Does Medicaid cover obesity treatments?
For children enrolled in Medicaid, the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit covers all medically necessary services which can include obesity-related services. For adults, the states can choose which services to provide, with most states choosing to cover at least one obesity treatment.
How can Medicaid or chip help reduce obesity?
Medicaid and the Children's Health Insurance Program (CHIP) can play a role in reducing the rate of obesity in the United States by improving access to health care services that support healthy weight.
What is being done to reduce obesity in the United States?
A number of states have efforts underway to improve awareness and use of obesity-related services by Medicaid eligible individuals, including MassHealth's " Mass in Motion ," Missouri's PHIT Kids (Promoting Health in Teens and Kids) weight management program, and the Texas Medicaid Child Obesity Prevention Pilot.
Does Medicaid cover bariatric surgery?
Assuming the criteria above are met, Medicaid covers the procedures below. Does Medicaid Require Surgery at a Center for Excellence? Yes, the facility that you have surgery at must be accredited as a Bariatric Center for Excellence. These facilities have acheived a level of excellence in bariatric surgery.
What is the best treatment option for extremely obese individuals?
The best way to treat obesity is to eat a healthy, reduced-calorie diet and exercise regularly. To do this you should: eat a balanced, calorie-controlled diet as recommended by your GP or weight loss management health professional (such as a dietitian) join a local weight loss group.
What are four treatments for obesity?
Healthy eating plan and regular physical activity. Following a healthy eating plan with fewer calories is often the first step in trying to treat overweight and obesity. ... Changing your habits. ... Weight-management programs. ... Weight-loss medicines. ... Weight-loss devices. ... Bariatric surgery. ... Special diets. ... References.
What services are available for obesity?
Obesity is associated with conditions such as type 2 diabetes, heart disease and certain cancers. Weight management services are offered by accredited practising dietitians, GPs, commercial weight loss programs, meal replacement programs (very low energy diets) and kilojoule-controlled meal programs.
What medication is approved for long-term obesity treatment?
Four weight-loss drugs have been approved by the U.S. Food and Drug Administration for long-term use:Bupropion-naltrexone (Contrave)Liraglutide (Saxenda)Orlistat (Xenical)Phentermine-topiramate (Qsymia)
What is the strongest weight loss prescription pill?
Phentermine-Topiramate extended release (Qsymia) is the most effective weight loss drug available to date. It combines an adrenergic agonist with a neurostabilizer. Daily doses with four strengths start at 3.75/23mg to 15mg/92mg.
What is the first line of treatment for obesity?
Metformin is therefore considered a first line drug in treating patients with type 2 diabetes and obesity. The most common side effects of metformin are nausea, flatulence, diarrhea, and bloating (103).
Can your doctor prescribe you weight loss pills?
Your doctor may prescribe you medicine to treat your obesity if you have: A BMI of 30 or greater. A BMI of 27 or more and you have a disease or condition that may be related to your weight (this could include diabetes or high blood pressure).
What is the injection for weight loss?
Now, people who are trying to lose weight have a new option—a medication called Wegovy (semaglutide) that is injected under the skin once a week. The medication received FDA approval earlier this summer.
What is the new weight loss injection?
The U.S. Food and Drug Administration on Friday announced the approval of pharmaceutical giant Novo Nordisk's Wegovy (semaglutide) injection for adults who either have obesity or are overweight and have at least one weight-related condition such as high blood pressure, type 2 diabetes, or high cholesterol.
What is the new obesity drug?
The medication generating the most excitement is a weekly injectable drug called semaglutide (brand name: Wegovy). It was approved in June 2021 for treating people with a body mass index in the obese range or just under that range but with weight-related health issues.
How does Topamax and phentermine work for weight loss?
Phentermine is in a class of medications called anorectics. It works by decreasing appetite. Topiramate is in a class of medications called anticonvulsants. It works by decreasing appetite and by causing feelings of fullness to last longer after eating.
Are there any weight loss pills that are FDA approved?
At this time, there are five weight-loss medications approved by the FDA for long-term weight management: phentermine/topiramate, liraglutide, semaglutide, naltrexone/bupropion, and orlistat. Weight-loss drugs work best when combined with diet, exercise, and other lifestyle modifications.
