Washington bill could transform prosthetics access for amputees
The proposed legislation would expand insurance coverage for assistive devices like running blades or waterproof legs — but not under all health plans.
/ March 12, 2025
At just 10 years old, Nicole Ver Kuilen and her family made an impossible choice — one that meant losing her left leg but saving her life. Cancer left them with no other option. She survived, but in the years that followed she found herself in a different struggle: access to the prosthetic technology she needed to move freely, to run, to simply be a kid.
A bill going through the Legislature currently, House Bill 1669, aims to address this by expanding insurance coverage for prosthetic limbs and custom orthotic braces, ensuring patients have access to medically necessary devices for daily activities and physical mobility.
For the next 16 years, Ver Kuilen navigated a world where running blades — costing anywhere from $15,000 to $25,000 — were out of reach, not covered by insurance. For Ver Kuilen the message was clear: Mobility was a privilege, not a right.
“As a kid, I remember running in gym class and my prosthetic foot just broke because it wasn’t meant for that kind of activity,” Ver Kuilen said. “I had to walk over to my gym teacher and say, ‘Hey, my prosthesis just broke — what can I do?’ That was a defining moment. I knew I could be active, but I was being limited by my access to the right technology, not by my own abilities.”
In 2017 she quit her job and embarked on a 1,500-mile triathlon along the Pacific Coast, calling it “Forrest Stump,” to raise awareness about the difficulties faced by individuals in similar situations.
Now based in Vancouver, Washington, Ver Kuilen continues her advocacy work as the Campaign Lead for So Every BODY Can Move, a national health care and disability rights campaign working to expand insurance coverage for prosthetic and orthotic care. The campaign has successfully enacted legislation in eight states and introduced bills in 19 states, including Washington. House Bill 1669 and its companion, Senate Bill 5629, are part of this broader effort to ensure people with disabilities have access to the custom medical care they need, provided by prosthetists and orthotists, to lead active, independent lives.
“When you’re constantly told ‘No,’ or when you’re sidelined because your prosthesis isn’t built for movement, you start questioning your own self-worth,” Ver Kuilen said. “This bill isn’t just about mobility — it’s about dignity. It’s about ensuring that kids and adults with limb loss are given the tools they need to live full, active lives.”
The bipartisan bill, sponsored by Rep. Monica Stonier (D-Vancouver), requires small and large group health plans to cover these devices starting in 2026, with coverage standards at least equal to those of Medicare Part B. While the bill improves access for many, it exempts individual market plans and certain public employee health plans, limiting its reach.
“This bill is not going to be broadly effective as we would hope, but it’s still a step forward,” Stonier said. “It’s about ensuring people can have access to prosthetics that enable them to experience life fully. It’s about providing the range of motion that people need, whether it’s for a child who needs a running blade or an athlete who requires a specialized prosthetic for performance.”
The Affordable Care Act mandates that most individual and small group health plans cover 10 categories of essential health benefits, including rehabilitative and habilitative services. But each state selects its own “benchmark” policy to determine what health benefits are essential to be required in their state. Washington follows this federal requirement by using its largest small-group market plan as the benchmark, ensuring coverage for braces, splints, prostheses and other orthopedic devices. Medically necessary prosthetics and orthotic braces are also covered under Medicare Part B and the Uniform Medical Plan, though coverage specifics vary across different insurance plans.
Under Washington’s current benchmark plan, coverage is generally limited to a single device per limb, focusing on functional necessity rather than activities like sports or recreation. HB 1669 does not modify the state’s Essential Health Benefits (EHB) benchmark plan but mandates that small and large group health plans issued or renewed on or after January 1, 2026, provide expanded coverage. These plans must cover one or more prostheses and custom orthotic braces per limb when medically necessary for daily activities, essential job-related tasks and physical activities such as running, swimming and biking. The bill also requires coverage for materials, components, necessary services, reasonable repairs or replacements, and prohibits discrimination in coverage for enrollees with disabilities.
“The issue is not that prosthetic care is inherently expensive — it’s that insurance doesn’t cover it,” said Ver Kuilen. “No one ever says, ‘Oh my gosh, a knee replacement is so expensive,’ but those can cost between $30,000 to $50,000. The difference is that those procedures are covered. Meanwhile, something as essential as a prosthetic running blade or a waterproof leg is deemed a ‘convenience’ rather than a necessity.”
This change to require coverage of one or more devices is expected to go further than what is currently required under Washington’s benchmark plan. As a result, it would be considered a new mandate, according to the Office of the Insurance Commissioner, meaning the state would need to cover the costs for individual health plans sold on the Washington Health Benefit Exchange.
The state has previously enacted only one new mandate for individual market plans, which had minimal costs, so the financial impact to the state of defraying this benefit is currently unknown and would need to be assessed through actuarial analysis.
The bill establishes clear protections to prevent insurers from denying coverage for prosthetic or orthotic devices if similar treatments would be available for nondisabled individuals, and any denial must be explained in writing. By 2028, insurers must report claims data to the Office of the Insurance Commissioner, which will aggregate the information and present findings to the Legislature.
Stonier acknowledged the financial concerns often raised by insurance providers when new mandates are introduced, but emphasized that the relatively small size of the affected population makes the cost of the bill minimal.
“It’s pennies on the dollar,” Stonier said. “The challenge is to make the case to the Legislature that this coverage is worth the investment.”
In addition to the unknown cost of defraying the benefit for plans sold through the Washington Health Benefit Exchange, the fiscal impact of the bill is expected to include costs to the Office of the Insurance Commissioner, which would spend approximately $283,883 in 2025-2027 and $23,336 annually in the following years to oversee the new insurance coverage requirements.
To address the state’s budget constraints, Stonier amended the bill to exclude public employee health plans from the mandate. While the decision was difficult, Stonier expressed optimism about future expansions.
“I’m hopeful that as the state’s financial situation improves, we can revisit this bill and include public plans,” Stonier said.
Ashley Carvalho, a licensed and board-certified prosthetist/orthotist at Harborview Medical Center in Seattle, provided compelling testimony on behalf of House Bill 1669 regarding the financial barriers faced by individuals with limb loss and mobility challenges. Carvalho explained that in her role she works with patients to design and fit custom prosthetic and orthotic devices, often with the goal of helping them return to physical activities like playing sports or going hiking.
However, she noted that many patients face prohibitive out-of-pocket costs for the necessary, activity-specific devices, leaving them with limited options.
“When one of my patients expresses interest in returning to physical activity, we often have a discussion about compromises to do things that the rest of us take for granted,” Carvalho said. “My patients have had to resort to measures like crowdfunding and applying for grants or risk overuse injury and being without an everyday device if it breaks in order to live active lifestyles.”
HB 1669 is currently in the House Rules Committee. This committee determines whether the bill will proceed to the House floor for a vote. It would need to be sent out of committee and passed by today’s “house of origin” cutoff to continue to be considered for adoption this session.