Prosthetic users in Missouri could receive insurance coverage for multiple kinds of prosthetic devices under terms of a bill heard Thursday in the House Health and Mental Health Committee.
Currently Mo HealthNet, Missouri’s Medicaid program, only covers one kind of prosthetic device for daily use. But most daily use devices are not suitable for water exposure, such as showering or bathing, or for exercise.
The proposed bill would require Mo HealthNet to cover two additional prosthetics appropriate for water usage and physical activity.
Bill sponsor Rep. Carolyn Caton (R-Blue Springs) said the goal of the bill isn’t to expand coverage; it’s to correct it.
“These individuals are not asking for special treatment," Caton said. "They're asking for the same opportunity as the rest of us have, without even thinking about it, to live daily life without their health deteriorating because the basic equipment they need are denied or restricted. HB 2034 recognizes that activity-based prosthesis, orthos and high performance or mobility supported wheelchairs are not luxuries.”
Missouri Insurance Coalition lawyer Hampton Williams said insurance companies oppose the bill. The Trump Administration’s threats to dismantle federal funding for the Affordable Care Act could mean Missouri needs to pay all the costs of the prosthetics.
“Should the federal government change the manner in which it has been interpreting and applying the ACA, it would require the state to pay for not only the expenses for mandates, for the cost it covers, but also those mandates for private insurance,” Williams said.
Rep. Burt Whaley (R-Clever) said there is a need for better prosthetics and asked Williams where he would stand in the middle ground.
Williams said he is uncertain there is a disparity between everyday use devices and the additional proposed devices funded.
“I don’t believe it's been to testimony that the primary devices that are currently covered are either outmoded or insufficient or harming people," Williams said.
Elijah Shultz is a high school athlete and prosthetic user from Joplin. He relies on charities and fundraising to cover the cost of his prosthetics to play sports. His running blade cost over $16,000, financed by three foundations.
“Health insurance companies define medical necessity that they believe it is only medically necessary for me to walk,” Schultz said. "But if I want to run, compete, train or protect my body from long term injury, it is considered not medically necessary.”
When Shultz was 12, he used a hand-me-down running blade from an adult female made in 2008. As prosthetics are designed specifically for the user’s body, hand-me-down prosthetics can lead to skin irritation, sores and discomfort.
Each additional prosthetic device would need to meet medical criteria and be evaluated by insurance payers to receive coverage.
“I want to make something very clear, every single device, every workhouse, every prosthesis, every wheelchair that will be covered under this bill must meet medical necessity criteria that includes a physician or licensed prescribers order documented functional goals by a certified clinician verification that the device is the most appropriate model and medical necessity,” Caton said.
Supporters of the bill argue coverage for the additional prosthetics would allow participation in more physical activities, keeping users healthier and reducing long-term health care costs.
13 states have passed similar legislation since 2023.
