Nicole, from Vancouver, lost her leg to bone cancer at the age of 10. However, Nicole was limited by her insurance-mandated prosthesis, which was meant only for walking.
Leah, who lives in Spokane, was born missing her left hand. Although Leah yearned to compete for the high school swimming team, she couldn’t. It wasn’t until 2022 that Leah received a prosthetic arm donated by her prosthetist because her health insurance had deemed it “not medically necessary.” Leah's prosthetics weren’t covered by insurance for her physical activity.
Dillen, from Bellingham, lost his foot after a hit-and-run while cycling. Even though Dillen struggled to return to his bike after the initial recovery, he knew staying active was the key to healing his body and mind. Dillen turned to rock climbing, which requires a unique prosthesis that insurance doesn’t cover.
Katy, who lives in Vancouver, was born with hemiplegic cerebral palsy (CP). However, Katy wears the ExoSym — a costly dynamic orthotic device she received in 2016 solely because of her community's $11,000 GoFundMe campaign.
Nicole, Leah, Dillen, and Katy are a few such fitness enthusiasts facing mobility and physical activity limitations. The lack of a proper medical insurance system doesn’t allow fair access to prostheses and orthoses for daily independence and physical activity.
To curtail this issue, Nicole VerKuilen, the state coach from the Amputee Coalition, who runs a nonprofit advocacy organization named ‘Forrest Stump,’ took it upon herself to do something about it.
The organization promotes equitable access to prosthetics and orthotics for individuals with a disability for mobility and physical activity.
Along with Nicole VerKuilen were a few like-minded people like Cody McDonald, PhD, MPH, CPO, a prosthetist orthotist and assistant professor in the Department of Rehabilitation Medicine, and Ashley Carvalho, MPO, LCPO, a licensed and board-certified prosthetist-orthotist with Rehabilitation Services, Harborview Medical Center. Together, the group fought for everyone who faces this less-known issue. With their combined effort, on April 15, 2025, So Every BODY Can Move (SEBCM) bill HB 1669 was officially passed in the House and Senate in Washington state and is now headed to be signed by Governor Bob Ferguson. The new bill will address coverage of physical activity, insurance fairness, and nondiscrimination standards.
“My role has primarily been as a supporting member of the SEBCM effort. I testified to the Washington State Senate Committee on Health & Long-Term Care on February 11th, 2025, about some related research about the prevalence of secondary prosthesis use in lower limb prosthesis users. I now also serve as a member of the So Every BODY Can Move (SEBCM) Medical and Research Advisory Committee (MRAC) to continue to support this movement nationwide,” says Dr. McDonald.
Currently, people who use prosthetic and orthotic devices for daily life are limited in their ability to participate in physical activity due to prohibitive out-of-pocket costs or risk of damage to their everyday use devices.
“This legislation requires large and small-group state commercial insurance plans to cover prosthetic and orthotic devices for physical activity in addition to an everyday device. We hope to expand coverage to more groups and plans in next year's legislative session so that as many Washingtonians with disabilities can engage in safe physical activity without excessive financial barriers,” adds Carvalho.
The new bill, HB 1669, includes three main changes to the current law that governs coverage of orthotic and prosthetic (O&P) devices by state commercial plans in Washington.
- Coverage for Physical Activity - Requires state commercial plans to cover O&P physical activity
- Insurance Fairness (Coverage + Payment) - Requires state commercial plans to cover and reimburse O&P care at a level at least equivalent to Medicare
- Nondiscrimination Standards - Prohibits insurers from denying activity-specific O&P care that would otherwise be provided to a patient without a disability to perform the same activity (e.g., ACL repair, knee replacement, etc.).
- Insurance Fairness (Coverage + Payment) - Requires state commercial plans to cover and reimburse O&P care at a level at least equivalent to Medicare
“I have always seen the value in advocacy and have supported advocacy efforts for disability rights in low and middle-income countries, but this was my first time testifying in support of legislation. Ashley has been instrumental in this effort. Her passion and tireless work set a fantastic example for our profession (and our UW Master of Prosthetics & Orthotics students) about what it truly means to commit yourself to the prosthetics and orthotics community,” says Dr. McDonald.
There are an estimated 168,000 individuals living with limb loss, limb difference, and mobility impairment in Washington. Many of these Washingtonians are unable to afford and access life-changing orthotic and prosthetic care that restores mobility and physical activity due to a lack of insurance coverage, "not medically necessary" denials, and high out-of-pocket costs.
“So Every BODY Can Move (SEBCM) is close to my heart as a lifelong athlete and someone who works with members of the disability community daily who are denied access to the same opportunities. When the opportunity arose to assemble a team to work on SEBCM legislation in Washington, I was eager to get involved and support the effort,” says Carvalho.
For Cody McDonald, the inspiration for the work came from Ashley Carvalho and Nicole VerKuilen.
“They have dedicated much time and effort to getting people access to the devices they need to exercise and be active. As a researcher, I am in a position of power and want to use my position and work to support positive social change. I have the opportunity to conduct research to highlight health inequities and support efforts to improve access to care. I've also realized that it is my responsibility to do the research and get the resulting information in front of the policymakers who make decisions,” adds Dr. McDonald.
Ashley is part of this project as co-state lead with fellow CPO and UW grad Molly McCoy and Nicole VerKuilen.
“We began planning for the legislation two years ago and have worked directly with stakeholders and legislators on the project for the past year. We are fortunate to have worked with an experienced lobbyist and committed bill champions in the state house and Senate to get the bill to where it is today, awaiting signature from Governor Ferguson,” adds Carvalho.
Similar proposals were recently passed in eight states. On her side, Dr. McDonald continues to help this community through her ongoing research focusing on improving equity for prosthetic and orthotic users. She employs qualitative methods to center prosthetic and orthotic users' perspectives, experiences, and priorities. Her research interests include global service provision in prosthetics and orthotics, outcome measure development, and education research.