NJ Bill Proposes Insurance Coverage for Athletes’ Artificial Limbs, but Some Feel Excluded
People living with limb loss in New Jersey, especially those actively involved in physical and recreational activities, are closely following a new bill under review by the New Jersey Legislature. The proposed legislation seeks to mandate insurance coverage for extra orthotic or prosthetic devices essential for participation in various physical activities.
As of this writing, the bill, S1439 / A3856, is pending before the Senate Budget and Appropriations Committee and the House Financial Institutions and Insurance Committee.
If passed, this bill could significantly impact individuals like 11-year-old adaptive athlete Gio DiPersia and many others who face challenges accessing necessary prosthetic technology. This legislative effort, spearheaded by Sens. Troy Singleton and Anthony M. Bucco, is part of a broader push for consistent and fair coverage for prosthetic devices.
Why this bill is necessary
The bill was first introduced in June 2023. It would require insurance coverage for additional prosthetic or orthotic devices for activities like bicycling, running, swimming, and various sports. The proposed reimbursement rate would match that of the federal Medicare program.
Although many employer-sponsored and Affordable Care Act plans cover “medically necessary” prosthetic devices as part of essential health benefits, there is inconsistency in availability. Some states, such as Mississippi, Oklahoma, and Texas, do not include these benefits in Medicaid coverage.
Additionally, Medicare Part B, which covers durable medical equipment, including prostheses, requires patients to pay 20% of the cost, which can amount to about $5,000 for a basic lower leg prosthesis. Specialized equipment, such as running and weightlifting, can cost tens of thousands of dollars and is currently not covered by insurance.
Five states, including Arkansas, Colorado, Illinois, Maine, and New Mexico, have already mandated insurance coverage for activity-specific prostheses, with advocacy efforts underway in 20 more states, including New Jersey.
Growing kids mean outgrowing prostheses often
One of the possible beneficiaries should the bill be passed is 11-year-old adaptive athlete Gio DiPersia. Gio had his left leg amputated below the knee at just 13 months old. He frequently outgrows his running blades, needing at least one or sometimes two replacements each year. In an interview with the Daily Record, Gio’s father, Anthony DiPersia, highlighted the impact that legislative aid would have on their family.
Gio enjoys surfing and finds that his running blade provides flexibility for various activities. His family has relied on grants from nonprofits to acquire the prosthetic equipment he needs.
Another supporter of the bill is Alex Manna of Montville, who is outgrowing his specialized weightlifting hand received from the Born to Run Foundation. While he has used the prosthesis daily for the past two years, it’s become too tight and can pose a risk during heavy lifting activities.
In an interview with the Daily Record, Manna shared his belief that access to specialized prosthetics should be covered by insurance, especially if one is already paying for it. He also emphasized the need for equal treatment for all individuals.