How does Medicaid help with obesity?
Medicaid and the Children's Health Insurance Program (CHIP) can play a role in reducing the rate of obesity in the United States by improving access to health care services that support healthy weight. For children enrolled in Medicaid, the Early and Periodic Screening, Diagnostic and Treatment ...
What is EPSDT in Medicaid?
For children enrolled in Medicaid, the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit covers all medically necessary services which can include obesity-related services. For adults, the states can choose which services to provide, with most states choosing to cover at least one obesity treatment.
What is Collaborate for Healthy Weight?
Collaborate for Healthy Weight brings primary care providers, public health professionals, and leaders of community-based organizations together to use quality improvement methods to reverse the obesity epidemic in communities across the country. It is a project of the National Initiatives for Children's Healthcare and Quality (NICHQ) and the HRSA.
Does Medicaid cover obesity?
However, individuals whose only access to medical care is through the Medicaid program might have difficulty finding information on weight loss or management programs through their coverage.
Is Medicaid federally funded?
Though federally funded, Medicaid programs are administered by the various states. Some aspects of the Medicaid program are uniform by federal law, but the states are allowed to determine their own policies with regard to Medicaid-covered weight loss programs.
Is Medicaid a federal or state program?
Medicaid is for many the sole source of health care coverage. Knowing the details of coverage can be tricky for anybody; some benefits are federally mandated while others are up to the states. Weight loss programs fall into the latter category, and each individual seeking coverage needs to know where to look for information.
Is weight loss medication covered by Medicaid?
Weight Loss Medications. One such example would be weight loss and management through the use of prescription medications. According to Families USA, “Weight-loss drugs are one of nine classes of drugs that Medicaid programs can exclude from coverage under federal law.”. This does not necessarily mean they are not covered; in many cases, ...
Does Medicaid cover gastric bypass surgery?
Families USA points out that “federal Medicaid law does not mention coverage of gastric bypass surgery specifically.”. This can lead to some confusion, and typically coverage for this procedure is reviewed on a case by case basis.
Description Information
Please Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.
Transmittal Information
10/2004 - Revised language to address coverage of particular care and services rather than definition of illness. Language change did not directly affect current Medicare coverage. Services are covered only when an integral and necessary part of a course of treatment for medical condition.
National Coverage Analyses (NCAs)
This NCD has been or is currently being reviewed under the National Coverage Determination process. The following are existing associations with NCAs, from the National Coverage Analyses database.
What are the co-morbidities of weight loss surgery?
Co-morbidities include sleep apnea, high blood pressure, high cholesterol, diabetes. If you are under 21, you must have a Body Mass Index (BMI) over 40 with at least one comorbidity. A letter from your primary care physician stating that weight loss surgery is medically necessary. Passes a psychological exam.
How old do you have to be to get medicaid?
In order for Medicaid to cover the cost of your surgery and the associated surgeon visits, you must meet the requirements below. Over the age of 13 for a female and 15 for a male. Body Mass Index must be over 35 with at least one comorbidity .
Does Medicaid cover weight loss surgery?
Medicaid Covers Weight Loss Surgery. Assuming that you meet the criteria below and that you don’t have any medical issues preventing you from surgery, Medicaid will cover weight loss surgery.
What drugs are used to reduce weight?
Common pharmaceuticals prescribed for weight loss include the lipase inhibitors. Xenical (Orlistat), Meridia (Sibutramine), and Adipex (Phentermine). A lipase inhibitor works by blocking the enzyme lipase which helps to break down dietary fat.
Which states have partial coverage for lipase inhibitors?
These states include: Idaho, Michigan, Minnesota, Missouri, Nebraska, New York, and Oregon. Prior authorization may require that the patient have a covered diagnosis such as Type II diabetes (Minnesota), ...
How long does it take for Medicaid to approve a plan?
Prior authorization approvals typically cover 3-6 months. Several states (Alabama, Hawaii, Iowa, Kansas, Vermont, Wisconsin) specify that the patient must also follow a recommended treatment plan which includes things such as a reduced calorie diet, exercise, and behavioral counseling. As you can see, the requirements for Medicaid coverage ...
