Home Modifications: Essential but Difficult to Fund
Laura J. Waterland, Senior Staff Attorney Disabilities Law Program
Reprinted with permission from The AT Messenger, Winter 2004 (Vol. 12, No. 1), published by the Delaware Assistive Technology Initiative.
Some modifications have been made to this article to best reflect laws and resources available to Maryland residents.

It has been nearly four years since the Supreme Court affirmed in Olmstead that states have an obligation under the Americans with Disabilities Act to provide services for people with disabilities in the least restrictive environment. Many states have at least one of their feet on the community integration bandwagon, although many gaps in the service continuum remain.

States have conducted assessments of their service systems to identify barriers to community living for people with disabilities. One barrier that has been repeatedly identified, but that no one seems to want to "own," is the lack of accessible, affordable housing. Finding an apartment or house in which a person with disabilities can actually get in the door, much less function inside, remains a major hurdle to community integration. This lack of housing makes it difficult for people to move from institutions when they are ready, and makes it hard for people in the community to stay there when they find that they need accessible housing.

Yet, in many cases, relatively minor modifications can make an "inaccessible" house or apartment livable, if not "accessible." Home modifications are alterations that make a living space more livable. They may include minor items, such as shower grab bars, handrails, and lever handles; more expensive alterations may involve widening doorways, installing ramps, or removing high pile carpeting so that someone in a wheelchair can use the unit. Some individuals may need specially-designed appliances such as stoves and refrigerators, environmental control systems, or accessible shower units.

Many modifications are inexpensive. For example, lowering a peep hole on a door for a person using a wheelchair can cost around $50. Installing remote control devices on light switches costs as little as $100. Grab bars cost approximately $25; add the labor and the cost is still under $100. A portable ramp costs around $300.

With these modifications, a fundamental barrier to community living is removed. The problem, as always, is money. Who pays for these modifications? Private funds, of course, are always an option, but what if the person has limited resources?

Make the landlord modify the unit (or at least let you do it)
Unfortunately, in most rental situations, a landlord cannot be made to modify a unit(1). Generally, if a unit in a multi-family dwelling has been built or substantially renovated since 1991, and if it is a first floor unit or on an upper floor served by an elevator, the unit should contain features of accessible design mandated by the Fair Housing Amendments Act and Section 504 of the Rehabilitation Act. Local building codes now contain similar requirements. If you find yourself in such a unit and it has not been properly designed, you would be within your rights to ask the owner or landlord to make accessibility modifications. If the request is refused, your only real recourse would be to sue, and that can take time that you don't have.

State and federal fair housing laws do require landlords to allow you to make modifications to make a unit accessible at your expense. The landlord can, within reason, express an opinion on the type of modifications to be made, and can require you to return the unit to its original state at your expense at the end of the tenancy. Refusal by a landlord to allow a tenant to make modifications is actionable discriminatory conduct.

If you live in housing funded by the federal government (2), in some circumstances you can ask the housing authority or project owner to pay for needed modifications as a reasonable accommodation under Section 504 of the Rehabilitation Act. The housing authority or project owner, as a "federally assisted housing provider," is required to bear costs, which do not amount to an undue financial and administrative burden.

Ask Maryland Medicaid to pay for modifications
Traditional Medicaid, and many private insurers, won't pay for home modifications because they are perceived as being a "non-medical" service. Most states have taken advantage of the Medicaid Home and Community Based Services Waiver (HCBW) Program authorized by Congress (3). Waiver programs allow states to offer traditionally non-medical services (i.e., home or environmental modifications, case management, homemaker services, transportation, habilitation, and respite care) to people in the community who would otherwise qualify for institutional care, in exchange for the federal government suspending some of its requirements for Medicaid programs, such as statewideness and comparability. Many individuals with disabilities who are transitioning out of nursing homes use the home and community based waivers to facilitate community placement. Without the waiver, living in the community would be impossible for many.

"Environmental accessibility adaptations" is actually a "tick off" item on the standard HCBW application form, and is clearly contemplated by Centers for Medicare and Medicaid (CMS) as an appropriate service in waiver programs. According to the "Overview of State Home and Community Based Services Waivers" on the CMS website (www.cms.gov/medicaid/1915c/agedphysdis.pdf), the vast majority of states that participate in the waiver provide this benefit. Maryland provides a home modification benefit as part of their HCBW programs. Maryland provides up to $5,500 per participant annually for environmental accessibility adaptations and assistive technology. Adaptations include lifts, ramps, visual alarms, widening of doors, grab bars, and many others.

Obtain a grant from another state agency or non-profit agency
The Maryland Rural Development Administration has grants of up to $7500 for rural homeowners who are 62 or older and have very low incomes. Grants can be used for home modifications, but grants are limited to rural areas only. Contact MD RDA at (302) 697-4303.

