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.
Medicaid and Weight Loss
Obesity and excessive weight are key contributors to a wide variety of health problems. 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. 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.
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, states have included coverage for these medications. The state by state inconsistencies, however, make it difficult for patients in need of these drugs to know whether or not they have coverage for them. Medicareinteractive.org provides a listing of all the states' policies regarding coverage for these medications, and such an overview can be very helpful for individuals.
Gastric Bypass Surgery
Another common procedure for weight loss is 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. Families USA goes on to state, “Individual cases about Medicaid coverage of gastric bypass surgery generally involve proving that for a particular patient, the surgery is medically necessary and not cosmetic.” If gastric bypass surgery is necessary for you, the best approach for obtaining coverage is to communicate with your doctor as you submit your claim to Medicaid. “States may not arbitrarily deny or reduce” medically necessary procedures, according to Families USA, so if your health care provider deems it necessary then you should be able to obtain coverage.
Check Out Your State's Guidelines
As you seek out coverage for weight loss programs and procedures through Medicaid, remember that each state administers its own plan. There will be guidelines specific to your location that need to be considered. “To find out more specific coverage rules,” Medicareinteractive.org recommends, “contact your state Medicaid office.” The site's Medicaid Coordination with Part D (by State) chart provides a brief overview of state coverages as well as links to local contacts for each state. With just a little research and initiative, you should be able to quickly discover what resources are available to you for weight loss under Medicaid in your state.