Does Rhode Island cover weight loss?
Rhode Island covers any weight-loss drug but for only 3 months with prior authorization. Several states (Hawaii, Iowa, Louisiana, New Hampshire, New Jersey, South Carolina) specify that weight-loss drugs are only approved for persons who have a BMI ≥ 30, or BMI ≥ 27 if the patient has a co-morbidity such as hypertension, dyslipidemia, diabetes, ...
Does Medicaid cover Xenical?
Some of the restrictions placed upon Medicaid coverage of weight-loss prescriptions are to be expected, while others are interesting.#N#For example, Georgia covers Xenical, but only for persons aged 12-21 and only for one year.#N#Rhode Island covers any weight-loss drug but for only 3 months with prior authorization.
What are the health threats associated with obesity?
The U.S., and the world in general, is experiencing an alarming uptick in overweight and obesity. In 1990, adults with obesity comprised less than 15% of the U.S. population. Today more than two out of three adults in America are overweight, and more than a third of us are obese.
How is a person diagnosed as overweight or obese?
The American medical community generally defines obesity and overweight in adults by body mass index, or BMI, a measure of body fat based on height and weight. It’s a more sophisticated reading than merely stepping on a scale, but it isn’t foolproof. BMI varies by gender, race, body composition, and other factors.
What kind of weight loss treatments do insurers cover?
The Affordable Care Act requires that most health insurers cover obesity screening and counseling as preventive care for adults and children. Diet counseling is also available for adults at higher risk for chronic disease.
How do I increase my chances of getting health insurance to pay for interventions?
If you don’t have health insurance or want to change your marketplace plan, use the special enrollment period open now through August 15 to compare health plans on Healthcare.gov, the federal marketplace established by the Affordable Care Act. Some states run their own marketplaces.
The bottom line
Being overweight or obese has serious implications for your health. There are effective treatments available today, including counseling, medication, and surgery, but consult with your healthcare provider to document your BMI and check your insurance coverage before you try any treatment. Don’t be afraid to advocate for yourself.
What is the BMI of a person with obesity?
Extreme Obesity: Having a body mass index (BMI) of ≥40 kg/m2; also referred to as Class III obesity (National Heart, Lung and Blood Institute, 2016). Note: the term “morbid obesity” is equivalent to extreme obesity.
What are covered benefits?
Each benefit plan contains its own specific provisions for coverage, limitations, and exclusions as stated in the member’s Evidence of Coverage (EOC)/Schedule of Benefits (SOB). If there is a discrepancy between this policy and the member’s EOC/SOB, the member’s EOC/SOB provision will govern.
Is bariatric surgery covered by the NIH?
Bariatric surgical procedures are covered when Medically Necessary and prior authorized. We will use evidence-based criteria to determine coverage of bariatric surgery, such as the most recent National Institutes of Health (NIH) guidelines, in determining the Medical Necessity of requests for surgical treatment for extreme obesity. Please refer to your Schedule of Benefits for Copayment/deductible information of this benefit, or you may call our Customer Service department for additional information.
Affordable Care Act Improves Prevention and Obesity Coverage
- The Affordable Care Act includes several provisions that promote preventive care including obesity-related services and coverage. 1. These provisions include an enhanced federal match for states that cover all U.S. Preventive Services Task Force (USPSTF) grade A and B recommended preventive servicesand the Advisory Committee of Immunization Practic...
State Efforts to Improve Access to Obesity Services
- A number of states have efforts underway to improve awareness and use of obesity-related services by Medicaid eligible individuals, including MassHealth's "Mass in Motion," Missouri's PHIT Kids (Promoting Health in Teens and Kids) weight management program, and the Texas Medicaid Child Obesity Prevention Pilot. Several states are working with their manage…
Additional Resources
- Collaborate for Healthy Weightbrings primary care providers, public health professionals, and leaders of community-based organizations together to use quality improvement methods to reverse the obesity epidemic in communities across the country. It is a project of the National Initiatives for Children's Healthcare and Quality (NICHQ) and the HRSA. 1. Overweight and Obesit…