Grants are provided in some cases by the following sources: the Maryland Division of Rehabilitation Services, the Maryland Development Disabilities Administration, the Jill Fox Memorial Fund, and the United Cerebral Palsy Equipment Fund. Grants from government agencies involve often-lengthy application processes and waiting periods, restrictions on eligibility and other limitations. Private foundations like the Jill Fox Memorial Fund and the United Cerebral Palsy Equipment Fund have eligibility restrictions, are usually need-based grants, and usually only cover a fraction of the full cost. Discounted or free labor and materials are available through several sources. A few charitable organizations including Christmas in April, Hearts and Hands, the Home Ramp project, the Remodelers Council and the Professional Remodelers Organization- do home repairs and modifications for free or at very low costs for people with low incomes. These projects select communities to serve each year, and do the work only at certain times, usually once a year. For a listing and phone numbers for any of these agencies or organizations, please contact MD TAP at 1-800-832-4827.

Centers for Independent Living can help you get the resources you need for home modifications. There are four centers in Maryland: MCIL- Resources for Independent Living serves Baltimore City and Baltimore, Harford, Carroll, Howard, and Anne Arundel Counties; Independence Now serves Prince George's and Montgomery Counties; Potomac Highlands Center for Independent Living serves Garrett, Allegany, Washington and Fredrick Counties; and Eastern Shore Center for Independent Living serves the nine Eastern Shore counties.
For phone numbers for any of the CILS in Maryland, please contact MD TAP at 1-800-832-4827.

Delaware-Maryland Paralyzed Veterans (PVA) runs a home modification program. The PVA has an application process and frequently runs out of funds. PVA strongly prefers homeowners for its program and prioritizes modifications for children with disabilities. Contact PVA at (800) 786-2039.

Note: The Maryland Technology Assistance Program maintains a Home Modificatiosn Resource Guide that lists state agencies, federal programs, organizations, businesses and contractors that provide funding and services for home modifications. This resource can be found online at www.mdtap.org or can be obtained in hard copy by calling MD TAP at 1-800-832-4827 or emailing us at mdtap@mdtap.org.

Borrow the money
Several government agencies and local governments operate low interest loan programs that make funds available for renovations and home modifications. Federally, these include the Veterans Administration's Specially Adapted Housing Program (www.homeloans.va.gov/sah.htm) and the Home Repair and Loan Program of USDA Rural Development (www.rurdev.usda.gov/de/housing.htm). Contact the USDA Rural Development at (302) 697-4353.

The Maryland Department of Housing and Community Development administers federal loans, of the Special Loans Program and the Maryland Housing Rehabilitation Program, to local jurisdictions throughout the state. The Special Loans Program provides low interest loans and deferred loans to low income Marylanders who own their homes and are elderly or disabled. The Housing Rehabilitation Program provides loans to disabled homeowners for the sole purpose of making home modifications for accessibility. Visit www.dhcd.state.md.us or call 1-800-7781 or (410) 514-7530 for more information.

Tax Benefits

Federal
You can deduct the cost of home modifications on your federal income tax if they are medically necessary. You need a written recommendation from doctor to prove the expense is needed due to a disability or medical condition. You also need an appraisal from a competent real estate appraiser to prove how much value (if any) a home modification adds to you property. You can also claim a deduction for operating and maintaining the modifications (e.g., a wheelchair lift, stair glide, ramp), whether or not the modification qualified as a medical expense. If a medically necessary home modification does not increase the value of you property, you can deduct the full cost. If it adds value to your property, you can deduct the differences between the cost of the modifications and the value it adds to the property. For example, if a modification costs $3,000, but adds $1,000 of value to you property, you can deduct $2,000.

State
Maryland offers a tax credit for expenses- including home modifications- related to adopting a child with special needs.

This patchwork of limited resources for home modifications is both inefficient and insufficient. Providing an opportunity for livable, affordable shelter for people with disabilities is a fundamental element of successful Olmstead compliance and the development of viable community living options. Maryland residents would benefit greatly from a streamlined housing policy and resource program that would provide not only information to certain loans or grants available, but would help (through support, information, and resources) Maryland residents with disabilities acquire, maintain, and develop accessible housing in order to maintain independent lifestyles.

Footnotes

1. If you own your home, you may still need to get approval from a homeowners' association and permits from local authorities, depending on the work being done. State and federal fair housing laws require homeowners and condominium associations to reasonably accommodate owners with disabilities, and to waive unreasonable restrictions that prevent an owner from making necessary changes to their properties.
   
2. This would include public housing, federal low income tax credit housing, and project-based assistance, but not landlords participating in the Section 8 Voucher Program.
   
3. One advantage of using Medicaid to fund home modifications is that Medicaid is a partially federally-funded program, with the state only paying 50 percent of the cost.