Forward movement in orthotic and prosthetic insurance coverage.
This past year the movement So Every BODY Can Move Minnesota made a huge step in the right direction by pushing and successfully passing the HF-3339/SF-3351 bill through Minnesota legislation. This team has relentlessly advocated for change regarding the current discriminatory healthcare treatment of people with disabilities. So Every BODY Can Move is dedicated to creating an equitable world where every person – no matter their disability – has access to mobility and their independence” (SEBCM, 2024). Prior to the passing of this bill, insurance would not cover a prosthetic or orthotic device for physical activities or a device for showering/bathing. A second device is deemed as “not medically necessary”. Individuals would get one device covered and unfortunately, just one prosthetic or orthotic product is not adequate for everyday life, physical activities AND basic hygiene. This discriminatory coverage results in individuals being unable to participate in physical activities that can lead to other health concerns due to a more sedentary lifestyle. People with limb loss or other disabilities are at a disadvantage when it comes to movement. They are also at a significant risk for falls when simply completing an everyday human hygiene need. Every human should have the right to shower or bathe independently without risking a significant fall due to limited access to necessary devices.
Impacts to the disabled community.
The lack of coverage for physical activity specific orthotic and prosthetic devices has greatly impacted the disabled community. Physical activity carries so many benefits throughout a lifetime including increasing strength and balance, improving mental health and reducing the risk of disease and cancer for everybody. “Children with disabilities are 4.5 times less likely to engage in physical activity compared to their peers” (ACSM, 2021) and “50% of adults with disabilities get absolutely no aerobic physical activity” (CDC, 2014). This puts the disabled community at a higher risk for other diseases and cancers increasing their healthcare costs annually simply due to not having access to devices that would allow for them to participate in activities. “Annual health care costs of obesity that are related to disability are estimated at approximately $44 billion” (CDC, 2024). So Every BODY Can Move took this information and demanded change and fair access to care that would otherwise be covered for a nondisabled person seeking medical intervention.
Out of pocket costs for such devices are extremely expensive and many people/families cannot afford to pay for devices not covered by their insurance. Movement and caring for basic hygiene needs is a right, not a privilege. Individuals and families should not be facing significant financial burdens in order to bathe, swim, and be healthy by participating in physical activities. It was time for change and this incredible group made it happen!
What does the passing of this bill mean?
This bill improves access to orthotic and prosthetic care for people of all ages by requiring state commercial plans to provide coverage for orthotic and prosthetic care for:
- Purposes of performing physical activities, as applicable, including but not limited to running, biking, and swimming, and maximizing the enrollee’s upper limb function.
- Purposes of showering or bathing, and
- In a manner that shall not deny an orthotic and prosthetic benefit for an individual with limb loss or absence that would otherwise be covered for a nondisabled person seeking medical or surgical intervention to restore or maintain the ability to perform the same activity.
As of January 1, 2025, this bill is in effect for state commercial plans and Medicaid. To break this down further, this includes state governed commercial plans (fully insured employer plans), state commercial plans (MNsure individually purchased plans and state employee plans), and state Medicaid plans. While this bill is not in effect for every insurance, it is a huge step in the right direction for our community. This is only the beginning; the advocate teams nationwide are working relentlessly to spark a national movement for change and create the opportunity to pursue federal, nationwide reform.
If you currently have a state commercial or Medicaid insurance plan and are interested in learning more about your coverage and the steps towards access to specific orthotic and prosthetic devices, please reach out to our office. We would be happy to answer any questions you may have. Our team is ready and eager to work with you to get coverage for the devices you deserve!
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