Committee hears testimony on bill to require insurers to cover medically necessary activity-specific prosthetics

Vermont lawmakers heard more than two hours of testimony on House Bill H432, legislation that would require insurers to provide coverage for medically necessary prosthetic and orthotic devices beyond a single basic prosthesis.

The bill’s sponsor, Representative Molly Burke, introduced the measure and said it aims to ensure amputees have equitable access to devices that restore full bodily function for daily life, work and recreation.

"This bill gives a person who has an amputation equitable opportunity to be returned to the full use of their body," Burke said in opening remarks.

Why it matters: Supporters — including a statewide advocate, clinicians, prosthetists and several people with limb loss — described routine denials when patients seek additional, activity-specific devices such as running blades, waterproof prostheses or ski legs. David Heiler, state lead for the So Everybody Can Move initiative, told the committee that single-device coverage often leaves people unable to do essential or restorative activities.

"Simply put, movement is medicine, and physically active should be a right, not a privilege," Heiler said, arguing that activity-specific devices are medically necessary for work, safety and mental health.

Technical and cost context: Jason Lalla, a prosthetist and an above-knee amputee, demonstrated differences between everyday prostheses and sport-specific devices. He described running blades as a carbon "spring" built for energy return and shock reduction, and said a full sport-specific prosthesis can cost in the low to mid tens of thousands of dollars depending on components. Lalla said some sport-specific foot components have retail prices around $12,000, while a complete snowboard-specific prosthesis can range into the low-to-mid $20,000s.

Testifiers pointed to precedent and limited fiscal impacts in other states. Maggie Balmer, legislative affairs lead for the initiative, said similar laws have passed in a dozen states and that New Hampshire estimated a premium increase of 1 to 5 cents per member per month; she also said New Mexico reported effectively no measurable premium increase among most payers after enactment.

Current coverage and scope: Witnesses told the committee Medicaid and most private payers typically cover a single, everyday prosthesis; the VA and some workers’ compensation programs sometimes cover activity-specific devices. Balmer noted that orthotics and prosthetics are covered under the Affordable Care Act’s essential health benefits, and said H432 would clarify that coverage to include medically necessary devices for physical activity.

Human impact: Young witnesses and parents described concrete effects. Gage Pelletier, 20, said H432 "would've made my high school experience significantly better," recounting missed seasons and gym classes because his everyday device was unsuitable for sports. Megan Mueller, whose toddler has proximal femoral focal deficiency, said pediatric patients require frequent socket changes — often every few months — and cited a recent prosthetic billed near $12,000 with roughly $4,000 out of pocket for her family.

Mental-health and downstream benefits: Clinician-witness Sue Schaefer, a psychotherapist and amputee, linked access to activity-specific devices with improved mental health, reduced isolation and better overall functioning. Proponents argued that increased activity could reduce long-term costs by lowering risks tied to sedentary comorbidities such as diabetes and cardiovascular disease, though they acknowledged precise savings are uncertain.

Next steps: Witnesses asked the committee to advance H432 for floor consideration. No formal vote or motion was recorded during this hearing; committee members requested more outcome data and clarifications about implementation and fiscal impacts before further action.

Sources: Testimony to the committee from Representative Molly Burke (bill sponsor); David Heiler (So Everybody Can Move state lead); Maggie Balmer (legislative affairs lead, So Everybody Can Move); prosthetist Jason Lalla; witnesses Gage Pelletier, Ryan McLaren, Jennifer Bisson, Sue Schaefer, and Megan Mueller.