep the paperwork. Warranty, serial number, supplier contact, and the date supplied. You will need it for repairs and for the next funding round.

Ask about repair turnaround before you choose a supplier. A wheelchair out of service for six weeks is a real problem.

Second-hand and loan schemes exist, through charities and some early intervention programs, and are worth asking about for items a child will outgrow quickly.

Questions parents ask

Insurance denied the wheelchair. Is that the end?

No. Denials are common and appeals often succeed. Get the denial reason in writing, ask the therapist to address that reason specifically in a revised letter of medical necessity, and use the appeal process. For a child on Medicaid, the early and periodic screening, diagnostic and treatment benefit requires coverage of medically necessary services for children and is worth citing. ⁵

When should we consider a powered wheelchair?

Earlier than most families expect. Evidence supports offering powered mobility early rather than as a last resort, because independent movement supports development and learning. ⁴ Ask your therapy team at what age a trial is possible.

Does using a wheelchair mean giving up on walking?

No, and this is one of the most common worries. Many children walk at home and use wheels for distance, because walking takes far more energy for them than for other children. Using wheels for distance preserves energy for everything else. It is a tool, not a verdict.

Who pays for home modifications?

Most often a Medicaid waiver, where your state has one that covers it, usually up to a cap. ¹ ² State programs and charities also fund specific projects, and where a legal case is resolved, modifications are normally part of a life care plan. Apply for the waiver early because of waiting lists.

Words on this page, in plain English

AFO: Ankle-foot orthosis. A brace that holds the ankle and foot in position for standing and walking.
G-tube: Gastrostomy tube. A feeding tube placed through the belly wall into the stomach.
Medicaid waiver: A state program that lets a child get Medicaid based on their own needs and income rather than the family's. Many have waiting lists.
life care plan: A detailed written estimate of everything a person will need over their lifetime and what it will cost.
IEP: Individualized Education Program. The written special education plan for a school-age child, with goals, services, and minutes.

See the full glossary and records decoder

Where these facts come from

Centers for Medicare and Medicaid Services, Medicaid.gov. Home and Community Based Services. 2025. www.medicaid.gov/medicaid/home-community-based-services/inde. Link checked September 3, 2026.
Centers for Medicare and Medicaid Services, Medicaid.gov. Section 1915(c) Home and Community-Based Waivers. 2025. www.medicaid.gov/medicaid/home-community-based-services/auth. Link checked September 3, 2026.
U.S. Government Publishing Office, Electronic Code of Federal Regulations. 34 CFR Part 300, Assistance to States for the Education of Children with Disabilities. 2025. www.ecfr.gov/current/title-34/subtitle-B/chapter-III/part-30. Link checked September 3, 2026.
Current Neurology and Neuroscience Reports. State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. 2020. pubmed.ncbi.nlm.nih.gov/32086598/. Link checked September 3, 2026.
Centers for Medicare and Medicaid Services, Medicaid.gov. Early and Periodic Screening, Diagnostic, and Treatment (EPSDT). 2025. www.medicaid.gov/medicaid/benefits/early-and-periodic-screen. Link checked September 3, 2026.
Center for Parent Information and Resources. Find Your Parent Center. 2025. www.parentcenterhub.org/find-your-center/. Link checked September 3, 2026.
Family Voices. Family-to-Family Health Information Centers. 2025. familyvoices.org/affiliate-organizations/. Link checked September 3, 2026.
Health Resources and Services Administration. Title V Maternal and Child Health Services Block Grant. 2025. mchb.hrsa.gov/programs-impact/title-v-maternal-child-health-. Link checked September 3, 2026.