Maine passed a law requiring health insurance policies regulated by the state consider the recreational needs of people under 18 when a decision is made on what prostheses will be covered.
The law, “An Act To Improve Outcomes for Persons with Limb Loss,” states that insurance providers must consider “a prosthetic device determined by the enrollee’s provider…to be the most appropriate model that meets the medical needs of the enrollee for recreational purposes, as applicable, to maximize the enrollee’s ability to ambulate, run, bike, and swim and to maximize upper-limb function.” It does not, however, require insurance to cover prostheses designed exclusively for an athletic purpose.
Jordan Simpson, who has congenital amputations, was the impetus to the law’s development and passage. Her insurance provider denied coverage for a running prosthesis when Simpson was a child saying it was not medically necessary.
“Insurance companies should not play a part in determining what is right or wrong for a person,” Simpson said. “That really should be between a patient and their prosthetist.”
Simpson earned social work degrees at the University of New England (UNE) and the University of Tennessee. Her push for the law began when she completed a project on the topic for an undergraduate class at UNE, Social Welfare Policy and Advocacy, and later met Maine State Representative Colleen Madigan during a class visit.
“I would never have known that [access to prosthetic devices] was a problem if I had not met Jordan in her class that day,” Madigan said.
Simpson and Madigan crafted the legislation and convinced other lawmakers to pass the bill into law.
Madigan says it was Simpson’s passion that convinced the legislators to support the measure.
“Jordan is a powerful speaker, and she made a compelling case,” Madigan said. “I am not surprised that we won on this bill. I think this shows that one person can make a huge difference.”
Simpson says her work advocating for people with limb loss is just beginning.
“I have been involved with various organizations and amputee camps for a number of years, and I know children and adults are still experiencing what I did,” she said. “My goal is to see this change nationally, because where you live should not determine your care. If I have to go state by state to ensure people receive the care and tools that they need to live their lives to the best of their ability, that is what I plan on doing.”
Editor’s note: This story was adapted from materials provided by the University of New England.
To read the bill, visit Maine House Bill 1003.
To read Simpson’s paper, “Exploring Recreational Access for Individuals with Limb Loss: A Research Report,” visit the University of New England.
