by Karla Ciaglo CTNewsJunkie
HARTFORD, CT — For Connecticut residents living with limb loss or limb difference, insurance coverage often extends only far enough for a single basic walking or upper-extremity device, leaving activity-specific prosthetics uncovered.
Lawmakers and advocates are pushing to amend state insurance law so prosthetic devices prescribed for physical activity and functional independence are treated as medically necessary, ensuring Connecticut children and adults with limb loss can access physician-prescribed care needed for daily life, school, work and exercise as intended under existing Essential Health Benefits law.
The proposal builds on Connecticut’s 2018 prosthetics parity law, Public Act 18-69, which requires state-regulated health plans to cover prosthetic limbs at least equivalent to Medicare coverage and prohibits classifying them as durable medical equipment. The statute also mandates coverage for medically necessary repairs and replacements.
However, the law excludes devices “designed exclusively for athletic purposes,” language supporters say insurers have used to deny coverage for activity-specific prosthetics that go beyond basic ambulation.
A similar measure, Senate Bill 1015, was introduced in 2025 but did not receive a public hearing and died in the Insurance and Real Estate Committee.
Maggie Baumer, of the grassroots organization So Every BODY Can Move said that while health care providers maintain positive relationships with the community, they often lack an understanding of the real-world experiences of people with limb loss and limb differences.
“When coverage is limited to a single basic walking device and additional devices for safety, exercise and other daily activities are denied, it’s the same as saying you can only use that device,” Baumer said. “It won’t work in the shower. It won’t work during exercise. And it won’t work when you’re playing with your child.”
Baumer said more than 45,000 Connecticut residents rely on appropriate prosthetic or adaptive technology, and roughly 40 percent receive care through private insurance plans where disputes over activity-capable devices most often arise.
Coverage decisions frequently rely on Medicare’s functional “K-level” classification system, which ranges from K1 for limited household ambulation to K4 for high-activity users. Advocates say insurers often approve devices aligned with lower functional levels while denying equipment that would support safer, higher levels of activity, even when prescribed by physicians.
Nationally, an estimated 5.6 million Americans live with limb loss or limb difference, and approximately 185,000 amputations occur each year, according to public health estimates.
In Connecticut, the Department of Public Health reported 1,582 inpatient discharges in 2022 involving diabetes-related lower-extremity amputations, underscoring the continuing prevalence of limb loss in the state.
State Comptroller Sean Scanlon, who helped pass the 2018 law while chairing the Insurance and Real Estate Committee, described the current effort as unfinished work.
“Eight years ago this was a true fairness issue,” Scanlon said. “We pass laws, we feel good about it, and then you realize you can’t ever stop fighting. This is about what true parity means.”
The 2018 measure passed unanimously in the final four hours of the legislative session. Scanlon said he hopes lawmakers can again reach bipartisan agreement.
Commissioner of the Connecticut Department of Veterans Affairs Ron P. Welch tied access to activity-capable prosthetics to broader health outcomes, particularly for veterans.
“In Connecticut we have 140,000 veterans, and 66 percent do not use VA healthcare. They rely on private insurance,” he said. “A healthy lifestyle combats anxiety, PTSD and depression. Everybody should have that opportunity.”
The US Department of Veterans Affairs reports, an average of roughly 17 veteran suicides per day, a statistic advocates cite when arguing that policies supporting mobility and physical activity can contribute to mental health interventions.
Rep. Sarah Keitt, D-Fairfield, speaks with reporters and advocates in support of an amendment to the state Constitution enshrining environmental rights has human rights during a news conference in the Legislative Office Building on Tuesday March 18, 2025. Credit: Coral Aponte / CTNewsJunkie
State Rep. Sarah Keitt, D-Fairfield, who was diagnosed with multiple sclerosis 26 years ago, said access to properly fitted mobility devices is critical to independence and survival. She said lawmakers must ensure insurers cover medically necessary equipment, noting even the state Capitol remains difficult to navigate for people with disabilities.
The proposal would apply to fully insured commercial health plans regulated by the state, while self-funded employer plans governed by federal ERISA law would not be subject to the mandate.
Opponents of similar measures in other states have raised concerns about premium increases. Public analyses in those states generally project costs of only a few cents per member per month, though Connecticut has not yet released a fiscal estimate.
Susan Halpin, co-principal at CT Government Relations Group of Robinson+Cole, says it’s a difficult balance.
“Each mandate considered by the legislature is truly well-intentioned, but each also adds appreciable cost that shows up in health care premiums at the same time that consumers, policymakers and regulators are demanding affordable coverage,” she said.
Halpin also noted that “any mandate passed applies only to a very small segment of the population subject to state regulation. The vast majority of the state’s insured population is governed by federal regulation and not subject to state mandates.”
The So Every BODY Can Move initiative hopes to create equitable access to prosthetic and orthotic care in 28 states by the 2028 Paralympics slated to be hosted in Los Angeles, CA.