Advocates and State Leaders Call for Medical Necessity Clarification on Prosthetic and Orthotic Care

Press release

Hartford, Conn. – So Every BODY Can Move (SEBCM) Connecticut today alongside state leaders called for an important technical clarification in state law regarding prosthetic and orthotic coverage. The legislation would ensure that "medical necessity" for prosthetic and orthotic care reflects functional movement and physical activity, as originally intended under federal and state Essential Health Benefits, ensuring that state residents have access to necessary prosthetics.

Currently, many insurance plans in Connecticut interpret benefits narrowly, often limiting patients to a single prosthesis intended only for basic walking. Insurers frequently label activity-specific devices, such as safety-focused shower legs or running legs for sports, as "not medically necessary," effectively overriding the clinical judgment of doctors. This bill is not a new mandate, but rather would align coverage with the original intent of federal and state Essential Health Benefits (EHB), which already include activity-specific prosthetics. The change would ensure current state law works as intended for the estimated 45,000 local residents living with limb loss.

The proposed legislation also addresses a critical gap affecting Connecticut’s veterans. While active-duty service members and many retired veterans who receive care through the Veterans Administration (VA) or Department of Defense (DoD) have access to prosthetic and orthotic devices designed to support higher levels of physical activity and enhanced function, not all veterans receive their care through those systems. As a result, some face unnecessary limitations in private insurance coverage. By clarifying state law, this proposal would ensure veterans outside the VA or DoD system have equitable access to activity-specific prosthetic and orthotic care, improving physical health, supporting mental well-being, and promoting greater independence and community participation.
"It’s morally imperative that our peers who experience limb loss have access to medically necessary prosthetic care,” said State Comptroller Sean Scanlon. “This bill makes an important clarification to existing law to ensure that people who experience limb loss still have access to the highest quality of life possible. I am proud to be standing along with so many colleagues and the So Every BODY Can Move Connecticut Coalition today."

"Insurers should not be able to deny a benefit for an individual with limb loss or limb difference that would be covered for a person without a disability seeking to perform the same activity," said Lindi Mitsou, Associate Professor of Prosthetics & Orthotics at the University of Hartford and Co-Lead of So Every BODY Can Move CT. "We are calling for a public hearing to allow the amputee and limb difference communities the opportunity to provide testimony and help advance this practical and necessary legislation.”

"Physical activity is a fundamental part of being human and is medically necessary to maintain physical, mental and emotional health,” said Maggie Baumer, SEBCM national Legislative Affairs Lead and Leader of Enterprise Patient Advocacy at the Hanger Clinic. “The Connecticut So Every BODY Can Move bill would clarify coverage to ensure that residents have access to custom medical care that supports their full functional potential, rather than just basic mobility."
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