Obesity Coverage Archive
Obesity Treatment Coverage
Relative to adults without obesity, adults with obesity (BMI ≥ 30 kg/m2) incur 42% higher medical costs and are nearly twice as likely to die before age 70. Nonetheless, coverage for these obesity treatment modalities is inconsistent across states. Intensive behavioral therapy, nutritional therapy, pharmacotherapy, and bariatric surgery are evidence-based strategies that support clinically-significant weight loss ( ≥ 5% reduction in body weight).
This website reviews findings from a comprehensive, state-by-state analysis of coverage for evidence-based obesity treatment modalities available to adults in Medicaid and state employee health insurance programs during the 2016-2017 plan year. Data were obtained through an extensive review of administrative documents, health plan websites, provider manuals, subscriber handbooks, fee schedules, and drug formularies from Medicaid and state employee health insurance programs in all fifty states and D.C.
For additional information regarding state-specific coverage, please see the full article and supporting material published in Obesity: 10.1002/oby.22307
IMPORTANT: This report is intended to provide an overview of state-by-state variation in coverage of obesity-related prevention and treatment services for adult Medicaid beneficiaries in the United States. Results presented herein are based on extensive review of publicly available documents and, in a minority of cases, information derived from direct telephone inquiries. Data were collected from November 2016 to July 2017 and may not reflect updated guidelines issued during or after this period. As such, it is possible that actual coverage may differ substantially from that suggested by this report. In some cases, reimbursement for treatment services ordinarily excluded from coverage may be provided for individuals with demonstrated medical necessity. We strongly encourage patients and healthcare providers to contact plans directly to inquire about individual coverage and have included potential points of contact with each state profile to facilitate this process.