Losing chiropractic benefits is painful for Minnesotans

Minnesotans are cramming into chiropractic offices and squeezing in treatments for back problems and pain relief before the state’s Medicaid program stops paying for them next month.

Ben Whitley doubled appointments in December, because the 33-year-old isn’t sure he will be able to afford them come January. Regular chiropractic care only reduces his pain on a 10-point scale from nine to six, he said, but that means he is no longer stuck in bed at home in Little Canada 20 hours every day.

“It’s life-changing,” he said. “I can stand long enough to cook a meal.”

Eliminating chiropractic benefits from Medicaid, starting in 2026, will likely affect tens of thousands of Minnesotans. The cuts allowed Gov. Tim Walz and lawmakers to close a deficit and save taxpayers about $6 million per year without cutting other payments to doctors and hospitals. Critics predicted dire tradeoffs, though, because the low-income and disabled Minnesotans who qualify for Medicaid are least likely to afford chiropractic treatments on their own and most likely to fall back on addictive opioid painkillers for relief.

“Low-income Minnesotans are left with fewer and more dangerous options,” said Adam Millsop, president of the Minnesota Chiropractic Association, the advocacy group for the state’s 3,300 licensed chiropractors.

The cuts disrupt something of a renaissance era for chiropractors, who were famously dubbed quacks decades ago by the American Medical Association but have established the effectiveness of their treatments through research and gained a foothold in mainstream medicine.

Chiropractic care centers on hands-on spinal manipulation techniques, designed to correct misaligned vertebrae in the back that can press on nerves and restrict muscles.

Minnesota covers 24 spinal manipulation sessions per year for Medicaid recipients along with X-ray exams and annual evaluations to ensure that chiropractic treatments are medically necessary. Next year, only people 21 and younger will retain chiropractic benefits.

Chiropractor Carron Perry said her treatments have reduced her patients’ needs for opioid painkillers, but she worries that some will now return to those drugs.

Minnesota has been mired in a drug overdose epidemic, which had its roots two decades ago in patients who developed addictions or dependencies to prescription painkillers. Overdose deaths have declined for two consecutive years, but remain a concern.

“If people are just going into urgent care or hospitals or pain doctors, I mean, they use opioids a lot,” Perry said. Her Discovery Chiropractic clinic in St. Paul is booked in December with patients using up Medicaid benefits.

Tonya Bailey said she can’t risk taking opioids, even if she can’t afford to continue treatments at Perry’s clinic. The 52-year-old Minneapolis woman moved from Las Vegas three years ago for a fresh start after achieving sobriety.

Not having it? “This is going to be scary,” she said.

Whitley said he will consider alternatives, including opioids, but that not much else has worked in his struggle over the past 15 years for pain relief. Perry had diagnosed his pain as a result of a rib that was misaligned and scar tissue that formed around it. Whitley recalled a popping noise when the chiropractor moved it in proper place.

“It was like a wave of relief spread out from that point over my back,” he said, though the relief is temporary and only restored by follow-up treatments.

Studies support chiropractic care for temporary relief of low back pain, including a 2018 comparison that found more improvements among active-duty U.S. military personnel who received chiropractic sessions alongside usual medical care. Doctors are more likely to refer patients to chiropractors these days as well, surveys show, but they still harbor concerns about practitioners who exceed their training or claim that spinal manipulation resolves more than muscle and joint pains.

About half of U.S. states offer chiropractic benefits through Medicaid, which is jointly funded by federal and state tax dollars. Medicaid in Minnesota includes the Medical Assistance program for low-income and disabled residents, and the MinnesotaCare expansion for people with slightly higher incomes who still struggle to afford health care.

State Sen. Jim Abeler, R-Anoka, said he would work to overturn the latest cuts, just like he did back then as a state representative. A licensed chiropractor, Abeler said Minnesota could end up spending more if patients who lose these benefits turn to higher-cost clinics and emergency rooms for pain relief.

It’s unclear whether chiropractic care reduces overall health care spending, though, by preventing patients from needing more expensive treatments. The Minnesota Department of Commerce couldn’t find convincing proof this year, when it evaluated the state’s decision to require coverage of chiropractic care by commercial health plans sold to individuals and small businesses.

More than 100,000 of the state’s 1.3 million Medicaid recipients used their benefits in 2023 to pay for chiropractic care, according to data provided by the Minnesota Department of Human Services.

The chiropractic cut is one of two benefit reductions taking effect next year. Patients also must gain prior authorization for coverage of physical therapy beyond 14 sessions per year and occupational therapy beyond 24 sessions.

Perry said about one third of her patients are covered by Medicaid, but she isn’t concerned about the impact to her practice. Minnesota has an aging population with more back and joint problems.