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Read. Follow. Verify.Louisiana requires health insurance and Medicaid to cover prosthetic and custom orthotic devices starting in 2027
Last action · April 9, 2026: Becomes HB 1235.Sponsor: Troy Hebert
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What This Bill Proposed
Beginning January 1, 2027, health insurance plans and the Louisiana Medicaid program must provide comprehensive coverage for medically necessary prosthetic and custom orthotic devices, repairs, replacements, and related clinical services. Insurers must ensure network adequacy with at least two providers, set cost-sharing no more restrictive than other benefits, and report claims experience data by 2029.
Enrollees with limb loss, limb absence, or neuromusculoskeletal disorders gain guaranteed insurance coverage for primary and secondary devices—such as those needed for physical activity, bathing, and daily living—along with formal appeal rights for coverage denials.
- State legislatures frequently evaluate health insurance mandate bills to establish minimum coverage standards for specialized medical equipment like prosthetics and orthotics. context
- House Bill 477 was introduced during the 2026 Regular Session of the Louisiana Legislature by Representative Troy Hebert. context
Who It Would Have Affected
Groups the bill's text would have affected, as described in the record. Being affected is not a position for or against it.
Health insurance enrollees
Enrollees gain guaranteed access to comprehensive coverage for medically necessary prosthetic and custom orthotic devices, replacement parts, and associated appeal rights.
Medicaid enrollees
Medicaid beneficiaries become eligible for coverage of prosthetic and custom orthotic devices and services under state Medicaid clinical criteria.
Health insurance carriers
Carriers must update plan benefits to include prosthetic and orthotic coverage, maintain network adequacy standards with at least two providers, and submit claims data reports for 2027-2028.
Prosthetic and orthotic service providers
Accredited facilities and providers are designated as the exclusive providers for covered devices, with requirements for insurer network participation and out-of-network reimbursement.
Key Facts
- Health insurance plans issued, renewed, or contracted in Louisiana on or after January 1, 2027, must provide coverage for prosthetic and custom orthotic devices and services.
- Minimum coverage must equal prevailing federal Medicare payment rates and provisions under 42 U.S.C. 1395k, 1395l, 1395m and associated regulations.
- Coverage is mandated for more than one prosthesis or orthosis when medically necessary to perform activities of daily living and essential job-related functions.
- Additional devices must be covered when determined by an orthotic or prosthetic care provider and treating physician to be necessary for physical activities like running, biking, swimming, and strength training, or for showering and bathing.
Show all 11 facts
- Medically necessary repair or replacement of devices must be covered without regard to continuous use or useful lifetime restrictions under specified conditions, including changes in physiological condition or repair costs exceeding sixty percent of replacement cost.
- Health coverage plans may require confirmation from the prescribing provider if a replaced device is less than three years old.
- Insurers must provide written reasons for any coverage denials based on medical necessity and include information on the appeals process.
- Cost-sharing such as co-payments, deductibles, or coinsurance for prosthetics and orthotics must not be more restrictive than that applied to other plan benefits.
- Carriers must ensure access to a network containing a minimum of two distinct prosthetic and custom orthotic service providers in the state, and provide out-of-network referrals with in-network cost-sharing when necessary.
- The Louisiana Medicaid program must provide coverage for prosthetic and custom orthotic devices and services when deemed medically necessary.
- Limited benefit health insurance policies or contracts are exempt from these coverage requirements.
Frequently Asked Questions
Does the law cover devices needed for sports or physical activities?
Does Louisiana Medicaid include coverage for these devices?
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News Coverage
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Votes, people, money & the original sourceWhere This Stands
This bill did not become law - Died at adjournment · in House committee.
Procedural history
6 actions- Apr 9, 2026HouseBecomes HB 1235.
- Apr 8, 2026HouseReported by substitute (11-0).
- Mar 9, 2026HouseIntroducedRead by title, under the rules, referred to the Committee on Insurance.
- Feb 27, 2026HouseFirst appeared in the Interim Calendar on 2/27/2026.
- Feb 26, 2026HousePrefiled.
- Feb 26, 2026HouseCommitteeUnder the rules, provisionally referred to the Committee on Insurance.
Version history
Only one version on file - nothing to compare yet. As later stages (committee substitute, engrossed, enrolled) are captured, the redline appears here.
View official text →Lobbying Activity
No state lobbying filings in our records match this bill. Federal lobbying reports (LDA) cover Congress, so they are not listed on state bills.
Full breakdown
Who this bill affects and the strongest case for and against it, written only from the bill’s own text.
Sponsors
Discoveries
Patterns POLISCOPE noticed across the record. These are observations to investigate, not conclusions.
Replacement Restrictions Removed
The law prohibits health plans from applying continuous use or useful lifetime restrictions when replacing devices due to changes in physiological condition, irreparable damage, or when repair costs exceed sixty percent of replacement cost.
Connected Entities
Sources
www.legis.la.gov
Analysis Score
0–100- Significance20Lowered because this bill did not pass (its text scored 75)
- Controversy30Intensity of disagreement among stakeholders
- Entertainment5Compellingness for a non-policy-wonk reader
- Buzz40Current news / social attention level
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