An intensive, three month long advocacy effort by O&P professionals in New York state has lead to a significant victory through a reversal of policy in the New York State Healthcare Exchange benchmark plan that limited coverage for artificial limbs to one prosthesis, per limb, per lifetime. In a letter dated May 17, 2015, Donna Frescatore, the Executive Director of the New York State Health Exchange indicated that the benchmark plan will be altered, effective January 1, 2016 to include coverage of the cost of repairs to and replacement of artificial limbs for both children and adults covered by the plan.
This reversal of an overly restrictive and unfair policy that limited coverage to one prosthesis per limb, per lifetime was the direct result of the tireless advocacy efforts of O&P practitioners in New York, who received direct support in their efforts by the Amputee Coalition and the National Association for the Advancement of Orthotics and Prosthetics, as well as broad support from industry groups such as AOPA and the O&P Alliance. The coalition that challenged this policy was extremely well organized and sent a very powerful message to lawmakers and policymakers in New York who had the authority to make this change, that beneficiaries must be treated fairly and have reasonable access to exchange based healthcare benefits that are required under the Affordable Care Act.
AOPA’s Take on this victory is that it is a valuable lesson regarding the value of advocacy in today’s healthcare environment. The folks in New York recognized that the one limb per lifetime restriction was extremely detrimental to beneficiaries looking to the healthcare exchange to purchase adequate health insurance. they were able to mobilize an incredible advocacy campaign and effect change in a very short amount of time.
AOPA continues to support grassroots advocacy across the country and is encouraged by the victory in New York. The only way to create change is to make sure that your voice is heard.
AOPA’s Take. Where You Go…..When You Need to Know!!!