Does Medicaid cover weight loss programs?
Written on April 14, 2023 by Gillian (Gigi) Singer, MPH. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.
Table of contents
- What is Medicaid?
- Medicaid coverage for weight loss programs
- Coverage by state
- Weight loss programs
- A note on medical necessity
- Related content
Weight loss programs can be difficult, expensive, and not universally accessible, so depending on the state you live in, it’s incredibly helpful when weight loss programs are covered by Medicaid. Read on to learn the answer to the question, “Does Medicaid cover weight loss programs?”
What is Medicaid?
The Medicaid program “is the principal source of long-term care coverage” for one in five Americans—the program is “the nation’s public health insurance program for people with low income” in response to the lack of other affordable options for health insurance [1].
According to the Kaiser Family Foundation, the following statistics are true regarding Medicaid [1]:
- It offers a wide range of healthcare services and sets a cap on the amount of money enrollees need to pay out of their own pockets
- It accounts for almost 20% of all personal healthcare spending
- It provides financing for hospitals, community health centers, physicians, nursing homes, and employment opportunities in the healthcare industry
- Title XIX of the Social Security Act and federal regulations govern Medicaid, setting federal requirements and outlining state options and powers
Medicaid coverage for weight loss programs
Many preventable conditions are associated with obesity—for this reason, it is considered a public health challenge in the United States. “Medicaid . . . programs help address this challenge by providing access to screenings and interventions to reduce obesity and promote healthy eating and physical activity,” says the official Medicaid website [2].
The website continues, “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” [3].
The “Affordable Care Act calls for states to design public awareness campaigns to educate Medicaid enrollees on the availability and coverage of preventive services, including obesity-related services” [2].
It's important to note that Medicaid may not cover weight loss programs for cosmetic reasons. Weight loss programs designed to improve one's appearance or aesthetics are not deemed medically necessary and, therefore, are not covered by Medicaid.
Coverage by state
The coverage of weight loss programs by Medicaid varies from state to state [4]. Some states cover weight loss programs for adults, while others do not [3]. It's important to check with your state's Medicaid program to determine what services are covered. However, generally speaking, Medicaid covers weight loss programs that are deemed medically necessary.
Weight loss programs
When it comes to the types of weight loss programs covered by Medicaid, you have several options. Weight loss programs can include “Body mass index (BMI) screening, education and counseling on nutrition and physical activity, prescription drugs that promote weight loss, and, as appropriate, bariatric surgery” [2].
Medicaid may cover the cost of medically supervised weight loss programs, which are programs that are overseen by a healthcare provider or registered dietitian. These programs may include a combination of diet and exercise interventions, as well as medication if necessary.
Medicaid may also cover the cost of weight loss surgery, also known as bariatric surgery. Bariatric surgery is a surgical procedure that helps individuals with severe obesity lose weight. Bariatric surgery may be recommended for individuals with a body mass index (BMI) of 40 or higher or for individuals with a BMI of 35 or higher who have obesity-related health conditions such as diabetes or high blood pressure. Bariatric surgery can be expensive, but Medicaid may cover the cost of the procedure for individuals who meet certain criteria.
It's important to note that not all weight loss programs are covered by Medicaid. For example, commercial weight loss programs such as Weight Watchers or Jenny Craig are typically not covered by Medicaid. However, some states may offer Medicaid-funded weight loss programs or partnerships with commercial weight loss programs to provide services to Medicaid beneficiaries.
A note on medical necessity
Medically necessary weight loss programs are those programs prescribed by a healthcare professional to treat a specific health condition related to obesity. For example, if an individual is suffering from obesity-related health conditions such as high blood pressure, diabetes, or heart disease, a healthcare professional may recommend a weight loss program to improve their health outcomes. In this case, Medicaid may cover the cost of the weight loss program. It's important to note that Medicaid will only cover weight loss programs that are medically necessary and deemed appropriate by a healthcare professional.
If you're interested in weight loss and would like to learn more by talking with a healthcare expert, consider weight care online via Everlywell's telehealth offering.
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References
- Garfield R, Rudowitz R. 10 things to know about Medicaid: Setting the facts straight. KFF. URL. Published February 4, 2020. Accessed April 13, 2023.
- Medicaid can cover obesity-related services, helping beneficiaries reduce the risk of chronic disease. Medicaid. URL. Accessed April 13, 2023.
- Reducing obesity. Medicaid. URL. Accessed April 13, 2023.
- Lee JS, Sheer JL, Lopez N, Rosenbaum S. Coverage of obesity treatment: a state-by-state analysis of Medicaid and state insurance laws. Public Health Rep. 2010;125(4):596-604. doi:10.1177/003335491012500415. URL