SUMMARY
Insurance coverage for equine-assisted services varies widely. Clinical therapy (PT, OT, SLP or psychotherapy) may be reimbursable when billed correctly, but adaptive riding, EAL, and most recreational services are usually private pay. Many families use a combination of insurance, HSA/FSA funds, disability waivers, grants, scholarships, and nonprofit support to make sessions accessible.
Equine-assisted services can transform physical skills, confidence, attention, and emotional well-being, but families often face one of their biggest questions early on:
How do people actually pay for this?
The answer depends less on the horse and more on the credentials of the person leading the session, how the service is classified, and the rules of your insurance plan. Funding is a mix of clinical benefits, education or recreation supports, state programs, and community-based resources.
This guide breaks down how insurance approaches equine services, when coverage is realistic, and what alternative funding options families commonly use.
Understanding What Insurance Actually Covers
A helpful way to approach insurance is to remember that insurance does not cover “equine therapy” as a category. Instead, it covers licensed clinical services—physical therapy, occupational therapy, speech therapy, or psychotherapy—that may incorporate horses as part of treatment. In those cases, the horse is not the service; the licensed provider’s work is.
Coverage depends on the provider’s license, the medical necessity of the plan of care, and the billing codes used. Programs that operate as recreational, educational, or skills-based experiences typically fall outside insurance coverage, even if they have meaningful therapeutic benefits.
Clinical Therapy Using Hippotherapy
For physical, occupational, or speech therapy that integrates a horse’s movement, insurance sometimes recognizes the service because it is billed under standard therapy codes. The therapist evaluates the rider, sets measurable goals, and uses the horse’s movement as a treatment tool rather than as the service itself.
Coverage is more likely when documentation is strong and the therapist is credentialed with the insurance company. However, some plans have exclusions for non-clinic settings or for alternative locations, and many require prior authorization. Families should expect a detailed intake process, regular progress notes, and clear communication with the therapist about how billing works.
Mental Health Services in an Equine Setting
When a licensed mental health clinician provides psychotherapy with horses, insurance may reimburse for the therapeutic service. The horse is not billed; the psychotherapy session is.
Some clinicians choose not to bill insurance because of session length, documentation requirements, or because the setting itself creates complications with reimbursement. Others provide superbills so clients can submit for out-of-network benefits. Coverage varies significantly, and families often rely on a mix of private pay and partial reimbursement.
Adaptive Riding and Recreational Programs
Adaptive or therapeutic riding focuses on riding skills, confidence, posture, and participation. Even though many riders gain physical or emotional benefits, these programs are considered educational or recreational, not medical. Because of that classification, insurance does not reimburse for adaptive riding. Families pay out of pocket or apply for scholarships within the program.
Equine-Assisted Learning (EAL)
EAL centers on life skills such as communication, teamwork, emotional awareness, and leadership. It is facilitated by trained professionals but does not involve medical treatment or diagnosis. Insurance does not cover EAL. However, schools, youth programs, and community agencies sometimes fund EAL classes for groups when they align with educational or social-emotional learning goals.
Medicaid and Disability Waivers
Medicaid creates a more complex picture. In some cases, Medicaid will cover PT, OT, or SLP sessions delivered by a credentialed provider who uses hippotherapy within a documented treatment plan.
Some states also offer home- and community-based waivers that support recreational or therapeutic activities aimed at community integration. Approval is inconsistent and typically handled case by case. Families often need to request justification based on goals, safety, and participation outcomes. While coverage is not guaranteed, it can be an avenue worth exploring, especially for long-term participation.
Using FSA and HSA Funds
Many families pay for hippotherapy or equine-assisted psychotherapy using FSA or HSA accounts because the services are delivered by licensed clinicians. Most programs can provide itemized receipts or letters of medical necessity when required.
HSAs and FSAs generally cannot be used for adaptive riding, EAL, recreational programs, or camps because those activities are not classified as medical services.
Grants, Scholarships, and Nonprofit Support
Across the United States, a wide range of foundations and community organizations help families access equine services. Some centers maintain their own scholarship funds supported by donors. Others partner with disability foundations, autism organizations, service clubs, or local philanthropies.
Veterans and first responders may find support through military-focused nonprofits, peer-support groups, or organizations specifically funding equine-based resilience programs. While grants rarely cover an entire year, they can make participation significantly more affordable.
Private Pay, Sliding Scale, and Payment Plans
Because equine programs vary so widely, many centers offer flexible payment structures. Sliding-scale fees, multi-session packages, monthly billing, or income-based discounts help reduce financial pressure.
Most families use a blended approach: insurance or HSA funds when possible, out-of-pocket payments for non-clinical programs, and grant or scholarship support for ongoing participation.
Asking About Coverage: How to Approach Your Provider
Clarity comes from asking the right questions. When calling an insurer, it helps to describe the service in clinical language rather than mentioning horses. For example: “My child receives physical therapy, and the therapist may integrate a treatment tool involving movement at an off-site location. The session will be billed under standard PT codes. What are my benefits for outpatient PT?”
For mental health sessions, the question becomes: “I am working with a licensed clinician who provides psychotherapy. Some sessions may occur outdoors or in an equine setting. Will my plan cover psychotherapy billed under standard codes?”
Programs themselves can also explain their billing processes, whether they provide superbills, what their scholarship options are, and which funding sources other families commonly use.
Conclusion
Funding equine-assisted services requires a mix of planning, creativity, and clear communication. Clinical services provided by licensed therapists may be reimbursable, while adaptive riding and skill-building programs are usually paid privately or supported by grants. Families often build sustainable participation by combining insurance benefits, FSA/HSA funds, state disability supports, sliding-scale fees, and community-based assistance.
With the right information and a program willing to guide you through the process, safe and meaningful equine experiences can become accessible and affordable over the long term.
