Insurance plans could soon be required to cover hippotherapy in Illinois

SPRINGFIELD – Under a bill awaiting the governor’s signature, certain insurance plans would have to cover hippotherapy and other forms of therapeutic horseback riding in Illinois.

Hippotherapy is a type of physical, occupational and speech therapy where the movement of a horse is used to treat a patient’s specific disability or disorder. The practice is used to treat conditions such as autism, cerebral palsy, arthritis, multiple sclerosis, strokes, head and spinal cord injuries, as well as behavioral disorders and psychiatric disorders, including PTSD.

Marita Wassman is the founder of Ride On St. Louis, a nonprofit organization that provides equine-assisted services to both children and adults in the St. Louis area. As one of five credentialed and certified therapeutic riding instructors at the advanced level in Missouri, Wassman’s stable has provided services to patients for over 27 years – the majority of whom she says are children needing physical or intellectual services.

A previous patient of Ride on St. Louis was an 8-year-old girl with cerebral palsy who struggled to hold her head upright on her own for extended periods of time. After four months of treatment, Wassman said the girl’s parents reported that she was able to both sit and hold her head up for over an hour when they went out to dinner – when previously, she would rest her head on her arms for a majority of the dinner.

“If you were to go ride a horse for an hour, it could benefit you exactly the same way as if you did a powerwalk for an hour,” Wassman said. “And for people specifically who can’t get that on their own, who are in wheelchairs or even if they are ambulatory but don’t have a symmetrical movement, sitting on a horse that is nice and even is really going to help their muscles.”

During sessions, a licensed therapist typically works alongside a horse handler, who confer with each other beforehand about the patient’s goals and the variables that would affect the session – like the breed of the horse and the activities that would be most beneficial to the patient.

“Horses movements are very different – you can have a horse that makes your hips and your pelvis have a lot more anterior and posterior movement, or forwards and backwards movement, or some of them are going to deliver more lateral movement,” Wassman said. “So, if you’re working with a person with cerebral palsy who is weak in their spine and they need to develop their anterior and posterior muscles more, you’re going to want to make sure they’re on a horse that has a movement that is more front and back.”

Beyond horseback riding, Wassman said there are a variety of other factors that make the practice effective. For some patients, being outside and partaking in a shared experience surrounded by supportive professionals can be emotionally uplifting, which she said may provide a sense of engagement and community.

Another aspect of the services sometimes involves overcoming fear for patients with anxiety, Wassman said. Since horses are large, intimidating creatures, overcoming a fear of the horse as well as engaging in and developing skills related to riding can help specific patients with self-esteem.

Equine-assisted service specialists like Wassman also report that horses seem to have a calming effect on patients, which Wassman attributes to their heart rates. Because they’re such large animals, horses have lower heart rates than humans, which she said soothes both humans and animals near a horse.

“A lot of times people’s breathing will kind of relax or slow down when they’re near or around the horses,” she said.

Some patients may not ride a horse but instead will simply interact with one during their session, she said. Occupational therapists may choose to treat a patient’s physical mobility by brushing a horse, especially when other forms of typical treatment aren’t working.

“It’s kind of like baking,” Wassman said. “When you’re baking, you use flour, sugar, salt, water, milk or whatever in so many of your baking recipes, but you don’t know what the outcome is going to be unless you specifically have your recipe. You could make pancakes, you could make crispy cookies, you could make chewy chocolate chips cookies, or whatever.

“It’s the same thing with equine-assisted services – what specific goals and objectives you have for each of those specific riders breaks down to your lesson plans and your treatment plans and everything that you’re writing to try help that person.”

She told another previous patient’s story – one who quickly attained results after previously making little progress in traditional therapy settings.

“The patient’s mother goes, ‘We did eight years of physical therapy. Then we came and started doing physical therapy on horseback, and we achieved so much more in six weeks than in eight years.’” Wassman said.

Wassman said the insurance aspect of equine-assisted services has always been a point of contention for stables and therapists in the past, as some insurance companies have fought compensating therapists for their hippotherapy services. At stables where other services are offered, she said patients and their parents can often get confused about what services insurance will and won’t cover.

“For services that are not involved with an occupational or physical therapist, speech therapist, or mental health professional, you cannot bill insurance,” she said. “There’s a lot of stables out there that don’t employ therapists but still provide services.”

Senate Bill 69 passed the Senate unanimously in April as well as the House in late May on a vote of 78-33. It will become law if signed by Gov. JB Pritzker.

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