The whole shebang Dori. My federal budget and contract health does not allow my tribe to pay for what they refer to as “durable medical supplies”. My transportation budget is running low and I don’t know how to get my people back and forth to dialysis. I guess I’m referring to set-up assistance and financial assistance as well. Does Medicare, medicaid or any private insurance cover these things?? Or any other programs??
Thanks for your timely response. Tina
Hi Tina,
A couple of things. First of all, this site is for home dialysis, so we have to strictly limit time that we spend dealing with problems related to in-center treatment, like transportation. My understanding–and Beth may chime in on this–is that Medicare does not pay for transportation. Private insurance policies may, but each is different. One of the advantages of home dialysis is lower cost and much less transportation needed, because people only have to go to the dialysis center once a month for clinic visits, vs. three times per week. As far as “durable medical supplies,” if your folks do home dialysis, it is still Medicare that is responsible for paying for the equipment and supplies. So I think you might come out ahead–and the patients would feel better.
Second, you can reply to the same thread you started–just hit reply. This is easier for others to follow than starting a new thread for each message. 
Medicare pays for ambulance transportation if there is a medical need for that level of transportation for Medicare beneficiaries. Here’s the webpage on the CMS website about ambulance coverage:
http://www.cms.hhs.gov/AmbulanceFeeSchedule/01_overview.asp
Medicaid generally covers transportation (commercial vehicles like cabs, wheelchair vans, and mileage reimbursement in some states) for those that are eligible for Medicaid. Check with your state Medicaid office about what your state covers.
Insurance companies may only cover ambulance transportation too, but patients need to read their policies to learn about their coverage.
So far as payment for dialysis, very briefly, if Medicare is the primary payer, Medicare reimburses for dialysis treatments done in-center and at home at 80% of the allowed rate. The rate Medicare pays includes machine and supplies for both PD and home hemo. If starts dialysis with an employer group health plan, during the first 30 months of Medicare eligibility the employer plan pays first and Medicare can pay second if the person has Medicare. You can read about Medicare coverage for home dialysis under Professional Resources on the Home Dialysis Central webpage. Medicare publishes a booklet for patients about coverage for dialysis and transplant.
http://www.medicare.gov/Publications/Pubs/pdf/10128.pdf
I wish I was more knowledgeable about the Indian Health Service. I have heard that funding of healthcare for Native Americans is an ongoing problem. I searched for data and found that in 2003, the most recent reported data, 1016 Native Americans were on hemodialysis and 63 on peritoneal dialysis.
http://www.usrds.org
With the rate of growth of diabetes (#1 cause of kidney failure) and Native Americans being at high risk for diabetes, I suspect these numbers will grow. The more patients that can do home dialysis, the better it will be for keeping costs down since home patients do not require as many staff to support them or require large buildings in which to treat them.