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Panel urges coverage for activity‑specific orthoses; sponsors challenge a state cost study
Summary
Supporters of House Bill 383, the "So Everybody Can Move" follow‑up, told the committee that Medicaid and insurers should cover custom activity‑specific orthoses used for sports and exercise as medically necessary; legislators and clinicians disputed a Department of Health cost study and asked for recalculation and more detailed utilization data.
Delegate Ashanti Martinez returned to the committee to present House Bill 383, the second part of last year’s So Everybody Can Move package. The measure would require Maryland Medical Assistance and private insurers to cover orthoses (custom braces and related components) used specifically for physical activity when medically necessary.
Patients, clinicians and advocates testified in favor. Prosthetists and orthotists, a podiatrist, a physical therapist and several individuals with limb differences or spinal cord injuries described how activity‑specific devices can restore mobility and prevent downstream injuries. Witnesses gave personal examples of how coverage (or lack of coverage) affected their ability to work, exercise and maintain health; several told the committee they had to rely on charity or pay out of pocket to obtain specialized devices.
Sponsor and industry witnesses criticized the Department of Health’s cost study and the fiscal note, saying the actuary used many irrelevant billing codes, overstated utilization projections and failed to reflect actual unit‑level utilization. A prosthetics/orthotics practitioner told the committee that many of the codes the report used are not activity‑specific and that state Medicaid fee schedule prices cited in testimony appeared misstated in the transcript (the witness provided an example figure from the 2024 Medicaid fee schedule for a molded supramalleolar orthosis).
Committee members asked for precise cost and utilization data. Sponsor Martinez said she had scheduled follow‑up meetings with the department and that stakeholders were obtaining implementation data from states that have adopted similar coverage.
Ending: The hearing emphasized clinical and personal benefits of activity‑specific orthoses and questioned the assumptions in the state cost analysis. The committee asked the sponsor and department for clarified code counts, utilization metrics and experience from other states before further action.
