Committee advances bill to require broader insurance coverage for orthotic and prosthetic devices; advocates highlight cost and youth impact

The Assembly Appropriations Committee on March 20 amended and favorably released A3856 (1st reprint) and S1439 (1st reprint), measures requiring health benefits coverage for additional orthotic and prosthetic appliances and extending coverage to appliances obtained through podiatrists in certain circumstances.

Committee supporters included prosthetics providers and patient advocates. Testimony emphasized the barriers children and young athletes face when insurers decline coverage for sports-specific prostheses. Logan Marmino, a 15-year-old student and below-knee amputee who plays baseball, told the committee his family must seek grants and fundraising every 18 months to purchase sports prosthetics because insurers treat sports legs as a “luxury,” not a medical necessity.

Experts testifying estimated the cost of a below-the-knee sports prosthesis between about $5,000 and $25,000 and noted that lack of access can affect a child’s mobility, rehabilitation and long-term health. Proponents said studies in other states found minimal premium impacts — estimates ranged from cents per insured person to a few tenths of a dollar — and urged New Jersey to align with eight other states that have passed similar mandates.

Several committee members spoke in support; some expressed concern about cumulative insurance mandates raising premiums over time and called for targeted means-testing to assist families with financial need. The record shows the committee amended the Assembly bill to align with the Senate version and favorably released both measures to the floor.