Colorado is facing a budget deficit that requires creative budget solutions. During their most recent budget session, Colorado’s state policymakers were weighing changes to equine (horse) related activities. The Association of Occupational Therapists, Association of Physical Therapists, and American Speech-Language-Hearing Association all recognize equine movement as a therapy tool within standard practice rather than as a separate service. For many CYSHCN, equine movement serves as an essential treatment that helps them reach their therapeutic goals.
History of Equine Therapy Legislation in Colorado
Historically, Occupational Therapists (OTs), Physical Therapists (PTs), and Speech-Language Pathologists (SLPs) were prohibited by Colorado Medicaid from billing for therapies involving equines. Instead, these therapies were allowed through select home- and community-based service (HCBS) waivers.
In 2022, a bill was passed allowing OTs, PTs, and SLPs to bill under the state Medicaid plan instead. The change went into effect in July 2024 and therapists began billing the Medicaid state plan under regular therapy codes when using equine assistance as a therapy tool, meaning reimbursement amounts were the same as traditional therapies and access was expanded. With the change, the HCBS waiver equine service was no longer needed. Colorado state Medicaid, instead of fully removing the waiver service, began work to redefine the benefit to allow Therapeutic Riding (equine activities done by non-licensed providers) under the waivers, which had never been available before.
Recent Advocacy Efforts
With the recent budget deficit of $1 billion in Colorado, the state chose to make cuts to the Medicaid program. Many of those cuts ultimately came from Long Term Care Medicaid Programs. One of the proposed cuts was to eliminate the planned expansion to cover Therapeutic Riding under the HCBS waivers. Advocates, including Family Voices of Colorado, agreed to the change acknowledging that adding new services in a budget crisis is unwise. However, during the legislative process, policymakers both eliminated Therapeutic Riding as a waiver benefit and created a bill HB26-1365 which would once again ban OTs, PTs, and SLPs from billing Medicaid for therapies using equine assistance.
After identifying the issue, Family Voices Colorado rallied families and advocates who worked together to educate lawmakers and request changes to the bill. Their consistent messaging, including how the change would not actually be cost saving, ended with the bill being postponed indefinitely. This advocacy win means that CYSHCN can continue to access the therapy tools that they need to achieve their therapeutic goals, including horses.
“In a season when we have had to accept many painful cuts to Long Term Care Medicaid programs due to an unprecedented state budget crisis, it was so important for us to fight to preserve a service where the proposed cut would cause harm without actually aiding in balancing the budget. We are so grateful for the advocates and families who shared their expertise and stories alongside us and the legislators who took the time to listen and understand so we could all come away with a win for individuals across Colorado.” – Megan Bowser, Family Voices of Colorado
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