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Bill Aims to End $2K DME Cap


California legislators met yesterday to discuss SB 1198, a state bill that would require private insurance to offer coverage for DME, and prohibit that coverage from including an annual benefit limit. Lifetime benefit limits would stay along with copayments and deductibles. Critics call the measure an unwarranted intrusion into the policies of private insurers.

California State Senator Sheila Kuehl (D–23rd District) [pictured] introduced the bill to amend the Health and Safety Code and the Insurance Code. Sponsored by the Disability Rights Education and Defense Fund (DREDF) and Protection and Advocacy Inc, the legislation would end what is typically an annual DME cap of $2,000. “That [the $2,000] won’t buy me a new chair and, like most people with disabilities, I’m not independently wealthy,” writes Mary Lou Breslin, co-founder of DREDF. “So I keep my old chair going with a wish and a prayer, and hope that I’m not in the middle of a busy intersection when it finally bites the dust.”

In 2006, legislators passed a similar law that removed benefit caps for prosthetics and orthotics. Currently, Medicare and Medi-Cal pay for DME, but according to Breslin, many who have private insurance are required to quit their jobs to qualify.

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